A comparison of the expected and actual pain experienced by women during insertion of an intrauterine contraceptive device.

Objective: To compare the expected and actual pain experienced with the insertion of intrauterine contraception in women, and to determine whether either of these are related to their personal circumstances, or affected their satisfaction with the procedure. Design: A convenience sample of 89 women aged 15-50 attending a sexual health clinic for same day intrauterine contraception insertion were given a questionnaire which they completed following the procedure. The women were asked to rate their expectation of pain prior to insertion and to rate the actual pain they experienced immediately after insertion, on a scale of 1 to 10 with 10 being severe pain. Information on the women’s circumstances and their level of satisfaction with the procedure was also obtained. Results: Overall, the median actual pain experienced by women during insertion (4) was significantly lower than the expected pain median (6) (p<0.001). For those women who had not had a previous vaginal delivery, actual pain was significantly higher compared with women who had a previous vaginal delivery (median [IQR] = 6 [3.5-7.5] and 3 [1-5], p<0.001), respectively), but there was no significant difference between expected and actual pain experiences. In women who had a previous vaginal delivery, actual pain was much lower than expected (p<0.001). Neither actual nor expected pain experiences were linked to any other socio-demographic reproductive health or service use factors. Conclusion: All women had a high expectation of pain prior to IUD insertion but, for those who had a previous vaginal delivery, this was significantly greater than that actually experienced. Satisfaction levels overall were high. Counselling of women should take into account their expected pain prior to IUD insertion and consideration should be given to alternative and additional methods of pain relief in women who had not had a previous vaginal delivery

Presenting risk information in sexual and reproductive health care

OBJECTIVES: Presenting risk information to patients is an important part of clinical encounters. Good risk communication improves patient satisfaction with their care and the decisions they make. In sexual and reproductive healthcare (SRH), women frequently need to make decisions based on their perceived risk. Risk perception can be altered by how actual risk is presented to patients. METHODS: Databases were searched using MeSH terms combined with a keyword search for articles relevant to SRH; the search was limited to English language. RESULTS: Personalised risk communication where a risk score is provided, increases knowledge and slightly increases uptake of screening tests. Decision aids improve a patient's knowledge of the options, create realistic expectations of their benefits and harms, reduce difficulty with decision-making, and increase participation in the process. The most effective way to present risks uses a range of structured, tailored presentation styles; interactive formats are best. Framing the information improves patient understanding. Most people understand natural frequencies or event rates better than probability formats with varying denominators. Expressing changes in risk as an absolute risk reduction or relative risk reduction with baseline risk formats improves understanding. Descriptive terms such as 'low risk' or 'high risk' should be quantified as a frequency rather than a percentage. Using a consistent denominator to portray risk is recommended. Using the 'number needed to treat' and visual aids puts benefits or risks into perspective. The duration of risk should be presented. CONCLUSION: Presenting risk information to patients can be optimised using a number of strategies

Counselling to include tailored use of combined oral contraception in clinical practice: an evaluation

BACKGROUND: Combined oral contraception (COC, 'the pill') remains the most prescribed method of contraception in the UK. Although a variety of regimens for taking monophasic COC are held to be clinically safe, women are not routinely counselled about these choices and there is a lack of evidence on how to provide this information to women. AIM: To assess the usefulness and feasibility of including tailored use of monophasic COC within routine COC counselling in a sexual and reproductive health (SRH) service using a structured format. METHOD: Using a structured format, healthcare professionals (HCPs) counselled new and established COC users attending an SRH service about standard and tailored ways of taking the pill. Questionnaires were used to survey both the HCPs and patients immediately after the initial consultation, and then the patients again 8 weeks later. RESULTS: Nearly all patients (98%, n=95) felt it was helpful to be informed of the different ways of using monophasic COC by the HCP, without giving too much information at one time (96%, n=108). The HCPs were confident of their COC counselling (99%, n=110) and did not think the consultations took significantly longer (88%, n=98). CONCLUSION: This study demonstrates that information on different pill taking regimens is useful and acceptable to patients, and can improve contraceptive pill user choice. It is also feasible for HCPs to perform COC counselling to include tailored pill use during routine consultations in a clinical setting

Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type.

OBJECTIVES: No copper intrauterine device (IUD) type is known to better suit young nulliparous women who tend to experience higher rates of IUD discontinuation compared with their older parous counterparts. A systematic review to determine which IUDs have higher continuation rates in young nulliparous women was undertaken. DESIGN: Systematic review and meta-analyses of available evidence based on IUD type. DATA SOURCES: AMED, BNI, CINAHL, DARE, EMBASE, EMCARE, HMIC, MEDLINE, PsycINFO, PubMed, TRIP, and the Cochrane Library electronic databases were searched from inception to 11 May 2022; as well as the Bandolier, Medicines and Healthcare products Regulatory Agency, Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, Department of Health, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines, WHO and Google Scholar websites. ELIGIBILITY CRITERIA: All studies on IUDs currently available in the UK or comparable (same design and size) to those available in the UK, involving nulliparous women of any age including those aged under 30. DATA EXTRACTION AND SYNTHESIS: Independently extracted data were assessed as low risk of bias using the Mixed Methods Appraisal Tool. Random effects meta-analyses of proportions were performed where data, including subgroups, were amenable to quantitative synthesis. Heterogeneity was reported using tau2 and I2 statistics, and sensitivity analyses were also performed. RESULTS: Nineteen studies involving 13 045 nulliparous women were included but the heterogeneity of participant ages, parity and IUD types made quantitative synthesis of outcome data in totality inappropriate. The highest continuation rate obtained was 91.02% (95% CI 88.01% to 93.64%) for the smaller TCu 380A at 12 months post insertion. CONCLUSIONS: Evidence for IUD use in young nulliparous women based on IUD type remains limited. Smaller sized IUD types appear better suited to this group of IUD users, however, more research is needed. PROSPERO REGISTRATION NUMBER: CRD42019120969

