New NICE Diagnostics guidance DG32 Adjunctive colposcopy technologies for assessing suspected cervical abnormalities

NICE Diagnostics guidance [DG32] Adjunctive colposcopy technologies for assessing suspected cervical abnormalities: the DYSIS colposcope with DYSISmap and the ZedScan I.
Published date: April 2018. Next review: April 2021                


This guidance replaces the NICE diagnostics guidance on adjunctive colposcopy technologies for examination of the uterine cervix – DySIS and the Niris Imaging System (DG4) and the NICE medtech innovation briefing on ZedScan as an adjunct to colposcopy in women with suspected cervical intra‑epithelial neoplasia (MIB20).


Read full guidance at: https://www.nice.org.uk/guidance/dg32

New NICE guideline NG88: Heavy menstrual bleeding: assessment and management

Heavy menstrual bleeding: assessment and management

This guideline covers assessing and managing heavy menstrual bleeding (menorrhagia). It aims to help healthcare professionals investigate the cause of heavy periods that are affecting a woman’s quality of life and to offer the right treatments, taking into account the woman’s priorities and preferences.

Published March: 2018
Next Review:2020


Full guidance found at https://www.nice.org.uk/guidance/ng88

New NICE Interventional procedures guidance IPG608: Laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina

Laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina


Evidence-based recommendations on laparoscopic mesh pectopexy for apical prolapse of the uterus or vagina. This involves inserting mesh to hold the uterus or the top of the vagina in place.
Published March 2018
Next review: March 2021


Full guidance available at https://www.nice.org.uk/guidance/ipg608

Pathogenesis and Management of Adiposity and Insulin Resistance in Polycystic Ovary Syndrome (PCOS)

In: Freemark M. (eds) Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham
Polycystic ovary syndrome (PCOS) is a common condition that often presents during adolescence with characteristic reproductive and hyperandrogenic features. Activation of the hypothalamic-pituitary (HP)-adrenal and HP-ovarian axes during adolescence often coexists with weight gain and heightened insulin resistance; PCOS manifests in those girls who are genetically predisposed. The association of PCOS (the subgroup with both oligo-amenorrhoea and hyperandrogenic features) with metabolic dysfunction, although not contributory as a diagnostic feature, deserves particular focus in adolescent girls. Given the increased risks for development of type 2 diabetes mellitus and dyslipidaemia, it is important that screening for metabolic dysfunction is applied, that “metabo-vigilance” is maintained, and that any emergent metabolic risk factor is managed accordingly. Weight loss remains the most important strategy for both prevention and management of PCOS in obese adolescent girls. With the burgeoning obesity epidemic, it is incumbent upon all of us to promote a healthy lifestyle amongst our children, to avoid excessive weight gain and the associated obesity-related morbidities such as PCOS.

UHCW Research: Thomas M Barber

Analysis of chromatin accessibility in decidualizing human endometrial stromal cells

FASEB J. 2017 Dec 19. pii: fj.201701098R. doi: 10.1096/fj.201701098R. [Epub ahead of print]

Spontaneous decidualization of the endometrium in response to progesterone signaling is confined to menstruating species, including humans and other higher primates. During this process, endometrial stromal cells (EnSCs) differentiate into specialized decidual cells that control embryo implantation. We subjected undifferentiated and decidualizing human EnSCs to an assay for transposase accessible chromatin with sequencing (ATAC-seq) to map the underlying chromatin changes. A total of 185,084 open DNA loci were mapped accurately in EnSCs. Altered chromatin accessibility upon decidualization was strongly associated with differential gene expression. Analysis of 1533 opening and closing chromatin regions revealed over-representation of DNA binding motifs for known decidual transcription factors (TFs) and identified putative new regulators. ATAC-seq footprint analysis provided evidence of TF binding at specific motifs. One of the largest footprints involved the most enriched motif-basic leucine zipper-as part of a triple motif that also comprised the estrogen receptor and Pax domain binding sites. Without exception, triple motifs were located within Alu elements, which suggests a role for this primate-specific transposable element (TE) in the evolution of decidual genes. Although other TEs were generally under-represented in open chromatin of undifferentiated EnSCs, several classes contributed to the regulatory DNA landscape that underpins decidual gene expression.

UHCW Research: Vrljicak P, Lucas, E S, and Brosens, J J

Transvaginal mesh repair of anterior or posterior vaginal wall prolapse [IPG599]

New interventional procedures guidance from NICE:

Evidence-based recommendations on transvaginal mesh repair of anterior or posterior vaginal wall prolapse. This involves inserting a mesh to replace tissue that has weakened and caused the pelvic organs to drop down (prolapse) into the vagina.

Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns. Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.nice

Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium

Elife. 2017 Dec 11;6. pii: e31274. doi: 10.7554/eLife.31274.

In cycling human endometrium, menstruation is followed by rapid estrogen-dependent growth. Upon ovulation, progesterone and rising cellular cAMP levels activate the transcription factor Forkhead box O1 (FOXO1) in endometrial stromal cells (EnSCs), leading to cell cycle exit and differentiation into decidual cells that control embryo implantation. Here we show that FOXO1 also causes acute senescence of a subpopulation of decidualizing EnSCs in an IL-8 dependent manner. Selective depletion or enrichment of this subpopulation revealed that decidual senescence drives the transient inflammatory response associated with endometrial receptivity. Further, senescent cells prevent differentiation of endometrial mesenchymal stem cells in decidualizing cultures. As the cycle progresses, IL-15 activated uterine natural killer (uNK) cells selectively target and clear senescent decidual cells through granule exocytosis. Our findings reveal that acute decidual senescence governs endometrial rejuvenation and remodeling at embryo implantation, and suggest a critical role for uNK cells in maintaining homeostasis in cycling endometrium.

