Sharon Cameron

• MB ChB MD FFSRH FRCOG
• Professor (Hon) at University of Edinburgh

( N Engl J Med . 2024;391:1685–1695. doi:10.1056/NEJMoa2401646) The research examines how safe and effective medication abortion (MA) (using mifepristone and misoprostol) is at very early stages of pregnancy before confirming an intrauterine pregnancy with ultrasound. Although MA is a commonly accepted and successful option for abortion, there is n...

IntroductionMedical abortion is known to be painful, with pain impacting acceptability and satisfaction for patients. Recommendations to use Non-Steroidal Anti-inflammatory Drugs (NSAIDs) to manage pain are based upon studies using higher than routinely prescribed single doses of ibuprofen (800mg-1600mg).Methods We conducted a two-phase quality imp...

Background: Pregnancy within a year of childbirth has negative impacts on women and their children’s health. We developed a digital health intervention (DHI) to empower women in contraceptive choices postpartum. Our pilot randomised controlled trial (RCT) aimed to establish the feasibility of a main RCT of the effects of the DHI compared with stand...

Background The postpartum period is a high-risk time for unintended pregnancy. We developed a 2-minute audiovisual animation on postpartum contraception (PPC) including the return of fertility after birth for patients. The aim of our study was to determine the views of healthcare professionals (HCPs) involved in pregnancy care on the animation and...

In women seeking medication abortion before intrauterine pregnancy was confirmed , an early start to the abortion was non-inferior to delayed, standard care with respect to complete abortion

Objectives To gather views of healthcare professionals on the regulation and provision of abortion in Britain. Methods Cross-sectional, stratified cluster sample survey of healthcare professionals working in a range of healthcare services including abortion services. Measures included knowledge of and attitudes towards the regulation and provision...

Background Most abortions in Scotland are conducted at home before 12 weeks’ gestation using telemedicine. The volume of information given at a pre-abortion consultation may feel overwhelming and contraception may not be prioritised. Telemedicine limits immediate provision of some methods. Pathways to improve access to post-abortion contraception (...

Background Access to post-abortion contraception (PAC) is critical for reducing unintended pregnancies and supporting reproductive decision-making. Patients often face challenges in identifying, accessing and initiating their preferred contraceptive methods post-abortion. This may be particularly so with telemedicine models of care with absence of...

Introduction: Looking after a baby and recovering from birth pose barriers to accessing and initiating effective contraception in the postpartum period. Another pregnancy at this time can end in abortion or a short interbirth interval. These are preventable if contraception is provided immediately from maternity settings. Our aim was to survey con...

Purpose of review Women are particularly vulnerable to unintended pregnancy in the 12 months following a birth. Improving access to postpartum contraception within maternity settings can prevent unintended and closely spaced births, improving the health of mother and child. This review will summarize the recent research in postpartum contraception...

Background Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. Objective Our study aimed to examine women’s satisfaction with abortion care and their suggestions for improvements. Design Q...

Objectives: Therapeutic, regulatory and technological changes have contributed to new directions in abortion care. We aimed to gather views of healthcare professionals on current and future regulation and provision of abortion in Britain. Design: Cross sectional, stratified cluster sample survey with additional free text comments. Setting: Healthca...

OBJECTIVE To assess whether menstrual cycle timing (follicular or luteal phase) of coronavirus disease 2019 (COVID-19) vaccine administration is associated with cycle length changes. METHODS We used prospectively collected (2021–2022) menstrual cycle tracking data from 19,497 reproductive-aged users of the application “Natural Cycles.” We identifi...

The purpose of sexual and reproductive healthcare should be the enhancement of personal relationships and a healthy sex life and not merely counselling and care related to procreation or sexually transmitted infections. Providing practical and evidence-based guidance, this textbook follows the curriculum of the joint EBCOG and ESCRH examination in...

The purpose of sexual and reproductive healthcare should be the enhancement of personal relationships and a healthy sex life and not merely counselling and care related to procreation or sexually transmitted infections. Providing practical and evidence-based guidance, this textbook follows the curriculum of the joint EBCOG and ESCRH examination in...