The use of local anaesthesia for intrauterine device insertion by health professionals in the UK

Background Pain associated with the insertion of an intrauterine device (IUD) is a known barrier to intrauterine contraception use in the UK. It is good practice for health professionals to discuss pain relief and use with women prior to the insertion of an IUD. Objectives This study aimed to determine the prevalence of and reasons for and against the use of local anaesthesia (LA) for IUD insertion. Methods A survey was undertaken using paper questionnaires to determine LA use for IUD insertion by UK health professionals. Results Overall, approximately one quarter (n=129) of all respondents use LA routinely, one quarter hardly ever or never use LA, while the remaining half use it sometimes. Use of LA was more prevalent among health professionals who worked in integrated sexual and reproductive health and contraception-only services, compared to general practice. UK health professionals who hardly ever or never used LA for the insertion of IUDs were more likely to be working in general practice. Conclusions The results of this survey suggest that more UK health professionals need to routinely discuss pain relief and offer this to their patients prior to IUD insertion as part of the care pathway for patients who choose to use intrauterine contraception

Nomegestrol acetate/17-beta estradiol: a review of efficacy, safety, and patient acceptability

Hannat Akintomide, Sabeena Panicker Sexual and Reproductive Health, Central and North West London NHS Trust, Margaret Pyke Centre, London, UK Abstract: Nomegestrol acetate (NOMAC) 2.5 mg with 17-beta estradiol (E2) 1.5 mg is a new combined oral contraceptive (COC) formulation and is the first monophasic E2 pill to be marketed, having been licensed for use in Europe in 2011. It is available to be taken daily in a regimen of 24 active pills followed by four placebo pills. NOMAC is a highly selective 19-nor progestogen derivative with specific binding to progesterone receptors, anti-estrogenic activity and no androgenic, mineralocorticoid nor glucocorticoid effects. E2 is an estrogen that is identical to endogenous estrogen. While it has been in use for only a short period of time, current evidence suggests that NOMAC/E2 is just as effective, safe, and acceptable as existing COC preparations. Two large Phase III trials conducted in the Americas and across Europe, Australia, and Asia showed lower cumulative pregnancy rates in the NOMAC/E2 groups compared to the drospirenone (DRSP) 3 mg in combination with ethinyl estradiol (EE) 30 &micro;g (DRSP/EE) groups but this difference was not statistically significant. NOMAC/E2 exhibits a good safety profile and has less effects on cardiovascular risk, hemostatic, metabolic, and endocrine factors in comparison to COCs containing EE in combination with levonorgestrel (LNG) or DRSP. NOMAC/E2 has also been found to cause less breast cell proliferation when compared to E2 alone and has some anti-proliferative effect on human breast cancer cells. NOMAC/E2 is considered acceptable as its compliance, continuation rates, and bleeding patterns were similar to COCs containing DRSP/EE and LNG 150 &micro;g combined with EE 30 &micro;g or LNG 100 &micro;g combined with EE 20 &micro;g (LNG/EE). However, discontinuation was found to be slightly higher in the NOMAC/E2 groups in the two large Phase III trials comparing NOMAC/E2 use with DRSP/EE. As the scientific literature has limited information on NOMAC/E2, further experience with NOMAC/E2 is required. Keywords: nomegestrol acetate, estradiol, efficacy, safety, acceptabilit

A comparison of the expected and actual pain experienced by women during insertion of an intrauterine contraceptive device

Nataliya Brima,1 Hannat Akintomide,2 Vivian Iguyovwe,3 Susan Mann4 1Medical Statistics, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, UK; 2Sexual and Reproductive Health, CNWL Camden Provider Services, Margaret Pyke Centre, London, UK; 3Department of Sexual and Reproductive Health, Camberwell Sexual Health Centre, Denmark Hill, London, UK; 4Sexual and Reproductive Health, Kings College Hospital, London, UK Objective: To compare the expected and actual pain experienced with the insertion of intrauterine contraception in women, and to determine whether either of these are related to their personal circumstances, or affected their satisfaction with the procedure. Design: A convenience sample of 89 women aged 15&ndash;50 years attending a sexual health clinic for same day intrauterine contraception insertion were given a questionnaire that they completed following the procedure. The women were asked to rate their expectation of pain prior to insertion and to rate the actual pain they experienced immediately after insertion, on a scale of 1&ndash;10, with 10 being severe pain. Information on the women&#39;s circumstances and their level of satisfaction with the procedure was also obtained. Results: Overall, the median actual pain experienced by women during insertion (4) was significantly lower than the expected pain median (6) (P&lt;0.001). For those women who had not had a previous vaginal delivery, actual pain was significantly higher compared with women who had had a previous vaginal delivery (median [interquartile range]: 6 [3.5&ndash;7.5] and 3 [1&ndash;5], P&lt;0.001, respectively), but there was no significant difference between expected and actual pain experiences. In women who had a previous vaginal delivery, actual pain was much lower than expected (P&lt;0.001). Neither actual nor expected pain experiences were linked to any other sociodemographic reproductive health or service use factors. Conclusion: All women had a high expectation of pain prior to IUD insertion, but for those who had had a previous vaginal delivery, this was significantly greater than that actually experienced. Satisfaction levels overall were high. Counseling of women should take into account their expected pain prior to IUD insertion and consideration should be given to alternative and additional methods of pain relief in women who have not had a previous vaginal delivery. Keywords: expected pain, IUD, IUD insertio