The Royal College of Obstetricians and Gynaecologists (RCOG) will celebrate International Women’s Day (IWD) on 4 March 2016 with the theme ‘Joining up care in maternal mental health’. Expert speakers will provide insights into the challenges experienced in providing effective, joined-up maternal mental health care and we will also hear from women who have experienced maternal mental healthcare problems.

Mental health illness during pregnancy and following delivery are sadly very common with between 12 per cent and 20 per cent of women experiencing anxiety and/or depression during pregnancy and within the first year of childbirth. It is also desperately upsetting that around one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems with one in seven of the women who die in this period committing suicide.

It is therefore vital that women receive the right support and at the right time. Greater integration between primary and secondary care is needed to ensure that women with significant medical and psychiatric conditions are assessed before becoming pregnant and referred to specialist care in a timely manner to ensure that the right support is provided throughout a woman’s pregnancy and beyond. These are themes that will be will also be discussed at the IWD event.

The RCOG has welcomed the news that non-invasive prenatal testing has been recommended for high-risk women on the NHS. This test is the most accurate and safest way of detecting diseases that may have potentially serious consequences, both enhancing the information available to pregnant women and reducing unnecessary invasive procedures. Should the test be rolled out, resources and training for healthcare professionals offering the test will be necessary, in particular around communication and counselling expectant parents about the implications of the test results.

The publication of the NICE menopause guideline at the end of last year was a milestone for both healthcare professionals and women alike. It will help ensure that the best possible care is provided in the diagnosis and treatment of the menopause, a biological stage that every woman experiences to some extent in their lives.

Treatment

For some women, menopausal symptoms such as hot flushes, night sweats, mood swings and depression as well as a loss of interest in having sex can be extremely debilitating and have a significant impact on a woman’s physical and psychological health, career, social life and relationships.  Unfortunately, many women still suffer in silence.

Our hope is that the guideline will not only support healthcare professionals but also provide women with the necessary information to empower them to make informed decisions about their choice of treatment. We also welcome the Chief Medical Officer’s efforts to ensure that employers are also able to offer support and working time flexibility to women through this time. Women feeling able to talk openly to healthcare professionals, their employers, friends and families about their symptoms is key to removing stigma around the menopause.

Fibroids are non-cancerous growths that develop in or around the womb (uterus). They can range in size from larger than a melon to as small as a coin. Around 1 in 3 women of childbearing age have uterine fibroids and while many women do not experience any problems, symptoms can be severe enough to require treatment. In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility.

We strongly encourage women to visit their GP if they have persistent symptoms of fibroids, which can include heavy and prolonged menstrual periods, low back or leg pain, pelvic pain or pressure, pain during sexual intercourse, pressure on the bladder which leads to a constant desire to urinate, pressure on the bowel which can lead to constipation and/or bloating or an enlarged abdomen which may be mistaken for weight gain or pregnancy.

An ultrasound scan is usually able to confirm the diagnosis and medication can help to relieve the symptoms. There are also other medical treatments available to help shrink fibroids. If these prove ineffective, surgical removal or other less invasive procedures may be recommended. Great surgical advances have been made to preserve fertility in the treatment of even the most severe fibroids.

Nowadays there are many complex assisted reproductive technology (ART) options for infertile couples, including gamete/embryo donation, egg/sperm sharing, surrogacy, adoption and fertility preservation. Understanding the current legal and regulatory situation regarding these options, as well as important considerations, such as the welfare of the child or children when surrogacy and adoption are considered, can be overwhelming.

A review published in the The Obstetrician & Gynaecologist last year talked about how the psychological impact and private agony of infertility must be carefully considered by healthcare professionals. The review identified infertility as a complex state and life crisis setting out the dangers of neglecting the emotional impact of involuntary childlessness and viewing it solely in biological or medical terms. The authors recommended that counselling practitioners can play a critical role in explaining some or all of the options available to patients and in ensuring that they are well informed before making any treatment choices.