O Magazine&G Vol 16 No 3 Spring 2014 Office gynaecology The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Contents Office gynaecology 13 Editorial OMagazine& G Brett Daniels O&G Magazine Advisory Group 14 Contraception: a new focus Dr Gillian Gibson Fellows Rep, New Zealand Suzanne Pearson and Sumudu Cooray A/Prof Stephen Robson Fellows Rep, ACT Dr John Schibeci Diplomates Rep, NSW 17 Hysteroscopic sterilisation Dr Brett Daniels Young Fellows Rep, TAS Dr Alexa Bendall Trainees Rep, QLD Astrid Budden Magazine Editors O&G 21 Mirena: modern-day miracle Penelope Griffiths Julia Serafin Edwina Morgan Lisa Westhaven 24 Colposcopy 2014 Designer and Production Editor Lisa Westhaven Louise Farrell Editorial Communications 26 NCSP renewal: 2016 O&G Magazine Advisory Group, RANZCOG Ian Hammond 254–260 Albert Street EAST MELBOURNE, VIC 3002 Australia 27 Investigating fertility (t) +61 3 9417 1699 Tamara Hunter (f) +61 3 9419 0672 (e) [email protected] 30 Polycystic ovarian syndrome Advertising Sales Megan Ogilvie Bill Minnis Director Minnis Journals (t) +61 3 9836 2808 33 Pelvic inflammatory disease (f) +61 3 9830 4500 Shannon Woodward and Sarah Martin (e) [email protected] Printer 36 Vulval pain: a registrar’s view Highway Press Nicola Quirk (t) +61 3 9887 1388 (f) +61 3 9800 2270 38 Medication management of chronic pelvic pain Susan Evans O&G Magazine authorised by Mr James McAdam © 2014 The Royal 40 Outpatient hysteroscopy Australian and New Zealand College of Obstetricians and Gynaecologists Namiko Kobayashi and Boon Lim (RANZCOG). All rights reserved. No part of this publication may be reproduced or 44 Hysteroscopy: tools, tips, tricks copied in any form or by any means without Khaldoun Aweidah the written permission of the publisher. The submission of articles, news items and letters is 47 Chronic vaginal discharge: causes and management encouraged. Patricia Car For further information about contributing to O&G Magazine visit: www.ranzcog.edu.au/ 52 Heavy and painful periods publications/oandg-magazine.html Ujvala Jagadish and Adam Mackie The statements and opinions expressed in articles, letters and advertisements in O&G 54 Postmenopausal bleeding Magazine are those of the authors and, unless specifically stated, are not necessarily the Adele Zito views of RANZCOG. Although all advertising material is expected to conform to ethical and legal standards, Letter to the editor acceptance does not imply endorsement by 56 Nausea and vomiting in pregnancy the College. Stephen Raymond ISSN 1442-5319 Cover: Shutterstock 76757920 © Sergiu Ungureanu 2 O&G Magazine Contents RANZCOG Regional Committees New Zealand Dr Ian Page Chair Women’s health Jane Cumming Executive Officer 57 Journal Club Level 6 Featherson Tower 23 Waring Taylor Street/ PO Box 10611 Brett Daniels WELLINGTON 6011, NEW ZEALAND (t) +64 4 472 4608 (f) +64 4 472 4609 (e) [email protected] 58 Expecting the unexpected Kellie Wight Australian Capital Territory TBA Chair 61 Alcohol and pregnancy New South Wales Prof Gabrielle Casper Chair Alec Welsh Lee Dawson Executive Officer Suite 4, Level 5, 69 Christie Street ST LEONARDS, NSW 2065 62 Partogram or instagram? (t) +61 2 9436 1688 (f) +61 2 9436 4166 (e) [email protected] Leo Leader Queensland Dr Lee Minuzzo Chair Lee-Anne Harris Executive Officer 66 Q&a: tests and algorithms for ovarian cyst work up Unit 22, Level 3, 17 Bowen Bridge Road HERSTON, QLD 4006 Adam Pendlebury (t) +61 7 3252 3073 (f) +61 7 3257 2370 (e) [email protected] South Australia/Northern Territory The College Dr Roy Watson Chair Tania Back Executive Officer 5 From the President 1–54 Palmer Place/PO Box 767 NORTH ADELAIDE, SA 5006 Michael Permezel (t) +61 8 8267 4377 (f) +61 8 8267 5700 (e) [email protected] 9 From the College Tasmania Dr Emily Hooper Chair James McAdam Mathew Davies Executive Officer College House 254–260 Albert Street 68 Visitors from the Pacific EAST MELBOURNE, VIC 3002 (t) +61 3 9663 5606 (f) + 61 3 9662 3908 Carmel Walker (e) [email protected] Victoria 69 Notice of deceased Fellows Dr Alison Fung Chair Mathew Davies Executive Officer 71 Staff news College House 254–260 Albert Street 72 Obituaries EAST MELBOURNE, VIC 3002 (t) +61 3 9663 5606 (f) + 61 3 9662 3908 (e) [email protected] Western Australia Dr Tamara Walters Chair Janet Davidson Executive Officer Level 1, 44 Kings Park Road WEST PERTH, WA 6005/PO Box 6258 EAST PERTH, WA 6892 (t) +61 8 9322 1051 (f) +61 8 6263 4432 (e) [email protected] The Royal Australian and New Zealand College of Obstetricians and Gynaecologists College House 254–260 Albert Street EAST MELBOURNE, VIC 3002 (t) +61 3 9417 1699 (f) +61 3 9417 0672 (e) [email protected] (w) www.ranzcog.edu.au President Prof Michael Permezel Vice Presidents Board Members A/Prof Stephen Robson Prof Ian Symonds Dr Vijay Roach Dr Sarah Tout Dr John Tait Treasurer Chief Executive Officer Dr Martin Ritossa Mr James McAdam Vol 16 No 3 Spring 2014 3 The College From the