Journal of Family Planning and Reproductive Health Care (J FAM PLAN REPROD H)

Publications in this journal

• Article: Improving uptake of the copper intrauterine device for emergency contraception by educating pharmacists in the community.

  Kathryn M Clement, Diana J Mansour
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  ABSTRACT: OBJECTIVES: The copper intrauterine device (Cu-IUD) is the most effective method of emergency contraception (EC) and provides ongoing contraception, yet few women choose this option. This study evaluates the impact of an educational initiative involving pharmacists on uptake of Cu-IUDs for EC in an integrated sexual health clinic in the North East of England. METHODS: Since November 2010, local pharmacists have received intensive education detailing EC options including Cu-IUDs. At the same time a rapid access referral pathway for fitting of an emergency Cu-IUD was established. The impact of this initiative has been assessed by analysing case notes of women attending a large city centre sexual health service who received an emergency Cu-IUD during September and October 2010 (prior to the initiative) and the same 2 months in 2011 (9 months after the start of the intervention). RESULTS: The number of women fitted with an emergency Cu-IUD increased by almost three-fold from 11 fitted in September and October 2010 to 30 fitted in these 2 months in 2011. One woman was referred from a pharmacist to the service in the first audit period compared with 17 in the second. No pregnancies occurred in the first month after Cu-IUD insertion in these 41 women. CONCLUSIONS: Educating pharmacists has increased referral and uptake of Cu-IUD used for EC and this has the potential to reduce unintended pregnancies now and in the future.
  Journal of Family Planning and Reproductive Health Care 05/2013;
• Article: What is the actual cost of providing the intrauterine system for contraception in a UK community sexual and reproductive health setting?

  Louise Cook, Charlotte Fleming
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  ABSTRACT: BACKGROUND: The anticipated increase in uptake of intrauterine system (IUS) fittings is slower than predicted by the National Institute for Health and Clinical Excellence (NICE). There is evidence to suggest that this is because of a high perceived cost of providing this contraceptive method. Whereas studies to date have all guessed at these costs, we calculated the actual costs of providing the IUS. METHODS: We tracked the notes of 283 women who had an IUS fitted in our community sexual and reproductive health service for 5 years. We recorded duration of use, measured the actual cost of all appointments and interventions over the lifespan of the device, and compared our findings with NICE predicted costs. RESULTS: With 70% complete follow-up, the average duration of use of the IUS was 3.44 years compared to NICE's prediction of 3.32. The average annual cost of providing an IUS for contraception in community clinics was £54.55 per woman; this compares with £70.49 modelled by NICE for provision in primary care. Most (80%) of the cost is incurred in the first year. The cost of managing problems is small. CONCLUSIONS: Providing the IUS for contraception was 23% cheaper in the present study than that predicted by NICE and cheaper than providing combined oral contraception in our service. Fitting IUSs in community clinics may be cheaper than in primary care. Streamlining the patient pathway will reduce costs further. Restricting access to the IUS because of initial cost is a false economy.
  Journal of Family Planning and Reproductive Health Care 04/2013;
• Article: Analysis of an innovative one-stop, hospital-based, outpatient acute gynaecology clinic: model for taking the service to community.

  Vinod Kumar, Janesh Gupta, Manjeet Shehmar
  Journal of Family Planning and Reproductive Health Care 04/2013;
• Article: Use of ulipristal acetate, levonorgestrel and the copper-intrauterine device for emergency contraception following the introduction of new FSRH guidelines.

  Aisling Susan Baird
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  ABSTRACT: OBJECTIVES: The UK Faculty of Sexual & Reproductive Healthcare (FSRH) has recommended that for emergency contraception (EC) the health professional should discuss individual needs and inform women of the different methods, efficacy, adverse effects, interactions, eligibility and additional contraception. In our sexual and reproductive health care service (Liverpool and Knowsley, UK), revised guidance was issued in early 2012, reflecting Faculty advice. We studied (1) how our use of EC changed, (2) which methods were offered and how this changed, (3) which method was chosen by women who were offered all three UK licensed methods of EC and (4) the appropriateness of the offer of only levonorgestrel (LNG). METHODS: We studied a total of 2989 case records in the 3 months before and 3 months following the adoption by our service of the 2011 FSRH guidance. This was a retrospective review of charts undertaken by interrogating our computerised Excelicare(®) system of clinical records. All EC episodes in the two 3-month periods were analysed, covering October-December 2011 and March-May 2012. Additionally, three non-probabilistic, purposeful samples of representative practitioners' charts were examined in groups of women offered all methods [and choosing either ulipristal acetate (UPA) or LNG] or who were offered LNG only. RESULTS: The use of LNG fell from 93.0% of EC issued to 76.0%; UPA use rose from 3.0% to 18.7%. In the second 3-month period, of the women offered all three methods, 54.9% chose LNG and 39.8% UPA. LNG-only offers in our judgement were clinically appropriate in 62.5% cases of such offers. CONCLUSIONS: Comparing the second period with the first, more women were offered all three methods, the use of LNG fell (93.0% to 76.0%) and that of UPA increased (3.0% to 18.7%). Women were encouraged to exercise choice. However, increasing choice in our service did not lead to a wholesale change from LNG to UPA.
  Journal of Family Planning and Reproductive Health Care 04/2013;
• Article: Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism.