The purpose of sexual and reproductive healthcare should be the enhancement of personal relationships and a healthy sex life and not merely counselling and care related to procreation or sexually transmitted infections. Providing practical and evidence-based guidance, this textbook follows the curriculum of the joint EBCOG and ESCRH examination in...

The purpose of sexual and reproductive healthcare should be the enhancement of personal relationships and a healthy sex life and not merely counselling and care related to procreation or sexually transmitted infections. Providing practical and evidence-based guidance, this textbook follows the curriculum of the joint EBCOG and ESCRH examination in...

Objectives To compare telephone consultations with in-person consultations for the provision of medical abortion (using mifepristone 200 mg and misoprostol 800 µg). We hypothesised that telemedicine consultations would be non-inferior to in-person consultations with a non-inferiority limit of 3%. Design Randomised controlled trial with 1:1 allocat...

Introduction Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pill...

COVID-19 vaccination temporarily lengthens the menstrual cycle. However, without knowing why this happens, we are limited in our ability to fully address ongoing concerns around menstrual health and COVID-19 vaccination. We assessed whether menstrual cycle timing (follicular or luteal phase) of COVID-19 vaccine administration is driving vaccine-ass...

Objective To assess whether coronavirus disease 2019 (COVID‐19) vaccination impacts menstrual bleeding quantity. Design Retrospective cohort. Setting Five global regions. Population Vaccinated and unvaccinated individuals with regular menstrual cycles using the digital fertility‐awareness application Natural Cycles°. Methods We used prospective...

Sexual activity and fertility can resume shortly after childbirth, but there are barriers to contraceptive access in the postpartum period. Unintended pregnancy and short interpregnancy intervals (of less than one year) can increase the risk of obstetric and neonatal complications. The antenatal period presents an opportunity to discuss contracepti...

“Very early medical abortion” (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies repor...

Introduction Abortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms o...

Background: Digital health interventions (DHI) have been used to enhance the uptake of postpartum contraception and reduce unmet contraception needs. We conducted a systematic review of the effectiveness of DHI on postpartum contraceptive use and repeated pregnancy. Method: We searched MEDLINE, Embase, Global Health, CINAHL and Cochrane CENTRAL...

Objectives To identify whether covid-19 vaccines are associated with menstrual changes in order to address concerns about menstrual cycle disruptions after covid-19 vaccination. Design Global, retrospective cohort study of prospectively collected data. Setting International users of the menstrual cycle tracking application, Natural Cycles. Parti...

Objective Assess whether coronavirus disease 2019 (COVID-19) vaccination impacts menstrual bleeding quantity. Design Retrospective cohort Setting Five global regions Populations Vaccinated and unvaccinated regularly cycling individuals using the digital fertility-awareness application “Natural Cycles”. Methods We used prospectively collected menstr...

Introduction Abortion is common worldwide and increasingly abortions are performed at less than 14 weeks’ gestation using medical methods, specifically using a combination of mifepristone and misoprostol. Medical abortion is known to be a painful process, but the optimal method of pain management is unclear. We sought to identify and compare pain m...

Background Changes in legislation due to COVID-19 led to the introduction of telemedicine for early medical abortion (EMA) at home in Scotland. The opportunity to provide contraception at presentation may be more limited with this model of care. We compared contraceptive use immediately post-abortion with 3–6 months later to determine if contracept...

Background: During COVID-19, early medical abortion (EMA) at home in Scotland was largely delivered by telemedicine. Short-acting post-abortion contraception was provided with EMA medications, but long-acting reversible contraception (LARC) (implant, injectable and intrauterine device) required an in-person visit. We wished to assess LARC uptake f...

Background: Abortion is common worldwide and increasingly abortions are performed at less than 14 weeks' gestation using medical methods, specifically using a combination of mifepristone and misoprostol. Medical abortion is known to be a painful process, but the optimal method of pain management is unclear. We sought to identify and compare pain m...