President Given the forthcoming joint Selection for specialist training RANZCOG/RCOG Scientific I write this on a fine Saturday morning, receiving news from our Meeting in Brisbane, in April 2015, prospective Trainees as to whether they have or have not been and the Sydney ASM, in late 2013, invited to the interview stage of College selection for specialist the decision was made not to have training. This year there were more than 250 applicants for fewer an Annual Scientific Meeting in than 80 positions in Australia (New Zealand completed their 2014. This has led to an increased parallel process earlier). So many current Fellows, not least the focus on the Regional Scientific author of these words, would have really struggled to achieve Meetings in 2014: Provincial Fellows selection under such intense competition. Disappointment merges in Port Lincoln, Queensland-NSW on with incredulity when an outstanding doctor misses out on his/her the Gold Coast, WA-SA in Broome ambition to begin a career in obstetrics and gynaecology. So what and Victoria-Tasmania in Melbourne. is the process? Prof Michael Permezel These are all important events in the College calendar, with high- In essence, selection for any position in the workforce must rely President quality scientific content and great on a written application accompanied by a curriculum vitae, camaraderie among attendees. referee reports and an interview. The curriculum vitae is scored, Each was superbly organised by Fellows, supported by College but relatively little differentiates prospective Trainees. Rurality, staff, with the best national speakers giving many superb talks. I Indigenous background or a brilliant academic record identify encourage you all to support your regional meetings in the future only a few. Almost all meet the criterion related to experience in – as well as the 2015 ASM in Brisbane. obstetrics and gynaecology. Referee reports are highly structured, SAVE THE DATE! UGSA UROGYNAECOLOGICAL SOCIETY OF AUSTRALASIA ANNUAL SCIENTIFIC & GENERAL MEETING 13 – 14 MARCH 2015 THE GRACE HOTEL, SYDNEY AUSTRALIA Following the unprecedented Join the meeting wait list success of the March 2014 to receive updates as they UGSA ASM in Melbourne, become available, contact: we are proud to announce the next UGSA ASM being held in Debra O’Brien Sydney, Australia. UGSA Administrator Featuring: [email protected] - International Key Note Speakers incl. +61 3 9417 1699 Professor Ingrid Nygaard, from the USA www.ugsa.org.au - State-of-the-art lectures with generous discussion time for delegates - Popular topics in office urogynaecology and surgical therapies - Debates on controversies in urogynaecology Vol 16 No 3 Spring 2014 5 The College but almost invariably the referees rate their prospective Trainees very highly across all areas. Challenging interview questions are developed by the selection subcommittee and are uniform across all interview panels. Any selection process will never be perfect and the selection process of all the specialist colleges will inevitably come under increased scrutiny as the tsunami of young medical graduates seek specialist training in a competitive environment that can only be described as extreme. The College will strive to further improve its processes with the objective of being both fair and transparent – but also with the intention of trying to select the best possible future specialists in obstetrics and gynaecology. ‘The College will strive to further improve its processes with the objective of being both fair and transparent – but also with the intention of trying to select the best possible future specialists in obstetrics and gynaecology.’ Women’s health Morcellation and mesh Morcellation of fibroids and mesh for pelvic organ prolapse are two issues that have attracted much recent publicity. This is, in part, because of some adverse outcomes, but more particularly following news statements from the US Food and Drug Administration (FDA) such as: the ‘FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids.’ The College clearly has a role to play in communicating accurate information to Fellows through such avenues as its website, electronic newsletter (Collegiate), journals and scientific meetings. Importantly, there is also a role for the College in limiting unfounded alarm, such as when urinary continence procedures involving tape had been inappropriately grouped in the same context as mesh procedures for pelvic organ prolapse. The College is indebted to members of the Women’s Health Committee and also to experts such as Prof Malcolm Frazer (Chair of the Urogynaecology Subspecialty Committee) and A/Prof Anusch Yazdani (Vice-President, AGES), who have greatly assisted in the development of College responses to these important issues. National Cervical Screening Program Members and Trainees are by now aware of the planned changes to the National Cervical Screening Program (NSCP).