The latest edition of the American Journal of Obstetrics and Gynecology includes a supplement entitled: A Hormonal Contraception Update: A Decade of Innovation & Transformation.

In addition AJOG published (online 11th July 2011) a study on the impact of long-acting reversible contraception on return for repeat abortion by Rose S B and Lawton B A. The objective of the study was to determine the rate of return for repeat abortion in relation to postabortion contraceptive method choice 24 months onward from an intervention study.  Its conclusion states: “This study provides strong support for the promotion of immediate postabortion access to LARC methods (particularly intrauterine devices) to prevent repeat abortion.”

September saw the European Society of Contraception (ESC) hold its 11^th Seminar in Kaunas, Lithuania. One of the most notable features was the number of participants for a regional symposium  – 533, with the majority being from Poland and Latvia. A number of our colleagues from the UK were involved in either presentations or workshops: Dr Sarah Randall, Dr Anne Webb and Dr Simone Reuter. In addition there was a Board of Directors’ meeting which involved the 2 UK representatives, Dr Meera Kishen and Shelley Mehigan.

Kaunas itself was fascinating for its combination of old and new: elements left over from its communist-dominated past with many crumbling, abandoned buildings and its, especially young, people who are trying to adapt to a new world with western influences. This was particularly evident in the apparent twin obsessions of pizza and eating outside – as well as this may work if the pizzas are made in the Italian way and the cafes are in the Mediterranean it suffers a little in translation to a chilly Baltic state with locally made fare.  This was partly corrected by an apparent benefit to the local blanket industry!

The next full Congress will be in Athens in June 2012.

Meanwhile at home:

Have you completed elements of the new DFSRH: e-SRH; Course of 5; Clinical Exerience and Assessment; e-Portfolio or the LoC SDI or IUT? The Faculty would like to hear from you. They have commissioned an independent review by Professor Ed Piele of the University of Warwick. Visit the Faculty website to give your feedback on your experiences.

UK Agony Aunts bed-in to make sexual health a priority -

What would be the correct, collective noun for a group of agony aunts?

Well in this case it could be a ‘bedful’ or maybe a ‘boudoir’ as 8 of the UKs finest gather to add their support to a group of sexual health charities – Brook, FPA (Family Planning Association), Terrence Higgins Trust, and MedFASH – calling on the government to protect sexual health services as many have seen reduced funding lead to cuts in vital services. This at a time when:
i) a survey by Brook confirms that only 6% of children learn the facts of life from their parents – the internet, TV and friends being the usual source of information (sometimes misinformation) and
ii) the House of Lords HIV and Aids Select Committee report last month found efforts to control the spread of HIV are woefully inadequate as £2.9m is spent on prevention compared with £762m on treatment.

Fiction Book Reviews

Have you enjoyed reading the fiction book reviews in the Journal? Did you agree with the reviews this time of The Room by Emma Donaghue and The Hand That First Held Mine by Maggie O’Farrell? The book for January 2012 will be Pain of Death by Adam Creed (Faber & Faber).

The newly published Journal includes a number of articles related to abortion: a book review; a commentary on medical abortion in Ethiopia – for which there is also a podcast; an Israeli view of the status of a foetus; HIV testing in clinics and repeat attendance in Britain.

In addition there is a profile of FIAPAC, the international organisation for abortion providers who have their next biennial Congress in Edinburgh in October 2012.

In Letters to the Editor there is continuing correspondence discussing the emotive subject of the use of cervical analgesia for IUD/IUS fitting which seems to have polarised opinion more than any other issue for some time.

The printed journal was accompanied by the most recently published Faculty Guidance on Emergency Contraception (2011), available electronically from: http://www.fsrh.org/pdfs/CEUguidanceEmergencyContraception11.pdf. This updates the previous guidance from 2006, includes the new oral preparation, ulipristal acetate, a progesterone receptor modulator licensed for use up to 5 days after unprotected sex and refers to the guidance for Quick Starting Contraception (2010) which details how to ‘quick start’ after use of emergency contraception.

This Guidance follows neatly on from the CEU Statement on Missed Pill Recommendations (May 2011), which accompanied the last edition of the Journal which also included a commentary by Dr Diana Mansour; Revision of the ‘missed pill’ rules, which details the background to the changes.  The statement was published after the MHRA asked the Faculty Clinical Effectiveness Unit to review its previous guidance (2005), with a view to producing harmonised guidance. This the CEU subsequently did and the new guidance has been endorsed and adopted by the MHRA, fpa and BNF although unfortunately not by the pharmaceutical industry.

BNF 62 includes the amended instructions for starting and switching combined hormonal contraception to take into account the above recommendations.  Continuing the initiative of working closely with the Clinical Effectiveness Committee the BNF section on Contraception (7.3) is up to date and in line with FSRH guidance. This makes it an accurate resource particularly for GPs and Practice Nurses who use it more than any other group of clinicians.

CD ROMs

The latest Faculty Presidents Newsletter, which also accompanied the print journal, highlights the need for all services and clinicians to dispose of and not use any of the old training CD ROMs for IUDs, implants and EC. Trainees should only use the up-to-date training modules from the e-learning website: www.e-lfh.org.uk.

My aim is to bring you news, views and information in the field of contraception and sexual health – some of which you may have seen and some not. I hope that as well as highlighting articles and issues from our journal this will signpost current issues and initiatives from the UK and around the world.

It has been an eventful year in contraception with a number of changes for clinical practice and over the coming weeks I will revisit the most important of these.

A round-up of some recent news items includes:

Mary Robinson calls for more funds for Family Planning.

As world leaders collected at the UN in New York last week Mary Robinson, the first woman president of Ireland (1990-1997), UN High Commissioner for Human Rights from 1997-2002, and chairwoman of the Global Leaders Council for Reproductive Health called for them to make good on their promise of 17 years ago at the UN International Conference on Population and Development in Cairo, when they agreed to make contraceptive services available for women all over the world by 2015. http://www.newsday.com/opinion/oped/robinson-more-funds-for-family-planning-1.3187083

WHO Medical Eligibility Criteria for Contraceptive Use 4^th ed wins first prize in the BMA Book Awards (O&G category).

The WHO MEC are the basis from which the UK MEC were developed and underpin clinical practice in contraception and sexual health. The most recent version of the UKMEC was published 2009:http://www.fsrh.org/pdfs/UKMEC2009.pdf

Medscape Education Clinical Briefs report a pooled analysis of 2 studies which seem to demonstrate that Intrauterine Devices Lower Cervical Cancer Risk. This involved 10 case-control studies done in 8 countries, and 16 studies of HPV prevalence from 16 countries looking at risks for cancer of the cervix and HPV in IUD users. http://www.medscape.org/viewarticle/749724?src=cmemp

In Rwanda, Africa’s most densely populated country, men are being encouraged to have vasectomies. The no-scalpel procedure is being offered for free according to a report in the Independent Newspaper on 7^th September.

Unapproved emergency birth control medicine in U.S. may be ineffective and unsafe. In July the FDA issued a warning to consumers not to buy a product named Evital as they may have been counterfeit. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm265847.htm

I welcome comments from readers and will publish those that I feel will be helpful to others.