John Guillebaud

The human population reached 8 billion in 2022 and is still growing, and will possibly peak at 10.4 billion in 2086. Environmental science mandates that continued growth of the human enterprise on a finite planet is unsustainable and already in overshoot. Indeed, 3 billion is an evidence-based target number, for our species in competition with all...

Overpopulation exacerbates environmental and health problems, from climate change to biodiversity loss and pandemics. It is the ‘upstream’ driver of numerous existential threats. Addressing this compassionately – always – should be axiomatic for doctors. Our profession, by dramatically reducing death-rates since the 1800s while birth-rates remained...

I fully endorse reducing anxiety, ‘verbal anaesthesia’, the skill of the health care provider (HCP) and having a ‘chatty’ assistant present: these are essential but not always sufficient. As the Bahamondes et al. 1 review states, around 17% of nulliparous and 11% of parous women report pain that is ‘severe’. If given freedom to say so, a further gr...

Fully updated for the second edition, this resource now contains additional practical guidance, algorithms and diagrams, a new chapter on recurrent miscarriage, as well as expanded information on topics such as PCOs and hirsuitism. It follows chronological age up to the menopause, covering areas such as the reproductive system, puberty, the menstru...

The contractile actions of α,β-methylene ATP (α,β-meATP) and ATP and the effects of K(+) channel blockers in longitudinal and circular muscles of human vas deferens were investigated with a view to clarifying the functional importance of P2X(1)-purinoceptor activation and K(+) channels in modulating contractility of the tissues. The results provide...

Antiepileptic drugs (AEDs) that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. There is also the potential for the hormonal method to affect the AED. Women may also be prescribed AEDs to treat conditions other than epilepsy, such as chronic pain an...

To observe the incidence of menstrual symptoms and relevant surgery after sterilisation. 1101 women sterilised with Filshie clips between 1983 and 2002 were assessed prospectively comparing menstrual symptomatology documented immediately before surgery and 5-14 years later by questionnaire. Prevalence of menstrual dysfunction and subsequent surgery...

The actions of L-type Ca2+ agonists, FPL 64176 and Bay K 8644 were investigated in human vas deferens in the presence of structurally different L-type Ca2+ antagonists. The L-type Ca2+ agonists (≤ 3 µM, ~ 10 min) produced no detectable contractions but higher concentrations evoked intermittent rhythmic contractility of longitudinal and circular mus...

To investigate the effects of the relatively selective T-type Ca(2+)-antagonists, mibefradil and flunarizine, and the L-type Ca(2+)-antagonist, nifedipine, on the contractions of longitudinal and circular muscles of human vas deferens, to elucidate the possible involvement of T-type voltage-gated Ca(2+) channels (VOCs) in the contractile function o...

This introductory article highlights the discrepancy between family planning and technological progress posing questions such as Where is the male pill or implant? or Where is the single user-friendly method that effectively prevents both conception and sexually transmitted infections?

To estimate the failure, regret, and reversal rates 5 or more years after laparoscopic Filshie clip sterilization using local anesthesia. A total of 1,101 women underwent Filshie clip sterilization between 1983 and 2002. They completed follow-up questionnaires that were analyzed for the following outcomes: failed sterilization, regret after the ope...

Universal access to family planning should be the priority

Initially approved for use in the United States nearly 50 years ago, oral hormonal contraceptives containing both estrogen and progestin have undergone steady improvements in safety and convenience. Concurrent with improvements in safety associated with decreasing doses of both steroids, there has been an increased incidence of unscheduled bleeding...

This is the second of a two-article series describing the outcomes of the Hormonal Contraceptives Trial Methodology Consensus Conference held in Philadelphia, PA, on September 23, 2005. The first manuscript, "Hormonal Contraceptive Trials: Variable Data Collection and Bleeding Assessment Methodologies Influence Study Outcome and Physician Perceptio...

Since the usual 7-day pill-free interval weakens the contraceptive effect, it is our recommendation that, in addition to increasing the daily dose of estrogen, the pill should be given in a tricycling regimen (5). These women should take three cycles of the hormonal contraceptive preparation (50–60 mcg of estrogen per day) consecutively, without a...

Although fertility declines with advancing age as the woman approaches the menopause, some risk of pregnancy persists, and effective contraception needs to be offered to avoid an unintended pregnancy. An older woman may have menstrual dysfunction or climacteric symptoms and these factors would need consideration when making the choice of contracept...

Heart disease is the leading cause of maternal mortality in the UK. There is therefore a need to disseminate amongst the medical profession accurate information about contraception and pre-pregnancy counselling for women with heart disease. The risk of pregnancy depends on the specific disease and the individual patient. For example the risk of mat...

This study was designed to assess the long-term efficacy (5 years) of the levonorgestrel-releasing intrauterine system (LNG-IUS) in protecting the endometrium from hyperplasia during estrogen replacement therapy in perimenopausal women. Prospective, open, outpatient clinical trial in London and Oxford. Eighty-two women received oral conjugated equi...

