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Drugs – What’s in a name?

6 Dec, 12 | by shellraine, e-Media Editor

Branded, generics or branded generics? Do you know the difference?

When a branded, or proprietary, drug comes ‘off patent’ it is common for other companies to apply for marketing authorisation and we are, increasingly, seeing this in sexual health. This can be for generic versions or for branded generics. Branded generics are simply generic equivalent drugs with a brand name given by the particular company. When a pharmacist dispenses a proprietary drug or branded generic they are obliged to dispense the named product, if a pure generic is prescribed they can give any product containing the generic compound/s but this is reimbursed at the current generic rate.

To give an example in contraception Microgynon 30 & Ovranette are proprietary brands and Levest & Rigevidon are branded generic equivalents.

MeReC bulletin summarises:

  • Generic medicines are, overall, much less expensive to the NHS. Their appropriate use instead of branded medicines delivers considerable cost savings. In England about 5% of medicines are still prescribed by their brand name when generic equivalents are available.
  • List prices for some ‘branded generics’ may be lower than the reimbursement price for equivalent generics. However, any cost savings achieved by their use may be unsustainable by the manufacturer and may not necessarily be cheaper, or in the best interests of the NHS overall.

This may be because many companies marketing branded generics negotiate a fixed price for a fixed period for their products with pharmacies or clinics which are lower than, even, generic alternatives – however generic drug prices are subject to fluctuation due to market forces and may fall over time meaning this would no longer be the case.

The MeReC bulletin also signposts the UK Medicines Information (UKMi) Q & A document “Which medicines are not suitable for generic prescribing in primary care?” This lists medicines that may be considered suitable to prescribe by specific manufacturer’s product (branded or generic). These include:

multiple ingredient products
– ensuring adherence to long-term medications, where differences in appearance between manufacturer’s products might cause confusion and anxiety

In contraception, over the years, we have probably not noticed when this has happened and the first of the reasons above, as well as the fact that there were not many generic versions available, may explain this. The second may be more pertinent in the future.

There are a number of reasons why these issues are currently topical in sexual health:

  • cost saving – not only perceived savings on generics vs brands but increased bulk/group purchasing to afford greater savings within Trusts
  • more companies are making and marketing branded generics than in the past
  • more medicines used in sexual health are due to come off patent now or in the next year including: sildenafil, many HIV drugs, desogestrel and mifepristone
  • increased use of paperless IT systems with built-in drug data bases, as in general practice, where generic equivalents are often highlighted
  • different ordering capabilities of independent pharmacies vs large national companies/chains

There are potentially more likely to be problems with contraceptive pills prescribed in general practice than in clinics as clinics generally see women at each visit and can explain any differences there may be in dispensed products. A woman taking an FP10 to a pharmacy (if it is prescribed generically) may be given a different product from previously without the prescriber being aware that this could occur. And this may happen even if she goes to the same pharmacy as last time. Clinicians will be aware of the issues that arise if women are given different pills and the anxiety this may cause followed by increased clinician time required for extra appointments to handle any problems. This is always assuming the woman doesn’t just stop her pills if she is unable to access help in a timely fashion. Food for thought.

 

ella-One® black triangle removed

The MHRA has removed the black triangle from ella-One®. The black triangle will be removed from all company materials over the next few months and EC providers may need to update some documentation.

Sept 26th World Contraception Day

25 Sep, 12 | by shellraine, e-Media Editor

Your Future.

Your Choice.

Your Contraception.

 

WCD 2012 focuses on empowering young people to think ahead and build contraception into their plans, in order to prevent an unplanned pregnancy or sexually transmitted infection (STI).

  • World Contraception Day (WCD) takes place on September 26 every year. This annual worldwide campaign centres around a vision for a world where every pregnancy is wanted
  • Every year, countries and regions around the world organize events to mark World Contraception Day and to demonstrate their commitment to raising awareness of contraception and improving education regarding reproductive and sexual health.
  •  Launched in 2007, WCD’s mission is to improve awareness of all contraceptive methods to enable young people around the world to make informed decisions on their sexual and reproductive health
  • One of the most effective ways for young people to prevent an unplanned pregnancy or STI is to think ahead and consider the best contraceptive option for them – before having sex
  •  An important part of planning for the future is knowing where to access accurate and unbiased information about contraception.

