NuvaRing investigation: Background information

An article from Pulse from October 2008 caught my attention today. The article, (here), outlined how plans were made as far back as 2008 to aline LARC availability with NICE guidlines.

They also suggest offering 3 QOF points to surgery’s offering all available contraception to women, including LARCS, amoung other measures.

Experts back HPV test for cervical smears

Experts have shown that HPV testing instead of cervical smears may be the best first line of defence in cervical screening.

Results published in the Lancet Oncolcogy showed HPV testing could reduce the number of cervical screenings which a woman need to attend. Researchers compared HPV testing with cytology in 81,220 women aged 25 to 60. In the second round of testing,  done in women who had tested positive for HPV, nine invasive cancers were found in the cytology group.

Combining HPV and cytology testing did not improve sensitivity, suggesting HPV testing alone was responsible for the increased detection of abnormalities.

However, switching to HPV testing will only be recommented for women over the age of 35, as in the  younger age group, HPV testing led to an over-diagnosis of regressive lesions, which, if treated surgically, can cause problems during pregnancy.

Professor Kitchener, who chairs the UK’s cervical screening advisory group, said in Pulse magazine: ‘In an era with a vaccinated cohort of women, there is a higher chance women will test negative for HPV and you can confine cytology to women who are HPV positive.

Investigation: Help needed

The NuvaRing, a new form of contraception, was launched in the UK in January 2009 after it was approved by NICE. However, it has become apparent that nearly one year after it was launched many PCTs in the country have listed this form of contraception as RED RED, RED orAMBER on their formularies (a list of which drugs are available to patients) meaning it is unavailable unless a doctor requests it specifically for a patient from the PCT. This is normally only done when there are health risks associated with the patient not receiving a drug.

In the past 18 months there has been increasing pressure to increase the availability of different forms of contraception on the NHS, specifically LARCs (long acting reversible contraception). The NuvaRing is unique in that it lasts a month, and is completely reversible. I has been launched in the US and has become increasingly popular.

I have started an investigation to find out how many PCTs in England and Wales have not made the NuvaRing available to patients. I want to find out which ones have branded it Amber, Red or Red Red and why.

I have left Scotland out of this investigation as the rules concerning formularies are different and it was launched there at a different time.

Here’s how you can help:

Call up your local PCT and ask them how the NuvaRing is branded in your area. Information can be found here.

Call up your local family planning clinic and ask if and how you can access it.

If you have had any problems or have not been happy with your access to contraception via the NHS, please leave your comments below.

Please send any information to hannahbflynn@googlemail.com

Blog Action Day 2009

To celebrate Blog Action Day 2009, here are two of my articles which were published on the interweb today:

An explanatory introduction to the UN Climate Conference, COP-15 in Copenhagen, published by IslamOnline.com: http://twurl.cc/1q89

A news story on the aquisition of Solel by Siemens, an important step for solar thermal technology, published by RenewableEnergyWorld.com: http://twurl.cc/1q8a

10 reasons you should have the HPV vaccine

Following the tragic death of a fourteen year-old girl just two hours after receiving the HPV vaccine as part of the UK’s policy to vaccinate all girls under 18, the media has been awash with confused stories regarding the safety of the jab.

The first stages of the postmortem showed she had an underlying health problem, most likely a heart defect which would commonly present for the first time at this age, which was the cause of her sudden death.

However, when the story broke, before the first results from the postmortem became available the media insinuated the HPV vaccine may have caused in her death. 

It is important we do not have a vaccination scare on the scale of the MMR, and young girls (and perhaps their families) are comfortable receiving this potentially life saving jab.

Therefore, here are ten reasons you should have the HPV vaccine:

1. It protects against the two types of HPV which cause 70% of cervical cancers.

2. Women have, on average, a 1.6% chance of developing cervical cancer in their life time; there is less than a 1 in a million chance of severe anaphylaxis due to this vaccine (3).