I have researched and reviewed this subject for 25 years am on the World Health Organization (WHO)’s Selected Practice Recommendations (SPR) Committee and broadly support their latest recommendations. Like so often though the devil lies in the detail. A brief summary of the evidence: The prime conception risk is after the pill-free interval (PFI) d...

Several areas exist in the practice of contraception where evidence for practice is deficient, yet clinical decisions need to be made. The aim of the study was to find the practice habits of lead practitioners in the area of contraception in specific clinical scenarios where the published evidence is inadequate to provide clear guidance to clinicia...

OBJECTIVES To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY Literature was identified through database searches, reference lists and individuals/organisations working in the field. SELECTION CRITERIA...

The main contraceptive effects of this valuable product [the levonorgestrel intrauterine system (LNG-IUS)] are by endometrial suppression and changes to the cervical mucus and uterotubal fluid that impair sperm migration. The blood levels of LNG are very low, so progestogenic symptoms are uncommon. Most women still ovulate and in the remainder suff...

To assess insertion-linked pain and the short-term user-acceptability and safety of the GyneFix as compared with T-framed intrauterine devices (IUDs). A randomised controlled trial in an outpatient clinic setting. Women requesting an IUD for emergency contraception (EC) were allocated to either the short-term arm (GyneFix versus Nova-T200, or the l...

To assess the force required for, and pain of, removal of the GyneFix as compared with T-framed intrauterine devices (IUDs). A comparative trial following patient-blinded randomisation in an outpatient clinic setting. Women requesting an IUD for emergency contraception were fitted with either a GyneFix or a Gyne-T380S. For those requesting removal...

The contractile actions of imidazoline alpha-adrenoceptor agonists were investigated in human vas deferens longitudinal and circular muscle. The effects of phenoxybenzamine were studied in comparison to dibenamine and SZL-49 (4-amino-6,7-dimethoxy-2-quinazolinyl-4-(2-bicyclo[2,2,2]octa-2,5-dienylcarbonyl-2-piperazine), an alkylating prazosin analog...

The first 200 women to be fitted with GyneFix at the Margaret Pyke Centre, a National Health Service contraception clinic situated in central London, have been followed up at 1 year after insertion. Removals, expulsions and accidental pregnancies in that first year are recorded. Of the cohort, 80% had a known outcome at 12 months. There was one per...

Contraception for women on enzyme-inducing drugs. To gather preliminary information on the contraceptive efficacy of the hormone-releasing intrauterine system (IUS) Mirena, when used concurrently with enzyme-inducers. Observational series. Setting/participants: Mirena users on enzyme-inducers were recruited from within the Margaret Pyke Centre and...

In the more than 40 years since the combined oral contraceptive pill was first marketed, much information has been obtained as to its risks. Considerably less publicity has been given to the balancing benefits that have also emerged. There has been an increasing realization that the risks are focused in those women with recognised risk factors, mea...

The effects of irreversible alpha1-adrenoceptor antagonists, SZL-49 (an alkylating analogue of prazosin), dibenamine and benextramine on contractions to noradrenaline (NA) in longitudinal and circular muscle of human epididymal vas deferens were investigated. Competitive alpha1-adrenoceptor antagonists were also used to further characterize the alp...

The purpose of this study was to determine whether lidocaine that is instilled onto the Fallopian tubes reduces pain scores in awake patients who undergo laparoscopic sterilization with Filshie clips. This was a prospective, randomized, placebo-controlled, double-blinded, clinical trial study that was approved by our institutional review board. Pai...

To present efficacy and cycle control data pooled from three pivotal studies of the contraceptive patch (Ortho Evra/Evra). Three multicenter, open-label, contraceptive studies that included up to 13 treatment cycles.Setting: 183 centers. 3,319 women.Intervention(s): Three consecutive 7-day patches (21 days) with 1 patch-free week per cycle. Contrac...

Recent advances in contraceptive pharmacology and immunology have revolutionised treatment options and improved safety/compliance problems with existing methods. This article outlines advances in oral, intra-uterine, depot, emergency and other methods of contraception-combined with practical advice on prescribing and avoidance of adverse effects.

Objective: To determine the contraceptive efficacy of a transdermal contraceptive which delivers norelgestromin 150 mg daily and ethinyl estradiol 20 mg daily to systemic circulation. Design: A total of 3319 healthy nonpregnant women aged 18-45 years were treated for 6 or 13 cycles with the transdermal contraceptive in 3 multicenter open-label tria...

This study aimed to identify specific haemostatic changes that might account for previous observations of higher venous thromboembolic risk among users of combined oral contraceptives (COCs) containing desogestrel (DSG) than levonorgestrel (LNG). Sixty-three current users of monophasic 30 microg oestrogen COCs containing either LNG or DSG omitted o...