The WCD website, www.Your-Life.com, contains up to date information on contraception to help young people and educational material with some useful quizzes under the ‘Media Center’ tab.

WCD is supported by a coalition of 11 international NGOs, scientific and medical societies with an interest in sexual health and is sponsored by Bayer HealthCare Pharmaceuticals. The NGOs and societies involved in WCD are:

  • Asian Pacific Council on Contraception (APCOC)
  • Centro Latinamericano Salud y Mujer (CELSAM)
  • European Society of Contraception and Reproductive Health (ESC)
  • German Foundation for World Population (DSW)
  • International Federation of Pediatric and Adolescent Gynecology (FIGIJ)
  • International Planned Parenthood Federation (IPPF)
  • Marie Stopes International (MSI)
  • Population Services International
  • The Population Council
  • The United States Agency for International Development (USAID)
  • Women Deliver

The website/blog Impatient Optimists, which is supported  by the Bill & Melinda Gates Foundation, documents some of the difficulties people and countries around the world face trying to implement these aims.

http://www.londonfamilyplanningsummit.co.uk/ On 11 July 2012 the UK Government and the Bill & Melinda Gates Foundation with UNFPA and other partners hosted a groundbreaking summit that will mobilize global policy, financing, commodity, and service delivery commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries to use contraceptive information, services and supplies, without coercion or discrimination, by 2020.

http://populationmatters.org/2012/ceo-blog/world-contraception-day-26-september-2012/ details the The Population Matters Annual General Meeting and Conference 2012 which will be held on Saturday 13th October 2012 in central London. The meeting is open to members, their guests and other interested parties on request. Advance registration is required.

40 years of innovation in sexual and reproductive health

30 Aug, 12 | by shellraine, e-Media Editor

WHO – 40 years of innovation in sexual and reproductive health

A comment piece in The Lancet by past and present directors of WHO’s Human Reproduction Programme (HRP) discusses the achievements of the Programme since it was established in 1972.

Online First – Evaluation of a community pharmacy delivered oral contraception service

“Anything for the weekend … and beyond, madam?” Community pharmacies increase oral contraceptive uptake

Parsons et al.’s evaluation of a community pharmacy delivered oral contraceptive (OC) service is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Between 2009 and 2011, seven specially trained pharmacists at five pharmacies in South-East London provided OCs under a Patient Group Direction (PGD) during 741 client consultations. The evaluation showed that trained pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need. Nearly half of all consultations occurred following emergency hormonal contraception supply, and nearly half of clients receiving an initial supply of OCs were first-time Pill users. Based on satisfaction questionnaires from a small sub-group, most clients valued this service, were happy about privacy, and would recommend it. Although the primary aim was to reduce teenage pregnancy , and nearly a quarter of clients were aged <20 years, the study shows that women aged 20+ years also require this service and should not be overlooked when formulating policies for service provision.
summary by Walli Bounds, Associate editor

Infertility: Survey shows nearly half of all GPs lack knowledge

Results of a comprehensive patient survey by the National Infertility Awareness Campaign (NIAC) shows that GPs need to be better informed about infertility treatment, including IVF, and the options available when the commissioning of IVF switches to local commissioning groups next year. The NIAC survey found that nearly 50% of GPs lacked the necessary knowledge of infertility and the treatment options available to provide an effective service. This could explain why some patients with fertility issues perceived their GPs as unsympathetic.

Calling All Baby Boomers: Get Your Hepatitis C Test

A report issued by the U.S. Centers for Disease Control and Prevention (CDC) recommended that all Americans born between 1945 and 1965 be tested for the hepatitis C virus (HCV). An estimated 2.7 million to 3.9 million people in the United States are infected with this liver-damaging—and sometimes lethal—virus, and many do not know they carry it. CDC calculates that roughly 75% of those infected are baby boomers: 3.25% of people born in that “birth cohort” test positive for HCV, which is five times higher than the rate in adults born before 1945 or after 1965. CDC has determined that universal testing of baby boomers is the most cost-effective strategy for detecting undiagnosed HCV infections.  As reported in Science

New lab for HIV research

The Indian Government has opened the new $12 million HIV Vaccine Translational Research Laboratory in New Delhi. The new Laboratory will aim to recruit around 30 scientists with the goal of creating a new vaccine against HIV, and will work in collaboration with the International AIDS Vaccine Initiative.  As reported in Science

