In this edition of Modern Medicine, we include a special feature on womens health, as well as pieces on haematology, pulmonology and many more.
We encourage you to have a look through the below edition, and to give them a read – we think you’ll find them interesting.
Heavy Menstrual Bleeding and Iron Deficiency | Breaking the Vicious Cycle
Heavy menstrual bleeding (HMB) is a common cause of chronic iron loss and iron deficiency, which may be symptomatic even when haemoglobin level is normal. Ferritin testing is essential and assessment of HMB should include quality of life and underlying causes, rather than only blood loss estimates. Investigations should be guided by symptoms, examination findings and risk factors. Management of HMB must both restore iron stores and reduce ongoing menstrual blood loss to prevent recurrence. Of the medical treatment options for blood loss, the 52mg levonorgestrel intrauterine device offers the greatest reduction. Early recognition of low iron levels, plus treatment of both iron stores and menstrual blood loss, helps prevent recurrence and improves wellbeing.
Hormone Replacement Therapy During and After Menopause
Hormone replacement therapy (HRT) has been used in clinical practice for decades as a therapeutic
approach for mitigating menopausal symptoms. The primary objective of HRT is to alleviate
menopausal symptoms during the perimenopausal and menopausal phases. The symptoms mostly
encompass vasomotor and genitourinary issues resulting from the deficiency of oestrogen and
progesterone. These symptoms include hot flashes, night sweats, vaginal dryness, mood swings,
sleep disturbances, depressive episodes, skin and metabolic changes.
Prescribing Menopausal Hormone Therapy | A Practical and Evidence-Based Approach to Treatment
Around three-quarters of women experience menopausal symptoms, predominantly vasomotor symptoms. Menopausal hormone therapy (MHT) is the most effective treatment for these and other direct consequences of menopause, such as bone loss. Although nonoral oestrogen is widely considered
to be the preferred option, oral oestrogen is a safe and effective option for most women who do not absorb or cannot tolerate transdermal oestrogen formulations. Micronised progesterone and dydrogesterone may be better tolerated than other progestogens, but studies are needed to determine
the breast safety of these progestogens beyond three to five years of use with concurrent oestrogen therapy. Easy access to safe and effective MHT is imperative for improving quality of life and long-term health outcomes for women in midlife.
Hepatitis Screening for a Safe Blood Supply
Viral hepatitis is considered a major public health issue. Chronic Hepatitis B and C infection can cause
liver damage that includes liver fibrosis, cirrhosis, hepatocellular carcinoma and features of portal
hypertension. The South African National Blood Service (SANBS) screening and testing practices for hepatitis are vital for maintaining a safe blood supply and preventing transfusion-transmitted infections. By utilising both thorough donor questionnaires and advanced testing, SANBS intercepts window-period infections, protecting vulnerable patients and tracking public health.
Swollen Legs: a Diagnostic and Management Update
Chronic limb oedema can have a wide variety of causes. Chronic oedema is defined as persistent swelling that is present for more than three months, regardless of its cause. It is a prevalent health condition that impacts on patients’ function and quality of life, and is associated with complications such as chronic wounds and cellulitis. An accurate diagnosis can guide effective management. In addition to the treatment of any underlying cause, the principles of lymphoedema management can be applied to
improve symptoms, reduce complications and improve quality of life for patients, regardless of the cause of chronic oedema.
Fixed-dose Combination Approach for Asthma and COPD
Chronic airway inflammation and obstruction are common symptoms associated with chronic obstructive pulmonary disease (COPD) and asthma. Combination inhaled corticosteroids (ICS) and longacting β2 – agonist (LABA) products have a substantial impact on the management of these diseases.
Dexlansoprazole for Managing Drug-induced GORD, Oesophagitis and Heartburn
Gastro-oesophageal reflux disease (GORD) is a chronic gastrointestinal disorder characterised by a recurrent retrograde flow of gastric contents into the oesophagus and sometimes into the oropharynx. The use of certain medications has been linked to the onset or worsening of GORD symptoms. A common and effective treatment of oesophagitis and GORD is to reduce gastric acid secretion with a proton pump inhibitor (PPI).
The Essential Role of Clinical Judgement
One of the central challenges in contemporary healthcare is delivering high-quality care under limited resources.
To address this, systems increasingly rely on protocols and guidelines to promote standardisation, safety, and efficiency – tools that are regarded as essential to practice. Yet when adherence becomes the overriding goal, it can undermine critical thinking, clinical judgement, and individualised care.
In this edition of Modern Medicine, we feature an ethics article on the impact of AI in our lives; clinical articles include a topical piece on the concurrent treatment of obesity and diabetes, and there’s also a Urology focus feature, including an article on OAB and another on microscopic haematuria; finally, there’s a COPD-linked article on the impact of ‘flu on the disease. They’re all good reads, and we encourage you to give them a look.