Research and development has led to an increasingly wide choice of contraceptive methods in developed countries. However according to the revised version of the WHO document on medical eligibility criteria for contraceptive use over 350 million couples worldwide do not have access to this full range. Even where contraceptives are supplied there are...

It gives me enormous pleasure to speak on this important and happy occasion. Martin and I "go back a long way". We first met in the postnatal ward of the old Nuffield Maternity Home here where I was an SHO and Anne had just delivered Alice (who is in the audience today). Professionally there has been an obvious and continuing association in the fie...

Objective To investigate the effects of stopping smoking on cervical Langerhans’ cells and lymphocytes.Design Prospective intervention study.Setting A large family planning clinic in central London.Population Women volunteers prepared to attempt to give up smoking for six months. Their most recent cervical smear showed no abnormality greater than m...

The supremacy of combined oral contraceptives (OCs) is being challenged. For too long combined OCs have been seen as synonymous with contraception, helping to maintain ignorance of alternative methods. Further, the efficacy of these OCs and condoms is often compromised by incorrect or inconsistent use. We particularly welcome developments in male s...

World population reaches 6 billion on 12 October, according to the best guess of demographers. It has tripled in a single lifetime, is projected to increase by half as much again next century, and, if current declines in fertility falter, could yet double. We have heard such statistics before, to the point of population crisis fatigue Yet we are li...

EDITOR--Chang et al report that the odds ratios for ischaemic stroke in young women with classical migraine (with aura) and simple migraine (without aura) were similar.1 These findings are at odds with earlier studies, which reported increased risk primarily in migraine with aura.2 We note that the 95% confidence interval for ischaemic stroke in mi...

The alpha1-adrenoceptor subtype(s) mediating contraction to noradrenaline in longitudinal and circular muscle of human epididymal vas deferens was studied using competitive antagonists. The effects of the alkylating agents, phenoxybenzamine and chloroethylclonidine were also investigated. Noradrenaline evoked concentration-dependent contractions of...

The World Health Organization (WHO) multicenter, randomized trial reported in this issue of "The Lancet" confirms that levonorgestrel-only (two 750-mcg doses) is significantly more effective in preventing pregnancy after unprotected intercourse than the standard Yuzpe regimen (two doses of 500 mcg levonorgestrel and 100 mcg ethinyl estradiol) and i...

The incidence of ischaemic stroke is low in women of reproductive age but increased in women with migraine, particularly if they also take combined oral contraceptives (COCs). Since there is limited evidence that this risk may be further focused on some groups of women with migraine, this paper presents current recommendations for COC use by a conf...

The incidence of ischaemic stroke is low in women of reproductive age but increased in women with migraine, particularly if they also take combined oral contraceptives (COCs). Since there is limited evidence that this risk may be further focused on some groups of women with migraine, this paper presents current recommendations for COC use by a conf...

Editor—The levonorgestrel intrauterine system (Mirena), a useful addition to contraceptive choice, is now approaching its third anniversary. In the United Kingdom the product licence for the levonorgestrel intrauterine system permits its use for three years. In all other countries where the system is marketed, however, its use is approved for fiv...

The levonorgestrel-releasing intrauterine system (LNG-IUS), has been developed by Leiras Pharmaceuticals, Turku, Finland. It is a new systemic hormonal contraceptive that releases levonorgestrel 20 micrograms every 24 hours. The device provides fertility control comparable with that of female sterilisation, complete reversibility and convenience, a...

Ethinyl estradiol is recognized as the prime prothrombotic constituent of contraceptive pills. Referring to his editorial which commented upon the letter from the Committee on Safety of Medicines and three studies the author stresses that women who have taken oral contraceptives for several years without experiencing a thrombotic event are unlikely...

Despite more than 30 years' experience with the pill, being by far the most thoroughly studied drug ever, we must conclude that there still is a remarkable paucity of data that would allow us to assess unambiguously its margins of efficacy. The physiological studies on which we must rely encompass limited numbers of subjects and are unlikely to inc...

To evaluate blood pressure changes in the pill-free interval and from baseline among women taking four different low-dose monophasic oral contraceptives. 131 women were randomized to four different oral contraceptives. Pressures were obtained at baseline, at the end of treatment cycles and at the end of the 7 pill-free days, during 6 months of trea...

This is the first report of vaginal erythematous areas associated with the use of a levonorgestrel-releasing contraceptive ring. Of 139 female subjects, 48 developed lesions of varying size and degrees of redness. Sixteen of these have undergone serial colposcopy and thirteen have also had biopsy examinations, which revealed acetowhite areas and, h...

An account is given of an observation of mass laparoscopic sterilizations done by Dr. P. Mehta, an Indian surgeon who claims to have performed 250,000 female sterilizations in less than 10 years. His record is 156 procedures in just under 2 hours. This observation and videotaping session took place in a rural setting, with the women lined up on ben...