A guide to Women's Health on the Internet Part 2. Gynaecology and Reproductive Medicine

Published in: He@lth Information on the Internet, February 2001; Issue 19:p.4-6
He@lth Information on the Internet can be found at <http://www.hioti.org> 
Copyright: Royal Society of Medicine Press

In Part 1: Pregnancy, childbirth and ultrasound (<http://www.hioti.org> Issue 12, December 1999)) Hans van der Slikke, Consultant Obstetrician/Gynaecologist at Free University Amsterdam Hospital, Netherlands and Chairman of the International Council of OBGYN.net looked at Internet resources that dealt with pregnancy, childbirth and ultrasound. In this second part Dr Van der Slikke turns his attention to Internet resources that focus on gynaecology and reproductive medicine.

Introduction
The problems relating to searching the Internet for medical information are well known; too many sites are identified and there is no easy way to filter out the good from the bad. Consequently, if search engines are not the best place to start your exploration of the Web for information relating to gynaecology and reproductive medicine, where is? In my opinion the best place to start is at the OBGYN.net site <http://www.obgyn.net>. Since its launch in September 1996, OBGYN.net has become the gateway to information in the field of obstetrics and gynaecology. Moreover, it is one of the few Web sites that translates the content into other languages, e.g. Spanish and Portuguese <http://latina.obgyn.net> and German and Dutch <http://europe.obgyn.net>. 

Within the OBGYN.net site there are several sections, each devoted to a gynaecological subspecialty. This is the approach I will adopt in this paper.

Fertility and Infertility
FertiNet <http://www.ferti.net>, the Worldwide Fertility Network, is probably one of the best sites on the Web for infertility information. The site has general information – including details of patient associations, fertility centres and treatment options – as well as more scientific information where, practitioners in this field can identify the latest research and learn about forthcoming conferences. Product information and access to online discussion forums is restricted to professional health workers in the field of assisted fertilisation and human reproduction.

The character of the site is mainly European and has a clear link to ESHRE, the European Society of Human Reproduction and Embryology <http://www.eshre.com>.  

ESHRE is one of the societies under the umbrella of the International Federation of Fertility Societies, IFFS <http://www.mnet.fr/webprofessionnel/i/iffs/index.htm>. At the IFFS site you will find the usual information about the organisation, details of forthcoming conferences and an online newsletter. Less typically, you will also find full text access (in PDF format) to a number of publications published by this body including “Infertility and Contraception: a textbook for clinical practice” <http://www.mnet.fr/webprofessionnel/i/iffs/bookinfertility/a_bookic.htm>. 

Other useful resources include Dr Marc Perloe's IVF.com site <http://www.ivf.com> and the American Society for Reproductive Medicine <http://www.asrm.com>. Both sites include detailed FAQ’s for consumers, whilst the IVF.com site also has an online chat room where Dr Perloe can be contacted at certain times of the week.

Self-help groups are another rich source of information. RESOLVE, the US National Infertility Association, has an extensive Web site <http://www.resolve.org> that provides information about the key issues (such as how to select an infertility specialist). In addition, online bulletin board and helplines encourage visitors to communicate with other people who have similar concerns and worries. In the UK the National Fertility Association <http://www.issue.co.uk/> provides a similar service.

Contraception
For health professionals the Web site of the International Planned Parenthood Federation, IPPF, <http://www.ippf.org> is a rich source of information. Of particular interest are the detailed country profiles <http://www.ippf.org/regions/countries/index.htm> which provide statistical data on fertility and contraception for over 180 countries. These profiles have been produced as a collaborative effort between Family Planning Associations affiliated to IPPF and IPPF Central and Regional Offices.

In the past few years there has been much comment and debate about the link between combination oral contraceptives and cardiovascular disease. For an authoritative discussion on this topic, with clear conclusions and recommendations, the Consensus document authored by the International Federation of Fertility Societies should be consulted. The full-text is available at: <http://www.mnet.fr/webprofessionnel/i/iffs/a_coc.htm> 

If contraception fails, abortion may be an option. This is obviously a very emotive subject, a fact reflected in many of the Web sites that address this issue. One Web site however, that provides factual information without too much political colouring is the International Society of Abortion Doctors (ISAD) <http://www.nedernet.nl/~ngva/isadindex.htm>. Here professionals will find a practical guide for doctors who undertake abortions and direct access to the ISAD-sponsored newsgroup Sci.med.abortion. 

For consumers, the sites of the pharmaceutical companies like Organon <http://www.organon.com/>, Schering <http://www.femalelife.com/> and Ortho-McNeil <http://www.ortho-mcneil.com/> provide information about contraception. At the Ortho-McNeil site for example, detailed information is provided on all the oral contraceptives, diaphragms and IUD’s produced by this company. Information provided here ranges from quick fact sheets through to the full, official, US Prescribing Information.

Menopause
The North American Menopause Society (NAMS), a non-profit organisation “devoted to promoting understanding of menopause, and thereby improving the health of women through midlife and beyond” has a wealth of information on its Web site <http://www.menopause.org/projour/abstract/mabstracts.html>. For health professionals, online access is provided to abstracts from the journal “Menopause”, as well as online CME courses and details of scientific meetings. Consumers are not forgotten either, as booklets, frequently asked questions, access to online discussion groups and details of clinicians who are members of NAMS, are all readily available.