UHCW Research: Vrljicak P, Tewary S, Lucas, E S and Ott S

Tests in secondary care to identify people at high risk of ovarian cancer [DG321

New: Diagnostic Guidance

Evidence-based recommendations on tests in secondary care to identify people at high risk of ovarian cancer. The tests are the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 250), ROMA and IOTA Simple Rules.

There is currently not enough evidence to recommend the routine adoption of the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 200 or 250), ROMA or IOTA Simple Rules in secondary care in the NHS to help decide whether to refer people with suspected ovarian cancer to a specialist multidisciplinary team (MDT).

Report shows prevalence of key conditions across England

Figures released by NHS Digital provide information on the prevalence of 21 conditions, including asthma, hypertension, dementia, diabetes, and depression.

The annual report, Quality and Outcomes Framework (QOF) - Prevalence, Achievements and Exceptions Report, England 2016-17 also identifies how the prevalence of these conditions has changed since the previous year.

Supporting women with learning disabilities to access cervical screening

This information, originally developed in North Tyneside, and published by Public Health England, is to support women with learning disabilities to access cervical screening.

Over 60% of women diagnosed with endometriosis go on to have multiple surgical procedures

Women with endometriosis have a significantly higher risk of multiple operations, shorter time to repeat surgery and hysterectomy compared with those without the condition, reveals a large study published in BJOG: An International Journal of Obstetrics and Gynaecology.

The authors say the results should help women with a new diagnosis make timely reproductive choices and assist with clinical service planning.

The findings show that 62% of women with endometriosis had further surgery, with a median time of less than two years to a second surgical procedure. Half of all women with endometriosis had undergone repeat surgery within 5.5 years and one in five women had hysterectomy or removal of one or both ovaries.

Diagnostic Laparoscopy

Consent advice No. 2 from the Royal College of Obstetricians and Gynaecologists.  This paper provides advice for clinicians in obtaining the consent of women undergoing diagnostic laparoscopy.

RCOG statement on hormone therapy use for menopause

Hormone therapy use up to 7 years among postmenopausal women was not associated with an increased risk of death from cardiovascular, cancer, or all causes for nearly 2 decades of follow up, a new analysis shows.The results from the Women's Health Initiative trial are published in JAMA.

Endometriosis: diagnosis and management

This guideline covers diagnosing and managing endometriosis. It aims to raise awareness of the symptoms of endometriosis, and to provide clear advice on what action to take when women with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available.Endometriosis: diagnosis and management

This guideline includes recommendations on:

• organisation of care
• information and support
• endometriosis symptoms and signs
• when to refer
• diagnosing endometriosis
• pharmacological management
• surgical management

Using mesh does not improve results in vaginal prolapse surgery

Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh.

From the NIHR Dissemination Centre

Case Report: An Unusual Presentation of Metastatic Renal Cell Carcinoma with Per-Vaginal Bleeding

Urology & Nephrology Open Access Journal. Volume 4 Issue 2 - 2017

Renal cell carcinoma is an aggressive cancer, which could explain why as many as a third of cases are diagnosed as metastatic at presentation. With the incidence of renal cell carcinoma on the rise and a 5-year survival rate of just over 10% with metastatic disease, it is important to highlight the role of early detection of this cancer in order to optimize management and improve outcomes. Vulva and vagina represent rare sites for metastases from renal cell cancer, with clear cell renal cell cancer accounting for about a fifth of metastatic vulval cancer. We focus on this rare presentation of vulvo-vaginal metastases from renal clear cell carcinoma by presenting an unusual case of per-vaginal bleeding 3 months following detection of a renal lesion on CT imaging and highlight the importance of having a multidisciplinary approach to managing such complex cases to provide patients with the best possible outcomes.

UHCW Research: B Pisavadia, A Mevcha, D Patel, B Sinha, ARJ Blacker and AA Deshpande

Health matters: making cervical screening more accessible

Attendance for cervical screening has been falling year on year. This professional resource aims to address this decline in attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.

Using mesh does not improve results in vaginal prolapse surgery

Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh. This large pragmatic study looked at over 3000 women with vaginal prolapse. Half of these were randomised; the rest contributed data but were not part of the main evaluation. The study separately compared mesh and biological grafts to a repair without these additions.

Mesh Oversight Group Report on vaginal mesh implant

This Mesh Oversight Group Report follows on from the Mesh Working Group Interim Report of December 2015. Both reports are about vaginal mesh implants used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women.

See RCOG's and BSUG's joint response to the report.

Hysteroscopic sterilisation by insertion of intrafallopian implants - guidance (IPG587)

New interventional procedures guidance on hysteroscopic sterilisation by insertion of intrafallopian implants in adults.

Current evidence on the safety and efficacy of hysteroscopic sterilisation by insertion of intrafallopian implants is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance and audit.