Welcome to Edition Six

Autumn is upon us and we are well in to 2016. It has been a challenging start to the year for us at Hobart OBGYN with the unexpected retirement of Dr James Brodribb. We are very appreciative to all of our staff, patients and to our colleagues for your support at this time. We are continuing to provide care for all of Dr Brodribb’s patients by the other specialists in our practice and hope we have minimised the disruption for you and your patients. We appreciate all the referrals you have changed and continue to change! If there are any concerns during this transition time please feel free to contact us.

Thank you to Dr James Brodribb

With 40 years of service to the women of Hobart through the Royal Hobart Hospital and as a private Obstetrician and Gynaecologist, Dr Brodribb has been involved in the lives of thousands of local families. He is a dedicated and competent professional, who is respected for his integrity, compassion and efficiency. His medical knowledge and ability to recall information are admired and his level-headed approach to situations is well appreciated.

We are also very thankful for the Hobart OBGYN structure he was instrumental in establishing. It was one of the first group obstetric practices in the country and has stood the test of time, managing to meet the needs of our patients with a safe, supported and balanced life for our obstetricians.

He has made a significant and positive impact on his patients and colleagues and is sadly missed.

Electronic Letters

Hopefully by now most practices are receiving correspondence from Hobart OBGYN electronically through Healthlink. This has allowed us to increase our efficiency and greatly reduce the length of time it takes for our letters to get to you. We are hoping the instant transfer of information is helpful – bypassing the rather slow postage system. It is reducing the time, cost and waste of preparing, printing and posting letters and hopefully helping efficiency at your end by eliminating the need for scanning and shredding with the advantage of immediate linking to patient files. Less paper seems to be better for everyone. We are very happy to receive correspondence from you via Healthlink. If you are experiencing any problems with this system please contact our practice manager. We are also very happy to fax, email or post information to you as requested.

Dr Sue Keating visits Nepal

Hobart OBGYN has become “Friends of Nepal” and is sponsoring the Kushudebu Hospital in Jumbesi. Dr Sue Keating visited Nepal in December taking with her supplies of antibiotics, dressings, sutures and sphygmomanometers.The practice will be fundraising for this hospital as well as providing substantial donations.The hospital provides primary care to the communities around the town of Jumbesi in the north east of Nepal, caring for over 10,000 local people. The hospital is completely funded by donations.

Nepal was devastated by a series of earthquakes in April 2015. Although four billion dollars of donations have been raised for Nepal, little of this has been distributed due to governance issues.

Hobart OBGYN is proud to be associated with the Kushudebu mission. All funds raised go directly to the hospital to allow this important service to continue. We would welcome any GP colleagues who would like to be involved in fundraising or donating medical supplies.

Snippet: The Oral Contraceptive Pill and pregnancy

Many pregnancies occur in the context of OCP failures or after recent cessation of the pill. Women who have these “breakthrough pregnancies” may wonder if there is any risk of exposure of the fetus to exogenous sex hormones. A prospective observational cohort study from Denmark published in the BMJ this year gives us information on recent or current oral contraceptive use and birth defects. Data from the 1997 to 2011 Danish birth records was collected (880 694 live births) and collated with the National Prescription Register, and the prevalence of major anomalies in children of four groups of women – never users, previous OC users (three months ago), recent OC users and those taking OCP’s during early pregnancy – were calculated. The major unexplained birth defect rates were 2.51%, 2.5%, 2.49% and 2.48% respectively, giving women who have conceived on, or shortly after, ceasing the OCP confidence that the OCP does not appear to be associated with an increased risk of major birth defects in the first year of life. Of note 1% of these women had used the OCP beyond conception and 8% of women had recently stopped the OCP just prior to pregnancy.

Non-hormonal Menopausal Treatments

The evidence is very clear that the most effective treatment of menopausal symptoms is hormonally based. Despite the more recent balanced views of the benefits and risks of HRT, with conclusions that HRT is safe for the majority of women for relief of menopausal symptoms around the natural time of menopause, there are still women who choose not to or are unable to use HRT to alleviate their menopausal symptoms.

The vaso-motor symptoms, predominantly hot flushes and night sweats can have a profound impact on the health and wellbeing of women with sleep disturbance, relationship and work stress common outcomes. There is evidence of some efficacy of select non-hormonal treatments for vasomotor symptoms. These include venlafaxine, paroxetine, gabapentin and clonidine as well as cognitive behavourial therapy. Each brings with it a different side effect profile.

Venlafaxine is started at 75mg SR daily and may be involved in setting body temperature. Side effects include dry mouth, nausea, sleep disturbance, decreased appetite and constipation. Relief of hot flushes should be rapid so a one week trial is enough to establish an effect. Paroxetine is used in lower doses than for depression but side effects also include drowsiness, dry mouth and it can’t be used by women taking tamoxifen. Anti-depressants decrease symptoms by approximately 40% compared with 90% for estrogen.

Gapabentin requires doses of at least 300mg TDS to be effective. It is expensive with risks of rash, dizziness and sleeplessness. Clonidine is started at 25mcg BD and increased to up to 75mcg BD and requires a four week trial. Side effects also include dry mouth, drowsiness, constipation and sleep disturbance.

These medications will only treat vaso-motor symptoms and will not have a significant impact on other symptoms such as mood, hair and skin changes, atrophic urogenital symptoms, musculoskeletal symptoms etc.They are however, worth trying in women who have vasomotor symptoms that are affecting their quality of life. In regards to non-prescription menopausal preparations, multiple preparations are available and their safety is uncertain, different preparations may vary and interactions with other medicines have been reported as well as endometrial disease. Care needs to be taken with long-term use of black cohosh especially.

A good resource both for us as practitioners and for our patients is the Australian Menopause Society website. Patient information sheets are available on the website www.menopause.org.au.

The Jean Hailes Centre for Women’s Health also has an informative website at http://jeanhailes.org.au. A recent interesting snippet from them is that women who have difficulty falling or staying asleep have a 45% increased risk of Type 2 Diabetes.

Educational events at Hobart OBYGN

Our first educational evening was held at Hobart OBGYN on Wednesday 9 March and was well attended by our local GPs. Dr Sue Keating gave a comprehensive talk on the mechanisms of urinary continence as well as assessment and management options for urinary incontinence. Dr Naomi Saunder followed this with specific tips for incontinence in the elderly population and the importance of modifiable lifestyle and environmental factors.

Our next evening will be on Wednesday June 22 from 6:30 – 8:30pm and will have presentations on Pelvic Pain by Dr Stephen Bradford and Dr Marian Chinnock. If you would like to attend please RSVP to our practice on 6228 3331.