3. Cervical cancer kills 1,000 women every year in the UK. It is thought the vaccination programme could save 400 of them.

4. The risks are low. All vaccines carry risk, but the HPV vaccine has shown few contraindications. The most common side effect is ’sore arm’.

5. 50% of sexually active women contract HPV by the time they are 30 .

6. Sexually transmitted diseases are on the rise which can increase your susceptibility to HPV and increase your risk of cervical cancer up to six times (1). For example, women who also have genital herpes are more likely to get more invasive forms of cervical cancer (2).

7. Cancer is a killer, but not only that. Treatment for cervical cancer can include surgery and chemotherapy which can leave you infertile, or with difficulty conceiving. This has happened to many women in their twenties.

8. We need as many people as possible to be vaccinated in order to reduce the prevalence of HPV in the population. Normally, vaccination programmes require 80% of the whole population (men included) to be vaccinated in order to eliminate a disease.

9. Promiscuity alone does not cause cervical cancer, as one third of women with only one sexual partner contract HPV within one year. As previously mentioned, 50% of women have been exposed to HPV by the time they are 30.

10. The NHS (and many other health authorities) have emphasised the importance of, and have promised to continue cervical screening. But there is no reason to not use belt and braces girls!

1. P Koskela, T Anttila, T Bjørge, A Brunsvig. (2000). Chlamydia trachomatis infection as a risk factor for invasive cervical cancer.International journal of cancer.

2. 2003. Cervical cancer risk rises if women with HPV also have herpes infection. International Family Planning Perspectives

3.  D. Cooper, (2007). Determinants of sexual activity and its relation to cervical cancer risk among South African Women. BMC Public Health

World Contraception Day

Ahead of World Contraception Day this Saturday 26 September, a number of studies have come out to hammer home the safe sex message.

Lloyds Pharmacy’s latest research shows the average British adult has indirectly had sex with 2,881,024 people. This shocking statistic is based on the average British adult having sex with 7.65 people in their life time.

 “When we have sex with someone, we are, in effect, not only sleeping with them, but also their previous partners and so on,” Clare Kerr, head of sexual health for the chemist chain,  as reported in the Metro today.

 You can calculate your own figure using the tool on their website.  This will base your answer on your age, your number of sexual partners and the age that they were.

 In a similar vein, the Australian publication, Pharmacy News reported an alarming number of women are ignorant of the potential threat to their health and the risk of pregnancy which can result from unprotected sex.

 The research was commissioned by Sexual Health and Family Planning Australia (SHFPA) and Bayer Schering and they found two out of three adult women admitted to having unprotected sex.

SHFPA’s Dr Christine Read said, “It’s worrying that young women continue to engage in unprotected sex, but it is equally concerning that many women don’t have basic knowledge of their menstrual cycle. For example, many women don’t realise they can get pregnant even if they have unprotected sex outside the time they’re ovulating.”

Dr Read went on to say that women taking hormonal contraceptive pills should be given more information about how to take them properly.

Today Conceptus, a company engaged in women’s health care recognised World Contraception Day. This year’s motto is “Your life, your voice: Talk Contraception.” One of the main focuses is encouraging more women to consider permanent forms of birth control.

15andcounting love Women’s Health Base!

This blog has been featured in the 15andcounting campaign’s blog.

They are a campaign group set up petition governments to make young people’s sexual health a policy priority and are well worth a look.

Stonewall poster campaign highlights lesbian health issues

Gay rights group Stonewall has launched a new poster campaign with the Department of Health encouraging lesbian and bisexual women to take better care of themselves.

The move follows the results of ‘Prescription for Change’, the first major survey ever conducted into lesbian and bisexual women’s health in Britain, which has revealed half of the UK’s 1.8 million lesbians report a recent negative NHS experience. The Stonewall research used over 6,000 lesbian and bisexual women in the study.

Stonewall has developed the slogan ‘Love your inner lesbian’ which is going to accompany the campaign. The research, released last year, found deeply disturbing levels of self-harm, substance abuse and exclusion from routine testing for cervical cancer.

