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By T. Justin Clark M.D., Janesh K. Gupta M.D.

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Investing in training a multiskilled workforce will help develop a cohesive, flexible and motivated team and increase staff retention. Staff will be better able to inform and educate patients and carers if they are familiar with the entire patient experience. Nursing staff should be encouraged to further develop their competencies and thus make a fuller contribution to service provision. The development in the UK of a formalized programme for training of ‘nurse hysteroscopists’ is such an example of extending traditional roles and modernizing service delivery.

Symptomatic women may harbour serious endometrial pathology, especially postmenopausal women (who should be seen within 2 weeks of referral) and so an effective, efficient service is mandatory. To achieve this requires implementing and disseminating strict evidence-based referral guidelines. 6. The rationale for these guidelines is as follows. Endometrial cancer and premalignant atypical hyperplasia are unlikely causes of abnormal bleeding patterns below the age of 40 years, but become increasingly important after this age.

From an endocrine point of view, oestrogen deficiency releases the hypothalamus and pituitary from inhibition (negative feedback) and FSH and LH levels become markedly elevated in an attempt to stimulate the resistant ovary. This compensatory increase in FSH and Further reading 15 LH can be measured (although absolute levels are of little clinical value unless premature ovarian failure is being investigated) and persists for around 10 years until the pituitary becomes exhausted and levels decline.

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