Online First – August

24 Aug, 12 | by shellraine, e-Media Editor

The following papers have been published this month at http://jfprhc.bmj.com/content/early/recent

More than poverty: disruptive events among women having abortions in the USA (Jones)

We are all aware that poverty is associated with abortion but how many of us knew that bad (or disruptive) life events also play a major role? The research by Jones et al. demonstrates that more than half of the women seeking abortion had experienced a disruptive life event in the preceding 12 months. Women are making decisions about their abortion whilst in the midst of complex life events. The authors’ suggestions for changes in policy may not be directly relevant in the UK; however, the study findings are of wider significance. from Gillian RobinsonAssociate Editor

Psycho-social factors affect semen quality (Cao)

Semen quality appears to be declining and this cross-sectional study in China casts light upon some factors that may be associated with that decline. The research team analysed the semen of 1346 healthy 20-40-year-old Chinese men, capturing their psychological, social and behaviour profiles via questionnaire. It appears that stress, social class and underwear made from man-made fibres all play a significant part in declining semen quality. from Scott WilkesAssociate Editor

Young people and chlamydia – peer led strategies to increase the uptake of screening (Horner)

The major burden of Chlamydia trachomatis infection is borne in individuals under 25 years of age. Complications of untreated infection are manifold and encompass pelvic inflammatory disease, sub-fertility, epididymo-orchitis, urethritis, arthritis, conjunctivitis and proctitis. Despite high hopes, uptake of the English National Chlamydia Screening Programme has been lower than expected. As a result, the expected decline in chlamydia prevalence has not been observed. Paddy Horner’s group have investigated the use of a peer-led approach to increase screening and examine the feasibility and acceptability of this strategy in young people. Interestingly, although this is a relatively small proof of principle study, women peer-led screening was more successful than male in recruiting peers to participate in the programme. from Rachael JonesAssociate Editor

Inequity in family planning provision in urban Nigeria: a providers’ perspective (Herbert)

In Nigeria contraceptive use is low: used by only 10% of married women and with 20% of women estimated to have an unmet need. Provision needs to improve, and understanding the roles and perspective of the mixed economy of contraceptive providers is a key step in designing better services. A qualitative study from the Nigerian Urban Reproductive Health Initiative explores the experiences and challenges faced by a range of providers in two urban Nigerian areas. Using structured in-depth interviews and checklists, researchers identified need for further training and support for all providers to empower them to provide a wider range of contraception. Few providers engaged in meaningful promotional activities for their products or services. Vulnerable groups, likely to have high needs for contraceptive advice and provision, were routinely excluded from family planning services: adolescents, married women and those seeking post-abortion care. Understanding the underlying reasons for this inequitable provision, and developing appropriate marketing strategies and materials will indeed be key to developing more sensitive service provision. from Imogen Stephens,  Associate Editor

New female condom, the ‘Woman’s Condom’ – will the Chinese go for it? (Coffey)

The need for products that simultaneously protect against unwanted pregnancy and STIs, including HIV, has prompted interest in the development of Multipurpose Prevention Technologies (MPTs), including new variants of the female condom. In this issue, Coffey and colleagues describe their survey of initial reactions to the ‘Woman’s Condom’ (which obtained marketing approval in China in 2010) by potential user groups in Shanghai. Their study demonstrates the importance of assessing the potential acceptability of new products in a range of populations, with differing expectations, needs and culture-specific influences. Their findings are of particular value to programme/service providers, in order to identify most likely adopters of this new type of female condom. from Walli BoundsAssociate Editor

The Journal – July Issue

27 Jul, 12 | by shellraine, e-Media Editor

Highlights from this issue include:

Norethisterone and VTE risk

Diana Mansour’s article previewed at online first and in the 15th June blog. See page 148

Helping women with hirsutism

Editor’s Choice article – Stephen Franks provides useful guidance for helping women with this common and often distressing condition. See page 182

US administration’s attitude to family planning

The winner of the 2010 Margaret Jackson Prize Essay for undergraduate medical students has looked at the differences between the Bush and Obama administrations’ attitudes to family planning and abortion. See page 187

Avoiding a shocking experience with intrauterine contraceptive procedures.