The survey also found lesbian and bisexual women are reluctant to be honest about their sexual orientation when talking to doctors. The poster campaign which will hit healthcare centres and clinics soon, aims to encourage women to talk frankly to their doctors about their healthcare needs.A series of posters is now been available depicting the slogan, as well as key statistics from the report – including smear testing, lesbian parenting, mental health issues and drink and drug habits.

The lack of attendance to cervical screening by lesbian and bisexual women is worrying considering the increasing trend for sexually transmitted diseases which can lead to the development of abnormalities on the cervix which can lead to cancer. However, 30% of cervical cancers  occur without pre-exposure to HPV; a cancer causing virus, meaning groups which are not in a high risk group for HPV, Chlamydia and gonorrohea i.e lesbian women, are still at risk of developing the disease. The report suggested their is an increased cost in treating lesbian and bisexual women who usually present with a disease later than their heterosexual peers.

One of the recommendations of the report is to make lesbian health issues more visible so women are more comfortable discussing them with a doctor.

Source: Utalkmarketing.com

Socialised medicine, obesity, the pill and guessing games

Because it’s Friday, here’s a round up of a week in the blogosphere:

• The American Medical Association endorsed Obama’s healthcare reform bill, marking the end to nearly a century of opposition to ’socialised medicine in the United States. The White House Blog has a video of the speech Obama made explaining why reform is needed now.
• Dr Kathryn Clancy, Assistant Professor of Anthropology at The University of Illinois, gives her opinion on the effects of the pill when considering the population as a whole in her three part series, What does this anthropologist think about hormonal contraception?.
• Twitter fave, His Boys Can Swim are running a contest to see who can guess the time their baby will be born. ‘Jane’ is currently 39 weeks pregnant and has been providing an account of her pregnancy through Twitter since the beginning.

Send your news and round ups to the comments box.

5 Reasons Health Forums are a Bad Idea

1) It’s not medical advice – Obvious, but something which is often forgotten. People responding to your queries or the queries of others are offering an opinion, not medical knowledge. Plus, though some forums such as Yahoo! Answers has a system which allows medical experts to identify themselves, there are few ways of authenticating the claims of respondents.

2) It’s US dominated – Fair enough if you are living in the United States and have very comprehensive medical insurance, but many people don’t fall into this category. Therefore anybody without patient choice, i.e. most European individuals, are unlikely to be able to use a lot of the ‘get  a second opinion’ advice. The same goes for people without medical insurance in the United States.

3) The anecdote rules – Have you heard the one about the 44 year-old woman who had been trying to conceive through IVF for years and then after giving up, conceived healthy twins? Well it was a one-off and it’s probably not going to happen to you. These forums almost never quote statistics but provide you with stories about how one ‘cure’ worked for someone. Its worst on pregnancy forums too. Every single twinge, absence of twinge, weird feeling and bodily function is analysed within an inch of its life by expectant mothers. Useful for support perhaps, but dangerous if used in place of medical advice at such a vulnerable time.

4) The advice is narrow – As few of the respondents are likely to be medical experts the range of potential causes and complications being discussed is exceedingly narrow. Most threads come to the conclusion the subject is either pregnant or has endometriosis. Sometimes polycystic ovaries. And fften advice is given with only minimal background information provided. A doctor, nurse or midwife is indispensable when it comes to taking medical backgrounds and using them appropriately to diagnose rarer or more complicated problems.

5) It will tell you what you want to hear – Type ‘late period’ into Google and the world will tell you that you are undoubtably pregnant. No matter what your background or circumstances, that is what they will say. Why? Because the internet is dominated by pregnancy forums with women desperate to get pregnant. I recently found a forum where a women who had experienced cramps and bleeding (i.e. a period) was told this was a sign of early pregnancy by numerous women who had experienced the same thing when they were trying. This is confusing and simplified at best, and dismissive and dangerous at worst.