  Johannes Bitzer, Jean-Jacques Amy, Rob Beerthuizen, Martin Birkhäuser, Teresa Bombas, Mitchell Creinin, Philip D Darney, Lisa Ferreira Vicente, Kristina Gemzell-Danielsson, Bruno Imthurn, [......], Thomas Rabe, Katarina Sedlecki, David Serfaty, Jacques Seydoux, Lee P Shulman, Regine Sitruk-Ware, Sven O Skouby, Anne Szarewski, James Trussell, Carolyn Westhoff
  Journal of Family Planning and Reproductive Health Care 04/2013;
• Article: Contraceptive options for women with SLE: response to Mansour letter.

  Kelly R Culwell, Kathryn M Curtis
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):151-152.
• Article: The Faculty of Sexual & Reproductive Healthcare: 20th anniversary.

  Christopher Wilkinson, Diana Halfnight
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):78-79.
• Article: Sex on the brain.

  Lesley Smith
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):142-143.
• Article: Combined hormonal contraceptives and the risk of venous and arterial thromboembolism and cardiovascular death: misuse of automated databases.

  Samuel Shapiro
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  ABSTRACT: BACKGROUND: In December 2011, the US Food and Drug Administration (FDA) convened a public Advisory Committee meeting to review evidence from a study commissioned by the agency. An analysis of findings derived from four databases was published on the FDA website, and presented at the meeting. Among users of combined hormonal contraceptives containing ethinylestradiol (EE) plus drospirenone (DRSP) the risks of venous (VTE) and arterial thromboembolism (ATE) were higher than among users of older reference contraceptives containing other progestogens. The findings have now been published in a peer-reviewed journal. OBJECTIVE: To evaluate the published evidence. METHODS: Generally accepted epidemiological principles of causality are applied. RESULTS: The findings did not satisfy the criteria of time order, bias, confounding, statistical stability and strength of association, duration-response, internal consistency, external consistency, or biological plausibility. CONCLUSIONS: The best evidence continues to suggest that the increased risk of VTE in combined hormonal contraceptive users is dependent on the dose of estrogen, and independent of the progestogen used. The best evidence also suggests that DRSP does not increase the risk of ATE, and may reduce it.
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):89-96.
• Article: Embryonic screening as a European human right.

  André den Exter
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):152-153.
• Article: Contraceptive options for women with SLE.

  Diana Mansour
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):150-151.
• Article: Does hormone replacement therapy cause breast cancer? Commentary on Shapiro et al. papers, Parts 1-5.

  Nick Panay
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):72-74.
• Article: College of Sexual and Relationship Therapists Conference, London, UK, November 2012.

  Susan Quilliam
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):146.
• Article: Embedded stainless steel ring intrauterine device.

  Vincent Y T Cheung
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):153-154.
• Article: The Internet in the reproductive health care sector: good or bad?

  Susan Quilliam
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):139-141.
• Article: Lactational amenorrhoea method: the evidence is there, why aren't we using it?

  Sarah Panzetta, Jill Shawe
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):136-138.
• Article: Does hormone replacement therapy (HRT) cause breast cancer? An application of causal principles to three studies.

  Samuel Shapiro, Richard D T Farmer, John C Stevenson, Henry G Burger, Alfred O Mueck, Anne Gompel
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  ABSTRACT: BACKGROUND: Based principally on findings in three studies, the Collaborative Reanalysis (CR), the Women's Health Initiative (WHI), and the Million Women Study, it is claimed that hormone replacement therapy (HRT) is an established cause of breast cancer. The authors have previously reviewed those studies (Parts 1-4). The WHI findings were first published in 2002, following which the use of HRT rapidly declined. A correspondingly rapid decline in the incidence of breast cancer has been reported, and attributed to the drop in the use of HRT. The evidence, however, is conflicting. METHODS: Using generally accepted causal criteria, in this article (Part 5) the authors evaluate reported trends in the incidence of breast cancer. RESULTS: The evidence to suggest a correlated decline in the incidence of breast cancer following a decline in the use of HRT has not adequately satisfied the criteria of time order, detection bias, confounding, statistical stability and strength of association, internal consistency, and external consistency; biological plausibility is difficult to assess. CONCLUSIONS: Based on the observed trends in the incidence of breast cancer following the decline in HRT use, the ecological evidence is too limited either to support or refute the possibility that HRT causes breast cancer.
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):80-88.
• Article: The policing of abortion services in England.

  Sam Rowlands
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):121-126.
• Article: Clinicians should consider the effect of bodily metaphors when discussing contraceptive options.

  Susan Walker
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):152.
• Article: Subcutaneous depo-medroxyprogesterone acetate.

  Sharon Cameron
  Journal of Family Planning and Reproductive Health Care 04/2013; 39(2):75-77.