Aisling Baird et al. make a compelling case for adherence to the current Faculty and UK Resuscitation Council guidelines. The last time this issue was raised, in the January 2011 edition of the journal, a flood of letters followed. See page 191

Nurse Training in the UK

Shelley Mehigan & Janice Burnett describe and discuss the Berkshire training programme for nurses which mimics the DFSRH. See page 194

The SDM: a realistic option for longer-term use

A report on the experience of nearly 500 women who used the Standard Days Method for between 2 and 3 years. See page 150

CycleBeads: the latest in ‘contraceptive jewellery’!

Describes CycleBeads®, a colour-coded string of beads, that are a visual tool that helps women use the SDM correctly. See page 157

Ovarian and cervical cancer: better awareness, earlier recognition, improved outcome?

Simon and colleagues developed and validated reliable disease-specific Cancer Awareness Measurement tools for both forms of cancer, testing them in matched comparison groups. See page 167

Encouraging IUD uptake after medical TOP

Sharon Cameron and colleagues in Edinburgh created a fast-track referral service so that women who had undergone early medical abortion & wished to use intrauterine contraception afterwards could be seen promptly for fitting. See page 175

Psychosexual therapists speak out

Psychosexual therapy can seem like one of the dark arts, but in this issue Consumer Correspondent Susan Quilliam brings us the therapists’ own stories. See page 196

 

APPG Inquiry reveals shocking findings ahead of World Summit

11 Jul, 12 | by shellraine, e-Media Editor

Yesterday saw the release of the report by the All Party Parliamentary Group on SRH in the UK following an investigation into restrictions to access of contraceptive services in the UK. Their report: ‘ Healthy Women Healthy Lives’ shows evidence of women being actively restricted from services and methods, with the over 25s bearing the brunt.

The Inquiry also expressed grave concerns about the fragmentation of NHS contraceptive services which, they concluded, are lacking in the effective strategic forward planning needed for when local authorities take ownership in 2013. “Many of the restrictions we found during the Inquiry shocked us,” said Baroness Gould of Potternewton, Chair of the APPG.

Evidence was submitted from service users, sexual health clinicians, sexual health charities, a GP and the Shadow Public Health Minister. Following its Inquiry, the APPG has asked the Government to consider its report and publish a response.

In gathering evidence, the Inquiry uncovered restrictions imposed by primary care trusts on contraceptive services. These include:

  • Stopping the over 25s from using community contraception clinics.
  • Making referrals for long-acting reversible methods of contraception (LARCs) ‘GP only’ (so women cannot self-refer as is currently common practice).
  • Running contraceptive services on a residents-only basis.
  • Only allowing the over 25s to get oral contraception (i.e. the pill) from a GP (not a clinic).

Several areas such as Harringey, Walthamstow, Bristol and Derbyshire were singled out in the report for placing restrictions on services.

Full report at fpa.org

The report’s findings should be particularly embarrassing for the UK in light of efforts to address the appalling situation worldwide for women as

Today sees the 2012 Global summit on Family Planning

organised by the UK Govenment Dept for International Development with the Gates Foundation the aim of this groundbreaking effort is to make affordable, lifesaving contraceptives, information, services, and supplies available to an additional 120 million women and girls in the world’s poorest countries by 2020.

The summit’s vision is to ensure women in developing countries can have the same freedom to access family planning services – without coercion, discrimination and violence – as women in the developed world.

Governments, civil society and communities will be called on to tackle the many barriers which prevent women and girls using family planning, such as a lack of contraceptives, lack of money and lack of support from their husbands.  More

 

SRH News from American Journals

1 Jun, 12 | by shellraine, e-Media Editor

Effectiveness of Long-Acting Reversible Contraception

From the New England Journal of Medicine: A large (7486 paticipants) prospective cohort study, by researchers at Washington University School of Medicine in St. Louis, to evaluate contraceptive methods has found dramatic differences in their effectiveness. Women who used pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than those who used longer-acting forms such as an intrauterine device (IUD) or implant.

And from the American Journal of Obstetrics & Gynecology

Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?

The purpose of this study in Colorado was to determine contraceptive continuation and repeat pregnancy rates in adolescents who are offered immediate postpartum etonogestrel implant insertion and showed excellent continuation 1 year after delivery; rapid repeat pregnancy was significantly decreased compared with control participants.