Introduction National guidelines advise that clinicians caring for women post-pregnancy should give women opportunities to discuss contraception, regardless of pregnancy outcome, and provide contraception to women who choose to take up a method. This study aimed to explore knowledge, views and needs of Early Pregnancy Unit (EPU) clinicians around d...

Background: During the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both medical abortion pills, mifepristone and misoprostol, at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via telephone or video call and medications delivered to w...

Background During the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both pills for medical abortion at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via phone or video call and medications delivered to women’s homes. The approvals in En...

Objective To present process evaluation results from the Bridge-it Study, a pragmatic cluster randomised cross-over trial to improve effective contraception uptake through provision of the progestogen only pill (POP) plus sexual and reproductive health (SRH) clinic rapid-access to women presenting to community pharmacies for emergency contraception...

Contrast‐induced nephropathy (CIN) is a major complication of imaging in patients with chronic kidney disease (CKD). The publication of an academic randomized controlled trial (RCT; n = 83) reporting oral (N)‐acetylcysteine (NAC) to reduce CIN led to > 70 clinical trials, 23 systematic reviews, and 2 large RCTs showing no benefit. However, no mecha...

Unintended pregnancy is common. It is estimated that one in three pregnancies end in abortion. Management of unintended pregnancy, in the form of surgical and medical abortion, is an essential part of reproductive healthcare and fundamental for training in obstetrics and gynaecology. Comprehensive abortion care includes provision of accurate inform...

This authoritative textbook provides a much-needed guide for postgraduate trainees preparing for the European Board and College of Obstetrics and Gynaecology (EBCOG) Fellowship examination. Published in association with EBCOG, it fully addresses the competencies defined by the EBCOG curriculum and builds the clinical practice related to these compe...

Pregnancy in women with certain medical conditions can result in significant fetal and maternal morbidity and mortality. It is therefore crucial that these women are able to plan and space their pregnancies appropriately through the use of contraception. Obstetricians and gynaecologists will often encounter these women in the inpatient and outpatie...

Background Telemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs). Methods Qualitative r...

Background The mechanism of action of a contraceptive method is an importantg consideration in a woman’s choice of contraception. For the development of new methods of contraception it is important to understand the acceptability of different contraceptive mechanisms within a population. Methods We recruited women attending contraceptive, terminat...

Background The Scottish government introduced legislation during the COVID-19 outbreak to permit medical abortion at home with telemedicine. All women received an initial telephone consultation. For those choosing medical abortion, we provided self-administered medications to eligible women with pregnancies under 12 weeks’ gestation. Aims To asses...

Objective: To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks' gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID-19) pandemic, to identify areas for improvement and inform service provision. Design: Qualitative interview study. Setting: A...

Background Immediate postpartum intrauterine device (PPIUD) insertion is safe and effective but largely unavailable in Europe. Data on maternity staff views on the provision and implementation of PPIUD services are limited. The objective of this qualitative evaluation was to explore the views and experiences of obstetricians and midwives providing...

Introduction Early medical abortion (EMA) is a two-stage process of terminating pregnancy using oral mifepristone (a progesterone-receptor antagonist) followed usually 1–2 days later by sublingual, vaginal or buccal misoprostol (a prostaglandin analogue). There are no published randomised controlled trials (RCTs) on the use of telemedicine for EMA....

Introduction: Unless women start effective contraception after using emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies that are unable to provide ongoing contraception (apart from barrier methods which have high failure rates). This means that women n...

Background In response to the COVID-19 pandemic, legislation and guidance were introduced in Scotland permitting medical abortion at home by telemedicine for pregnancies at less than 12 weeks’ gestation. Women had a telephone consultation with a clinician. Routine ultrasound was not performed. Medications and a low-sensitivity pregnancy test to con...

Introduction Routine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a communi...