Other sites of interest include the US Doctor’s Guide to the Menopause <http://www.pslgroup.com/Menopause.htm> and the menopause and perimenopause sections on OBGYN.net <http://www.obgyn.net/meno/meno.asp>.  f particular interest here is the active forum where specialists in this field answer patient questions. Finally, readers should also be aware of the text “Practical HRT”, published by the European HRT Network Foundation <http://www.hrtnet.org/prachrt/toc.htm>. This comprehensive and up-to-date textbook covers all the topics related to oestrogen replacement therapy.

Laparoscopy and Hysteroscopy
Starting again at OBGYN.net <http://www.obgyn.net/hysteroscopy/hysteroscopy.asp> you will find online articles, case studies, fact sheets along with a collection of audio and video presentations that cover many aspects of laparoscopy and hysteroscopy.

The International Society for Gynecologic Endoscopy (ISGE) has an online gynaecologic endoscopic atlas <http://isge.org/pic/content.html>. Further images are available on the ENDOSURG site <http://www.chirurgie-endo.asso.fr/endosurg/index.html>.  

For information specifically on hysteroscopy, the Brazilian Hysteroscopy site <http://www.histeroscopia.med.br/hysteroscopy.htm>, developed by Dr Afonso, is worth visiting. Though it may not be the easiest site to navigate, there is much information to be found here including numerous online images and videos, and details of the history of hysteroscopy.

For clinical guidelines the Web site of the Society of Obstetricians and Gynaecologists of Canada <http://www.sogc.org/SOGCnet/sogc_docs/common/guide/library_e.shtml> is an excellent reference point. If a guideline you seek is not covered here, the database of the US National Guideline Clearing House <http://www.guidelines.gov/index.asp> can be searched.

Urogynaecology
Patients who suffer from incontinence are, in general, embarrassed by their condition. For them good information on the Web is essential. One site that addresses this need is Drylife from the US <http://www.drylife.org/drylife.html>. Here one is provided with a step-by-step guide to treating incontinence and access to a database of practising urologists.

For clinicians, the Web site of the American Urological Association <http://www.auanet.org/index_hi.cfm> contains much useful information, including clinical practice guidelines, best practice policies and access to the “Journal of Urology”. Much of this information, however, is only available to subscribing members.

The OBGYN.net section that deals with urogynaecology <http://www.obgyn.net/urogyn/urogyn.asp> contains original papers, congress videos and links, and is freely available. 

Oncology
Finally, I would like to highlight some sites that look at gynaecologic oncology. [Note: Though in some countries breast cancer falls within the remit of the gynaecologic oncologist it will not be discussed here.]

For oncology of the female genital organs the FIGO (International Federation of Gynecology and Obstetrics) staging is widely accepted. Information on the staging of the cancers of the uterus (cervix and corpus), ovary, vagina and vulva and gestational trophoblastic diseases (GTD) can all be downloaded from the FIGO site at <http://www.figo.org/default.asp?id=32>. 

The US National Cancer Institute (NCI) has a wonderful site, <http://www.nci.nih.gov>, that contains general information about cancer and highly detailed, location-specific information. Information on location-specific cancer is accessible through the alphabetic listing of cancer-types <http://cancernet.nci.nih.gov/alphalist.html>. 

Visitors to this site can also identify what clinical trails are currently being undertaken on a particular cancer-type <http://cancernet.nci.nih.gov/trialsrch.shtml>.  If a search yields too many trials users are given the option of refining the search by stage of cancer, modality and phase of trial. The NCI are also responsible for the “CancerLit” database. To help clinicians make best use of this resource a number of pre-prepared searches have been constructed on all aspects of gynaecologic cancers. Subjects covered include “Therapy of cervical cancer”, “Gestational trophoblastic neoplasms” and “Vaginal and vulvar cancer”. Updated monthly, the searches and their results can be found at <http://cnetdb.nci.nih.gov/clinpdq/canlit/gynecologic.html>. 

Other interesting sites relevant to this topic include the University of Washington’s Division of Gynecologic Oncology <http://gynoncology.obgyn.washington.edu/> and OncoLink <http://www.oncolink.upenn.edu/> from the University of Pennsylvania. Both sites provide online tutorials on all the gynaecological cancer locations, whilst the University of Washington is particularly strong on the treatment of rare gynaecological cancers.

For information about cervical pathology, the Web sites of the American Society for Colposcopy and Cervical Pathology <http://www.asccp.org/> and the US National Cervical Cancer Coalition <http://www.nccc-online.org> are both highly recommended.

Sites for Patients and Consumers
There is a strong belief that lay-people prefer information that is aimed at health professionals, perceiving it to be original and unfiltered information. This phenomenon is best illustrated by the enormous increase in the number of people searching MEDLINE since this database (PubMed <http://www.ncbi.nlm.nih.gov/PubMed/>) became freely available on the Web.

That said, there are still a number of very good Web sites that cover all aspects of women’s health and focus exclusively on the lay consumer. The WellnessWeb Women’s Health Centre <http://www.wellweb.com/WOMEN/women.htm> is one such example. WellnessWeb is a collaboration of patients, healthcare professionals, and other caregivers, whose mission is to “help to find the best and most appropriate medical information and support available”.

Another useful site is Joan Korenman's home page <http://research.umbc.edu/~korenman/wmst/links_hlth.html> which provides a quick, annotated guide to some of the best sites that offer information about women’s health issues.

Finally, MEDLINEplus <http://www.medlineplus.gov>, from the US National Library of Medicine, provides authoritative information on a range of health issues, including women’s health <http://www.nlm.nih.gov/medlineplus/womenshealth.html>. Recognising the difficulty some users may experience in conducting an effective MEDLINE search, MEDLINEplus offers a number of pre-prepared ‘clickable’ MEDLINE searches.

Hans van der Slikke can be contacted at hans@obgyn.net