Predictors of long-acting reversible contraception use among unmarried young adults

The objective of the study from South Carolina was to improve the understanding of long-acting reversible contraception (LARC) use patterns among unmarried, young adults at risk of unintended pregnancy. LARC use was associated with older age, high IUD knowledge, and earlier onset of sexual activity and concluded that increasing knowledge of IUD among certain groups may improve LARC use among young, unmarried adults and in turn decrease unintended pregnancy.

Knowledge of contraceptive effectiveness

Another study from St Louis, Missouri looking at 4144 women’s knowledge of contraceptive effectiveness and, not surprisingly, showed many gaps.

Unintended pregnancy and contraception among active-duty servicewomen and veterans

The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.

Antenatal sexually transmitted infection screening in private and indigent clinics in a community hospital system

The study aimed to determine whether clinics that serve indigent patients demonstrate equal compliance with sexually transmitted infection testing guidelines when compared with private clinics in North Carolina. They concluded that clinics serving indigent patient populations had a higher compliance with required testing compared to private clinics. HIV testing in the third trimester remains the greatest need for improvement for all practice types.

Another flawed database analysis of VTE risk and hormonal contraceptives

15 May, 12 | by shellraine, e-Media Editor

Lidegaard O, Nielson LH, Skovlund CW, Lokkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ 2012;344:e2990 doi: 10.1136/bmj.e2990 (Published 10 May 2012)

This is basically a companion paper to the one published last year in the BMJ, which concentrated on the Pill and was comprehensively criticised in the January issue of the Journal (Dinger & Shapiro 2012), to which readers are referred, as well as to the Rapid Responses posted on the BMJ website. This analysis, also from the Danish registry looks at the EVRA patch NuvaRing, Implanon and the levonorgestrel-releasing intra-uterine system (Mirena IUS). All the previous issues of confounding, lack of information regarding smoking, BMI, and family history, and not comparing like with like apply here.

It is important to compare new users with new users, as a well-established fact is that the risk of VTE is highest in the first 6 months of use of oestrogen-containing contraceptives. It is therefore important to look at the launch dates of contraceptive products. NuvaRing was launched in Denmark in late 2001 / early 2002, while the EVRA patch was launched there in September 2003. Meanwhile combined pills containing levonorgestrel have been in use since the 1970s, and those containing norgestimate since the mid 1980s. Thus, since the study period began in 2001, all users of NuvaRing and EVRA must have been new users, and so also more likely to be first time users / women with risk factors. Meanwhile, the users of the comparator COCs were more likely to be long term users and therefore at lower risk, since the high risk women in those groups will have been weeded out within the first 6 months of use – before the study began (ie attrition of susceptibles). The effect of duration of use is most clearly seen with NuvaRing in Table 4, where compared with non-users of hormonal contraceptives,  the relative risk becomes appreciably lower with increasing duration of use, declining from 8.36 for <1 year of use to 3.83 for use of 1 to 4 years. In addition, the numbers in each duration category are small, leading to random variability.  For the patch (6 exposed women) and the implant (5 women) not even the overall numbers are adequate.

With regard to the two progestogen only methods under study, not surprisingly neither was associated with a significantly increased risk of VTE – progestogen only methods have not been implicated in VTE risk, since this is related to oestrogen (Reid et al, 2010). Indeed, progestogen only methods are advised for women with risk factors for VTE (Blanco-Molina et al 2012). However, in the abstract, the authors misleadingly state that ‘the relative risk was increased in women who used subcutaneous implants’ and yet their relative risk of 1.4 had confidence intervals of 0.6 – 3.4, ie not even approaching statistical significance.  For the IUS, not only was the relative risk not increased, it was significantly decreased at 0.6 (95% CI 0.4 – 0.8). This has no biological plausibility and simply highlights the lack of credibility of the analysis.