Introduction: The safety and acceptability of medical abortion using mifepristone and misoprostol at home at ≤9+0 weeks' gestation is well established. However, the upper gestational limit at which the procedure remains safe and acceptable at home is not known. To inform a national guideline on abortion care we conducted a systematic review to det...

Background Unless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency cont...

Objective To determine the optimal cervical priming regimen before surgical abortion between 14⁺⁰ and 24⁺⁰ weeks’ gestation. Data Sources Embase, MEDLINE and the Cochrane Library were searched for publications up to February 2020. Experts were consulted for any ongoing or missed trials. Study Eligibility Criteria Randomized controlled trials, pub...

Background Unprecedented public health actions restricting movement and non-COVID related health services are likely to have affected abortion care during the pandemic in Europe. In the absence of a common approach to ensure access to this essential health service, we sought to describe the variability of abortion policies during the outbreak in Eu...

Objectives: The aims of the study were to explore women's experiences of an immediate postpartum intrauterine contraception (PPIUC) service recently introduced in a UK maternity setting, to identify areas for improvement and inform service provision. Methods: Qualitative research was carried out in hospital and community maternity services in Lo...

OBJECTIVE To determine the optimal cervical priming regimen before surgical abortion up to and including 13⁺⁶ weeks’ gestation. DATA SOURCES Embase, MEDLINE and the Cochrane Library were searched up to February 2020. Experts were consulted for any ongoing or missed trials. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, published in Engl...

The UK has the highest rate of teenage pregnancies in Western Europe and within the UK higher rates are found amongst women with certain social risk factors, such as those who live in areas of higher deprivation. Teenage pregnancy can be a positive event for some young women. However, there are a number of adverse social outcomes associated with te...

Background Between 2017 and 2019, legislation was introduced in the UK that approved the home as a place for self-administration of misoprostol for early medical abortion. While research has shown that early medical abortion at home is as safe as in a clinical setting, women’s experiences in the UK in the light of this change have not yet been inve...

Background: Induced abortion is a common procedure. However, there is marked variation in accessibility of services across England. Accessing abortion services may be difficult, particularly for women who live in remote areas, are in the second trimester of pregnancy, have complex pre-existing conditions or have difficult social circumstances. Ob...

Introduction: There is some evidence that audiovisual formats can be an effective way of providing information about early medical abortion (EMA). A short animation (three minutes) was developed about EMA in three languages that summarised the EMA process for use in the UK, France and Sweden. Material and methods: We conducted a multicentre rand...

Background Emergency contraception (EC) was approved in the UK as a pharmacy medicine for purchase without prescription in 1991. Twenty years later we conducted a study to characterise routine practice pharmacy provision of EC. Study design Mystery shopper study of 30 pharmacies in Edinburgh, Dundee and London participating in a clinical trial of...

Introduction Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling. Methods Qualitative r...

Background Guidelines from the UK recommend that women should be able to self-refer to abortion services. In 2016, a self-referral system was introduced to the abortion service in Edinburgh, Scotland, as an option for women. Women could telephone a dedicated phone line during office hours and speak to an administrative assistant working in the abor...

Background Abortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability/satisfaction of surgical compared with medical abortion of pregnancy between 13 ⁺⁰ and 23 ⁺⁶ weeks’ gestation for a new national guideline. Methods We searched Emba...

Ovulation resumes as quickly as 21 days after birth in a non-fully breastfeeding woman. Traditionally contraceptive services have been offered 6 weeks’ post-partum. This is far from ideal and results in unnecessary abortions or inadequate birth spacing which both carry an increased risk of morbidity to mother and potential newborn as well as costs...

Background: Long-acting reversible contraceptives (LARCs) are safe, effective and convenient post-abortal methods. However, there is concern that some LARCs may reduce the effectiveness of abortifacient drugs or result in other adverse outcomes. Objective and rationale: We undertook two systematic reviews to examine the early administration of L...

Background Medical abortion with mifepristone and misoprostol usually involves an interval of 36–48 hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effecti...

