Journals watch: IUDs, prostate cancer and alcohol in pregnancy

A GP research round -up by Dr Gwen Lewis

Misconceptions about IUDs may need to be addressed with patients
Misconceptions about IUDs may need to be addressed with patients

IUDs and requests for pregnancy termination

J Fam Plann Reprod Health Care 2013; doi:10.1136/jfprhc-2012-100497

The use of long-acting reversible contraception (LARC) is to be promoted generally. In particular, the immediate insertion of an intrauterine device (IUD) following termination of pregnancy (TOP) is associated with significant reduction in risk of another TOP. So why are more IUDs not fitted after TOP?

An anonymous self-administered questionnaire was conducted in women seeking a TOP in a hospital service in Scotland. Some 105 women completed the questionnaire to ascertain their views on IUDs.

The two most common reasons for not having an IUD fitted were that it was thought that the procedure would be painful, and that it was thought the IUD could move around the body. But 25% of the women planned to have an IUD fitted.

Perhaps by addressing these particular concerns when we consult with women requesting TOP, we can increase the uptake of IUDs and prevent a further unplanned pregnancy.

IUD insertions - which variables affect fitting?

J Fam Plann Reprod Health Care 2013; doi:10.1136/jfprhc-2012-100383

We GPs have been encouraged to discuss and fit IUDs in many patients following NICE guidance.

This study from Canada sought to examine the effects of a few variables on IUD insertion tolerability, complications and follow-up issues.

A retrospective review was undertaken of all IUD insertions over an 11-month period: a total of 354 insertions. The effects of parity, age, use of local anaesthetic and other variables on insertion pain were studied.

It was found that nulliparous women and those who received local anaesthetic reported more insertion pain whereas age, type of IUD and recent abortion status did not affect insertion pain. In addition, nulliparous women did not experience significantly more insertion difficulty or complications. This is reassuring for those of us who fit IUDs in nulliparous women.

Tolerance to benzodiazepines in long-term use in primary care

Fam Pract 2013; 30(4): 404-10

Tolerance towards the effects of benzodiazepines has been observed in various studies and I was certainly taught this as a student. Therefore, it is assumed that patients taking benzodiazepines will need to increase the dose of the drug over time to experience the same effect.

A group of long-term benzodiazepine users was identified from the Dutch National Information Network of Family Practices. A total of 1,105 patients taking benzodiazepines for six months or longer were studied over a period of 24 months.

It was found, contrary to previous thinking, that there was no increase in prescribed dose among long-term users.

I rarely prescribe benzodiazepines but will be aware now that an increase in the dose over time is not needed.

Long-term survival with prostate cancer

N Engl J Med 2013; 369: 603-10

In the Prostate Cancer Prevention Trial (PCPT) in the US, finasteride significantly reduced the risk of prostate cancer, but was associated with an increased risk of high-grade disease. This study has been ongoing for 18 years.

A total of 18,880 men were involved. Prostate cancer was diagnosed in 10.5% of those given finasteride and 14.9% of those who received placebo in its place. In those on finasteride, 3.5% had high-grade tumours (Gleason score 7-10) and 3% had high-grade tumours in the control group. There was no difference in the 10-year survival rate.

Finasteride reduced the risk of prostate cancer by about a third and while high-grade cancer was more common in the finasteride group than the placebo group, after 18 years there was no significant difference between groups in rates of overall survival or survival after diagnosis of prostate cancer.

Following alcohol in pregnancy recommendations

BJOG 2013. DOI 10.1111/1471-0528.12356

It is recommended that women in the UK do not drink any alcohol during pregnancy. Likewise, in Australia the advice is to abstain from alcohol. Do women adhere to this advice?

The alcohol consumption pre and during pregnancy of 1,969 pregnant women in Australia in 2000, 2003, 2006 and 2009 was assessed; 82% continued to drink alcohol during pregnancy. They were more likely to consume alcohol if they had drunk at least weekly pre-pregnancy or were binge drinking prior to pregnancy.

I discuss alcohol intake with pregnant women at their booking appointment but don't do so at further appointments. Perhaps I should.

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

  • 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.

  • Undertake a search of women who have undergone a termination of pregnancy and assess use of IUDs following TOP
  • Perform a patient satisfaction survey of IUD fittings in your practice
  • Arrange a practice meeting to discuss the advice you provide about alcohol use in pregnancy

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