1. Osteoporosis: What women need to know Women’s Health Information Evening Dr Katie Wood, GP Registrar

2. Osteoporosis What is osteoporosis? What increases my chances of getting osteoporosis? How can I find out if I have osteoporosis? How can I prevent it? How is it treated? More information on osteoporosis

3. What is osteoporosis? A condition which makes the bones fragile, and more likely to break There are usually no warnings you've developed osteoporosis and it's often only diagnosed when a bone is fractured after even minor falls Affects the whole skeleton but fractures most commonly occur to the wrist, hip and spine

4. The effects of osteoporosis on bone Each year in the UK there are around 70,000 hip, 120,000 spine and 50,000 wrist fractures that are linked to osteoporosis.

5. What increases my chances of getting osteoporosis? Osteoporosis affects both sexes but being female puts you at increased risk: Women tend to have smaller, thinner bones than men Oestrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss. This is why the chance of developing osteoporosis increases as women reach menopause You’re also at greater risk of developed osteoporosis if you: Have needed steroid treatment for more than three months Have a family history of osteoporosis Don’t do much weight-bearing exercise Are a heavy drinker or smoker Have a conditions affecting bone metabolism, e.g. inflammatory conditions, coeliac disease Have a poor diet, and/or are very underweight

6. How can I find out if I have osteoporosis? There’s no good evidence that screening the whole population for osteoporosis would be helpful However, you should speak with your GP about having a DEXA scan to assess for osteoporosis if: You’ve already had a low-impact fracture You need steroid treatments for three months or more You had your menopause before the age of 45 Either of your parents has had a hip fracture You have another condition which can affect the bones

7. How can I prevent osteoporosis? Get plenty of calcium and vitamin D as part of a well-balanced diet Exercise regularly, especially weight-bearing or resistance exercises Stop smoking Don’t drink too much alcohol

8. Calcium and Vitamin D Calcium: Adults need 700mg a day, which you should be able to get from your diet As well as dairy products, other calcium-rich foods include leafy green vegetables, dried fruit, certain fish, and tofu Vitamin D: Helps your body absorb calcium Eggs, milk and oily fish Sunlight exposure: Short exposure to sunlight (10 mins twice a day) throughout Summer should provide you with enough Vit D for whole year

9. How is osteoporosis treated? First-line treatments: Calcium and Vitamin D supplements Bisphosphonates Works by slowing bone loss Other treatments include: HRT Not recommended as 1 st choice treatment for women >60 years as linked with increased risk of breast cancer, blood clots and heart attack Denosumab Block the cells that break down bone, leading to increased bone mass

10. Where can I find out more? Arthritis Research UK Copeman House St Mary’s Court St Mary’s Gate, Chesterfield Derbyshire S41 7TD Phone: 0300 790 0400 www.arthritisresearchuk.org National Osteoporosis Society Camerton Bath BA2 0PJ Phone: 01761 471771 Helpline: 0845 450 0230 Helpline email: nurses@nos.org.uk www.nos.org.uk NHS Choices The NHS Choices website has a useful overview of Osteoporosis www.nhs.uk/conditions/osteoporosis/pages/introduction.aspx

11. Pelvic Organ Prolapse Women’s Health Information Evening Dr Katie Wood, GP Registrar

12. Pelvic Organ Prolapse Why pelvic organ prolapse happens The different types of prolapse When to see your GP What are the options for treatment? Can prolapse be prevented? More information on pelvic organ prolapse

13. Why pelvic organ prolapse happens The organs within a woman’s pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles known as the pelvic floor If these support structures are weakened by overstretching, the pelvic organs can bulge (prolapse) from their natural position into the vagina

14. Why pelvic organ prolapse happens

15. The different types of prolapse A prolapse may arise: In the front wall of the vagina (from the bladder bulging into the vagina) In the back wall of the vagina (from the rectum bulging into the vagina) At the top of the vagina (from the uterus hanging down into the vagina) Many women have more than one type of prolapse at the same time

16. When to see your GP Pelvic organ prolapse isn't life-threatening, but it can affect your quality of life See your GP if you have any of the symptoms of a prolapse a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back discomfort during sex problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise Problems passing stools – such as having to strain to pass stools, a feeling that your bowels have not emptied fully, the need to push on, or around, your vagina to enable stools to pass

17. When to see your GP If prolapse is suspected, your doctor will carry out a vaginal examination. This will usually involve passing a speculum into the vagina to see exactly which organ(s) are prolapsing This only takes a few minutes and is similar to having a smear test

18. What are the options for treatment? 1.Lifestyle changes Most women with mild prolapse don’t need treatment, as the problem doesn’t seriously interfere with their normal activities Lifestyle changes such as weight loss and pelvic floor exercises may stop the prolapse from getting any worse 2.A vaginal pessary A plastic or silicone device that fits into the vagina to help support the pelvic organs and hold up the uterus Many GPs are able to insert these Particularly helpful for prolapse affecting the front and top walls of the vagina

19. What are the options for treatment? 3.Surgery The decision will depend on how severe your symptoms are and how your prolapse affects your daily life You may want to consider surgery if other options have not adequately helped

20. Can prolapse be prevented? Regular pelvic floor exercises, especially if you are planning to get pregnant, are pregnant, or have given birth Good guide for pelvic floor exercises available here: http://www.guysandstthomas.nhs.uk/resources/patient- information/maternity/pelvic-floor-exercises-for- women.pdf If you are overweight, try to lose weight Eat a high-fibre diet and drink plenty of water to avoid constipation

21. Where can I find out more? Royal College of Obstetricians and Gynaecologists Their website has a useful patient information leaflet on pelvic organ prolapse, and links to further information www.rcog.org.uk Bladder and Bowel Foundation Helpline – 08453450165 www.bladderandbowelfoundation.org Patient.co.uk A good patient information leaflet titled ‘genitourinary prolapse’