Introduction: Women are increasingly presenting for abortion at very early gestation. However, providers may be reluctant to conduct abortion at this stage as they may be concerned that they cannot exclude an ectopic pregnancy or that they may terminate a non-viable pregnancy, or may be concerned that both medical and surgical methods may be less...

Background In order to develop the 2019 National Institute for Health and Care Excellence (NICE) national guideline on abortion care for the National Health Service1 we undertook a systematic review comparing anti-D prophylaxis to no prophylaxis in rhesus D (RhD)-negative women undergoing medical or surgical abortion of pregnancy at ≤13 ⁺⁶ weeks’ g...

There is evidence that obesity can impact negatively upon sexual health. More specifically, some studies have suggested that women with obesity are less likely to use effective contraception and are more likely to experience an unintended pregnancy than women of normal weight. Studies have also shown that men with obesity are more likely to suffer...

Introduction: Expanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter-pregnancy intervals, however provision across Europe is limited. Our aim was to the determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health s...

Objective: To compare the effectiveness, safety and acceptability of 1) in-clinic and remote/self-assessment and 2) different remote/self-assessments, for confirming the success of medical abortion at ≤10+0 weeks' gestation. Data sources: Ovid Embase Classic and Embase; Ovid MEDLINE(R) and Epub Ahead-of-Print, In-Process & Other Non-Indexed Cita...

In many settings, a follow‐up clinic visit two weeks after early medical abortion (EMA) is scheduled for a routine ultrasound to confirm that the pregnancy had been terminated. However, ultrasound facilities and the necessary manpower are costly and limit the settings where follow up can be provided.

Introduction Oral emergency contraception (EC) can prevent unintended pregnancy but it is important to start a regular method of contraception. Women in the UK usually access EC from a pharmacy but then need a subsequent appointment with a general practitioner or a sexual and reproductive health (SRH) service to access regular contraception. Uninte...

Objective To evaluate the acceptability of the new contraceptive champion role to the first hospital and community midwives in NHS Lothian trained in this role. Design Health service evaluation. Population Hospital and community midwives trained as contraceptive champions, NHS Lothian, Scotland, UK. Methods Qualitative research: 1:1 semi-structu...

Evidence-based guidelines on the management of pain associated with first-trimester medical abortion are lacking. Most published clinical trials have failed to report on this important aspect of the procedure. The aim of this comprehensive work was to provide clinical advice based on a comprehensive literature review, supplemented by the clinical e...

Introduction In October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic. Objective To evaluate the impact of this change on the uptake and success rate of EMA, and o...

Objective To evaluate antenatal contraceptive counselling and provision of postpartum contraception on contraceptive choices of first-time teenage mothers enrolled with a Family Nurse Partnership (FNP) programme. Design Health service research evaluation. Population Cohort of FNP clients (n=195), Scotland, UK. Methods Antenatal contraceptive cou...

Abstract Background Chlamydia trachomatis (C. trachomatis) is the most common bacterial sexually transmitted infection in the UK. Recent studies suggest that in addition to the genital tract, C. trachomatis is found in the throat and rectum, suggesting the number of infections is under-reported. There is an urgent need to study the impact of extend...

Emergency contraception (EC) is a drug or a device that is taken after sexual intercourse to prevent unintended pregnancy. The most effective EC is the copper-bearing intrauterine device (Cu-IUD), but oral EC methods are more commonly used and include a single dose of either levonorgestrel (1.5 mg) or ulipristal acetate (30 mg). Although all EC met...

Purpose: The European Society of Contraception Expert Group on Abortion identified as one of its priorities the need to disseminate up-to-date evidence-based information on the use of urine pregnancy tests by women for the self assessment of the success of early medical abortion (EMA). Methods and materials: A concise communication was produced whi...

Introduction Reduced funding to contraceptive services in the UK is resulting in restricted access for women. Pharmacists are already embedded in sexual and reproductive health (SRH) care in the UK and could provide an alternative way for women to access contraception. The aim of this study was to determine the views of UK contraception providers a...