Anne Szarewski, Editor-in-Chief, J Fam Plann Reprod Health Care

Diana Mansour, Consultant in Community Gynaecology and Reproductive Health Care, Head of Sexual Health Services, Newcastle Upon Tyne,

References

Dinger JC, Shapiro S. Combined oral contraceptives, venous thromboembolism, and the problem of interpreting large but incomplete datasets  J Fam Plann Reprod Health Care 2012;38:2–6. doi:10.1136/jfprhc-2011-100260

Reid RL, Westhoff C, Mansour D, de Vries C, Verhaeghe J, Boschitsch E,et al.   Oral Contraceptives and Venous Thromboembolism: Consensus Opinion from an International Workshop held in Berlin, Germany in December 2009  J Fam Plann Reprod Health Care 2010; 36(3): 117–122

Blanco-Molina MA, Lozano M, Cano A, Cristobal I, Pallardo LP, Lete I. Progestin-only contraception and venous thromboembolism Thrombosis Research 129 (2012) e257–e262

News items from April

4 May, 12 | by shellraine, e-Media Editor

Better access to birth control would reduce stress on global resources

as reported by Nigel Hawkes in the BMJ. The rich should consume less and the poor should procreate less, says the Royal Society in a new report. The report was produced by a working party chaired by John Sulston, who headed the UK part of the Human Genome Project, and took 21 months to research and write.

Morning after pill courier service launched

A new service allows women (living in London) to order emergency contraception on the internet, so it arrives within two hours, rather than having to see their GP to obtain the drugs. For £20, women can order the drug by filling out an online form through the internet medical practice DrEd.com. The forms, which ask users to confirm they are aged over 18, will be assessed by doctors before pills are dispatched by courier. Currently they only offer Levonelle®, which can also be purchased in advance and by buying 2 packets for £24.00 at a saving of 37%.

Pharmacists should provide oral contraceptive services, says NHS report

As reported by Jacqui Wise in the BMJ:
“A report from NHS South East London has recommended that trained community pharmacists provide oral contraceptive consultation services after a successful pilot scheme to widen access to contraception.  The part of the report that has received the most media coverage is a recommendation to “consider providing the service to women under 16 years where appropriate.” The report said that this may help reduce numbers of teenage pregnancies.”

Brook and fpa respond to proposal to introduce contraceptive pill in pharmacies

Responding to the proposal that the contraceptive pill should be available from pharmacies without a prescription to young people, including those under 16, the chief executives of Brook and FPA, Simon Blake and Julie Bentley said: “The majority of young people under 16 are not having sex, however we must ensure that those who are can access support and services when they need to. “Although Brook and FPA welcome proposals which could increase young people’s access to sexual health services and information, all the necessary safeguards must be in place to ensure young people can get the information and support they need. “This includes pharmacists having the appropriate clinical knowledge about contraception, being able to communicate effectively with young people, having the right type of environment including a confidential space, as well as the appropriate support and referral networks.”

Egg-Sharing in Fertility Treatment

Evaluating egg-sharing: new findings on old debates – as reported in BioNews
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs. As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences. Until recently, there has been very little empirical data to inform these discussions. However, new research conducted by Gurtin and Golombok at the University of Cambridge Centre for Family Research, in collaboration with the London Women’s Clinic, hopes to redress this balance.

Men’s health expert presents to Members of European Parliament

A leading men’s health expert presented a report detailing the health challenges facing men across Europe MEPs and key European decision-makers at the European Parliament in Brussels.

Professor Alan White, Director of the Centre for Men’s Health at Leeds Metropolitan University was commissioned by the European Commission to produce a report which gives the first complete picture of the breadth of issues affecting men’s health across Europe.  Professor White brought together 36 leading researchers from 34 countries across Europe to undertake the research which highlights the state of men’s health in Europe as a serious public health concern. more info

Faculty Consultations

The CEU Guideline on “Barrier Methods-Contraception and STI prevention” is for consultation until 21st May. see FSRH website:

BASHH Mentoring Group is currently seeking new members:

BASHH would like new representatives to support coordination of mentors and mentees within North West regions and Wales. The successful candidates would also be involved in the activities that the Mentoring Group is currently taking forward nationally. Closing date for applications: 16th May 2012.  see BASHH website for more details

And finally – we hear reports that Virgin Care have obtained ‘preferred bidder’ status in the tender to run West Sussex sexual health services .

