Latest evidence · for clinicians
Latest evidence
A weekly digest of new research in the conditions I treat, screened to the papers that meet the evidence bar, verified on PubMed and read by me, with one verdict on each: does it change what I tell patients or do in theatre, support current practice, or leave it unchanged.
These pages are written for clinicians and referrers and are not advice for individual patients. If you are a patient, each stream links to the plain-language page on that condition, and the conditions and treatments index lists them all.
What this is
Every week PubMed is searched, through its official interface, for papers added in the previous seven days across the nine streams below, together with everything the main journals in the field added in the same week. At most ten papers a week are kept: randomised trials, systematic reviews and meta-analyses, guidelines, prospective cohorts of a hundred or more, registry studies, and diagnostic accuracy studies of endometriosis or niche imaging. In the two fields where papers are rare, Asherman's syndrome and the caesarean scar niche, smaller prospective cohorts and retrospective series of fifty or more are included as well. Case reports, laboratory studies and conference abstracts are left out.
Each paper is verified on its PubMed record before it is summarised, and the authors, journal, design, sample size and result are taken from that record. The summary gives the design and setting, the main result with its effect size and confidence interval where the abstract states them, and a verdict. "Changes practice" is reserved for findings strong enough to alter counselling or surgery, so most weeks most papers support current practice or leave it unchanged. Where a trial is industry-funded, the page says so.
Who it is for
GPs, fertility clinicians and gynaecologists who refer to me or want to know what is new in these fields, and anyone checking the evidence behind what the condition pages on this site say. I read every entry before it appears here, and the date of that reading is shown with each paper. The pages are not a substitute for reading the paper, and they are not advice for an individual patient.
Latest digest
: Ten papers included across the three new streams; the most important is a network meta-analysis of 58 randomised trials (6,846 women) confirming sacrocolpopexy as the most durable apical repair, with mesh repairs cutting anatomical recurrence by about a third against native tissue at the cost of mesh-related reoperation, highest for vaginal mesh.
The nine streams
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Endometriosis and adenomyosis
Deep and bowel disease, surgical outcomes, imaging and staging, recurrence, medical treatment after surgery, adenomyosis and fertility or miscarriage.
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Asherman's and intrauterine adhesions
Hysteroscopic adhesiolysis, prevention of re-adhesion (barriers, balloons, oestrogen), regenerative therapy for thin or scarred endometrium.
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Caesarean scar niche
Repair techniques, symptom and fertility outcomes, niche measurement on ultrasound.
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Surgery before IVF
Endometrioma surgery and ovarian reserve, hydrosalpinx, septum, polyps and fibroids before transfer, recurrent implantation failure.
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Robotic gynaecological surgery
Outcomes compared with laparoscopy, cost, single-port and new platforms, training and learning curves.
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Fibroids
Myomectomy technique, morcellation safety, newer oral medical treatments.
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Prolapse and mesh
Sacrocolpopexy and sacrohysteropexy outcomes, mesh safety and complications, uterosacral and native-tissue suspension, recurrence after apical repair, pessary and pelvic floor treatment compared with surgery.
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Chronic pelvic pain and hysteroscopy pain
Chronic pelvic pain assessment and treatment, central sensitisation and pain after surgery, pain relief for outpatient hysteroscopy (inhaled, local and oral), vaginoscopy, patient experience of office procedures.
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Recurrent miscarriage and ovarian cysts
Recurrent miscarriage investigation and treatment, structural causes (septum, adhesions, polyps, fibroids), progesterone and other medical treatment, ovarian cyst assessment and classification, ovary-sparing cystectomy and ovarian reserve, dermoid and endometrioma surgery.
Every paper shown on these pages is also published as open data at /evidence/papers.json, with its PubMed identifier, DOI, verdict and the date reviewed. Referrers can find how to refer, and what to expect, on the page for GPs and fertility units.
Last reviewed . Reviewed by Mr Haider Jan, Consultant Gynaecologist.