Journals watch: Young people and contraception

Too busy to read the journals? Dr Gwen Lewis selects the latest papers of interest to GPs.

IUDs could be offered to more nulliparous women, researchers suggest (SPL)
IUDs could be offered to more nulliparous women, researchers suggest (SPL)

Intra-uterine contraception in nulliparous women

J Fam Plann Reprod Health Care 2015 doi:10.1136/jfprhc-2014-101046

GPs and other doctors are now being encouraged to offer intra- uterine (IU) contraception to very young women, to reduce the unplanned pregnancy rate.

However, very few studies exist of the use of IU contraception in nulliparous women and many doctors remain reluctant to offer it to young women, or even discuss it with them.

In this study, 109 nulliparous women aged 18-30 years were fitted with IU contraception at a student health centre between 2012 and 2014 and were surveyed at one, six, 12 and 18 months after insertion.

Overall satisfaction was high, with 83% happy or very happy with their contraception. There was no difference between satisfaction rates with different devices.

A total of 75% reported that the insertion procedure 'went well', even though 78% rated pain at insertion as moderate to severe, with 45% experiencing vasovagal symptoms.

At 12 months, continuation rate was 89%, with discontinuations for expulsion (3%), side-effects (6%), lack of anticipated benefit (1%) and pregnancy (1%).

Young people and contraception

Sex Transm Infect 2015; 91(3): 171-7

STIs and unplanned pregnancies are most prevalent in the young.

This study from Denmark was conducted among a random sample of 20,000 young men and women aged 15-29 years in 2012. Unfortunately, the response rate to the questionnaire was only 20.4%.

At sexual debut, condoms were used by 69.9% of women and 62.3% of men, while 14.3% of women and 15.1% of men used no method of contraception at this time.

With a regular partner, just over half of both women and men used condoms alone for contraception, while 10% used no contraception. Having a casual sexual encounter decreased the likelihood of condom use and increased the likelihood of no contraceptive use.

I found these figures worrying, especially because Denmark has a lower rate of unplanned pregnancy than the UK.

Use of LARC after abortion

J Fam Plann Reprod Health Care 2015 doi:10.1136/jfprhc-2014-101031

We know that in the UK, one third of all terminations of pregnancy (TOP) are repeat TOPs. However, the use of long-acting reversible contraception (LARC) after TOP reduces subsequent abortion rates.

In this study based in New Zealand, data on post-TOP use of LARC was obtained from 2007 to 2012 from a large clinic in Wellington.

Use of LARC after TOP increased from 20.2% in 2007 to 45.6% in 2012, with intra-uterine contraception increasing from 20.2% to 31.8% and implant use increasing to 14%.

During this time, implants became government-funded, to increase their uptake. The greatest increase in use of LARC was among nulliparous women aged under 20 years.

In the UK, LARC is only used by 9% of women of reproductive age, while worldwide, the rate of use is 14.1%.

Urinary incontinence in women

BJOG 2015; 122(6): 816-24

This study from France assessed urinary incontinence in a cohort of 4,127 women aged 47-52 years at baseline, over an 18-year period. They were questioned at baseline and at three-yearly intervals.

Annual incidence for urinary incontinence was 3.3% and for remission, 6.2%. High education level, parity (at least one pregnancy versus no pregnancy), menopause, weight gain, depression and impairment of health-related quality of life all contributed to higher rates of incontinence. GPs are not in a position to improve all of these factors, but we can advise weight loss and treat depression in incontinence.

Obesity and chronic disease

MJA 2015; 202(7): 370-2

Obesity is a global problem and guidelines in Australia suggest BMI and waist measurement should be recorded in general practice.

However, analysis of routine GP data from 270,426 patients in Melbourne found that only 22.2% of patients had their BMI recorded and 4.3%, their waist circumference.

It was found that those aged over 75 years were more likely to have BMI recorded, while women were less likely. Patients with chronic diseases - diabetes, hypertension and hyperlipidaemia - were more likely to have their BMI recorded.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Carry out a practice audit of the use of IU contraception by patients aged under 30 years
  • Research local and national guidelines about offering LARC to women patients
  • Devise a practice protocol for ways in which you can monitor and address obesity in your patients

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

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