Journal highlights – April issue

30 Mar, 12 | by shellraine, e-Media Editor

This quarter’s Journal includes the following:

Redefinition of women’s health care

Last year the Royal College of Obstetricians and Gynaecologists published ‘High Quality Women’s Health Care: a Proposal for Change’ that proposed a radical change to the structure of UK women’s health services. Andrew Horne and Johannes Bitzer discuss this exciting document from both a UK and a European perspective, commenting on its implications for sexual health provision. See page 68

Multidrug-resistant gonorrhoea

Gonorrhoea infection is increasing in the UK with a 3% increase in cases between 2009 and 2010. Last year there was a report of a ceftriaxone-resistant isolate; there is a growing concern that gonorrhoea may become incurable. The commentary by Taylor and Bignell is timely. It reviews the current position and provides clear guidelines on screening and treatment, which may prove challenging for some community services that rely exclusively on the use of nucleic acid amplification tests. See page 70

At last, a COC licensed for use in a flexible extended regimen

Data are presented from Phase III studies of a 20 µg ethinylestradiol/3 mg drospirenone combined pill, designed to be used in a flexible regimen. The studies evaluated the efficacy of the regimen, bleeding patterns, safety (ie, metabolic and endometrial parameters) and effect on dysmenorrhoea. Comparisons were with a fixed extended regimen and the conventional 24-day regimen. Results show good efficacy, tolerability and safety with the flexible regimen, and a significant reduction in both bleeding and dysmenorrhoea. See pages 73, 84, 94

Does hormone replacement therapy cause breast cancer? Part 4. The Million Women Study

Shapiro et al. continue their review of breast cancer and hormone replacement therapy papers, this time focusing on the Million Women Study. They conclude that despite its massive size, this study did not satisfy causal criteria. The online version of this paper has already been the focus of a great deal of media publicity and both a news piece and an editorial in the BMJ. Readers should also look at the Letters section for related correspondence that the Journal has received as a result. See page 102

A new aid to diagnosis

Ultrasound imaging has been of value to our specialty for over two decades and skills and equipment have steadily become more available within sexual and reproductive health clinics. In their article on hysterosonography using a local anaesthetic gel, Pillai and Shefras present their experience with a simple and effective new technique that takes imaging a step further, allowing clear diagnosis of intrauterine abnormalities, particularly causes of abnormal bleeding or failed intrauterine device/system (IUD/IUS) insertion, as well as aiding location and easier retrieval of IUDs with missing threads. Many readers will be familiar with the use of lidocaine gel to aid IUD insertion: not surprisingly, uterine instrumentation in conjunction with scanning was reported to be less painful with this technique. This is a promising approach to simplifying and improving the cost-effectiveness of care for women presenting with some complex contraception problems. See page 110

Abortion legislation in a changed world

In his latest Legal Opinion article, Sam Rowlands reviews legislation governing early medical abortion (EMA) and the licensing of EMA drugs in the UK and in other jurisdictions. He then looks at the ways in which such legislation has been used – or in some cases circumvented. EMA has helped to fulfil the crucial need for safe abortion worldwide, but in the author’s view the laws governing abortion in most countries are out of step with scientific advances. Readers may find the author’s conclusions and suggestions for future changes to our own abortion laws thought-provoking. See page 117

Role of doulas in abortion care

Doulas, or lay support persons, have had a longstanding role in supporting women in labour. Chor et al. argue that their role should be extended to caring for women having abortions, where they can help women relax and provide information. They suggest that engagement of the medical community will be instrumental in successfully expanding the role of abortion doula programmes within abortion provision. See page 123

Abortion in the classical world

Lesley Smith continues her series on the history of contraception and reproductive health with a look at attitudes to and practices of abortion in ancient times. It appears that even then, abortion was at the heart of much medical ethical debate. See page 125

Status of health professionals in the 21st century

Has the status of health professionals in society today fallen? If so, why? And is it a good or a bad thing? The Journal’s Consumer Correspondent, Susan Quilliam, explores the issue in her latest article. See page 127

Twenty-five years on: HIV remains a concern

In his latest ‘Then and Now’ article, Lindsay Edouard looks at topics covered by this Journal in 1987. New approaches to contraception were emerging. But was there a threat to community family planning services and would litigation faced by USA manufacturers restrict contraceptive choice? However, the major concern was the emergence of HIV/AIDS, with reinforcement of the advice that barriers should be used in addition to hormonal methods. In 2012, in the light of controversial research suggesting a possible association between hormonal contraception and increased HIV risk in some settings, Edouard draws our attention to the WHO very recent guidance regarding dual protection: 25 years on, advice has not changed. See page 131

Plus – Online Poll

Will the recent article on hormone replacement therapy and breast cancer alter your prescribing practice with regard to HRT?

Faculty News

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Latest from JFPRHC