Kirsten Black

Incidence and outcomes of pregnancy-associated cancer in Australia, 1994?2008: a population-based linkage study

Please cite this paper as: Lee Y, Roberts C, Dobbins T, Stavrou E, Black K, Morris J, Young J. Incidence and outcomes of pregnancy‐associated cancer in Australia, 1994–2008: a population‐based linkage study. BJOG 2012;119:1572–1582.

Worldwide use of intrauterine contraception: a review

BACKGROUND Globally, 14.3% of women of reproductive age use intrauterine contraception (IUC), but the distribution of IUC users is strikingly nonuniform. In some countries, the percentage of women using IUC is <2%, whereas in other countries, it is >40%. Reasons for this large variation are not well documented. The aims of this review are to describe the worldwide variation in IUC utilization and to explore factors that impact utilization rates among women of reproductive age in different continents and countries. STUDY DESIGN Published literature from 1982 to 2012 was reviewed, using Medline and Embase, to identify publications reporting diverse practices of IUC provision, including variation in the types of IUC available. Local experts who are active members of international advisory groups or congresses were also consulted to document variations in practice regulations, published guidelines and cost of IUC in different countries. RESULTS Multiple factors appear to contribute to global variability in IUC use, including government policy on family planning, the types of health care providers (HCPs) who are authorized to place and remove IUC, the medicolegal environment, the availability of practical training for HCPs, cost differences and the geographical spread of clinics providing IUC services. CONCLUSIONS Our review shows that the use of IUC is influenced more by factors such as geographic differences, government policy and the HCPs educational level than by medical eligibility criteria. These factors can be influenced through education of HCPs and greater understanding among policy makers of the effectiveness and cost-effectiveness of IUC methods. IMPLICATIONS Globally, 14.3% of women of reproductive age use IUC, but the percentage of women using IUC is in some countries <2%, whereas in other countries, it is >40%. This paper reviews the reasons for this diverse and highlights possible starting points to improve the inclusion of IUC in contraceptive counseling.

A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women

Abstract Objectives Intrauterine contracepives (IUCs) are highly effective and safe for use in all women, including those who are nulliparous. However, many myths and barriers prevent more widespread utilisation. The objective of this article was to explore the health care provider (HCP), health system and user issues that prevent more widespread use of IUCs, particularly among nulliparous women, and to present the evidence that supports achieving greater utilisation of these devices. Methods MEDLINE, PubMed and Embase were used to identify studies reporting attitudes and beliefs around IUCs, and clinical studies providing evidence of their risks and benefits. Results HCP, health system and user factors limiting use of IUCs were identified. The most widely explored barriers in published studies are those at the HCP level. User barriers are less well documented and health system barriers are mostly assessed through indirect evidence. Many, but not all, of the barriers can be reduced through greater understanding of the evidence. Conclusions Efforts need to be made to disseminate the evidence, which shows that few contraindications exist to IUC use. Addressing HCP lack of knowledge, training and confidence with IUC insertions, particularly in nulliparous women, could make a substantial positive impact on IUC utilisation.

Unplanned pregnancy and contraceptive use in women attending drug treatment services

At an international level, there are calls for a greater focus on women and harm reduction in recognition that female drug users have a unique set of issues that are not routinely assessed in drug treatment programs.

Why do women experience untimed pregnancies? A review of contraceptive failure rates.

Contraceptive failure contributes to a substantial proportion of unintended pregnancy, particularly in the developed world. A number of socio-demographic factors seem to impact on the risk of a woman experiencing contraceptive failure. Many of the issues exist across cultural boundaries and are complex to address. In discussing the failure rates for individual contraceptive methods, this article will highlight the advantage of improving uptake of long-acting reversible methods of contraception which have a high efficacy and are less user-dependent than many of the other available methods.

Provision of emergency contraception: a pilot study comparing access through pharmacies and clinical settings ☆

OBJECTIVE The study was conducted to compare the provision of emergency hormonal contraception (EHC) through pharmacies and clinical services to determine whether aspects of client satisfaction and subsequent sexual health outcomes vary significantly between these services. STUDY DESIGN A pilot observational study was conducted in South London. Participants were recruited from pharmacies and clinical services when they presented requesting EHC and met with the researcher to complete a structured questionnaire 4 months later. RESULTS One hundred thirty-three women were enrolled in the study, 50 of whom accessed a community pharmacy for EHC plus 83 women who obtained EHC from a clinical service. Seventy percent of women who went to a pharmacy and 43.9% who went to a clinical service obtained EHC within 24 h (p=.004). A greater proportion of women attending a clinical service felt at least quite comfortable asking for EHC, compared to those who went to a pharmacy (p=.007). Those who obtained EHC from a clinic also felt significantly better informed about both EHC (p=.015) and their future contraceptive options (p=.000), compared to the women who attended a pharmacy. CONCLUSIONS This pilot study found that women who went to a pharmacy had more rapid access to EHC compared to those who chose to attend a clinical service. Other aspects of provision and client satisfaction seem to favor attendance at a clinical setting over a pharmacy as a venue for obtaining EHC.

Nerve fibers in ovarian endometriomas

Ovarian endometriomas (n = 29) were innervated by mainly sympathetic and sensory fibers. These fibers may be involved in the generation of pain symptoms.

A study investigating obstetricians' and gynaecologists' management of women requesting an intrauterine device

Background:  Intrauterine methods including the copper intrauterine device (Cu‐IUD) and the levonorgestrel intrauterine system (LNG‐IUS) provide highly effective long‐term reversible contraception. The reasons for relative low use of these methods in Australia compared to many European countries are not clear, but may in part relate to provider reluctance because of outdated knowledge about their safety and efficacy.

Novel finding of high density of activated mast cells in endometrial polyps.

Endometrial polyps are benign lesions frequently identified in women with infertility or abnormal uterine bleeding in the reproductive and postmenopausal phases We report the striking observation that the numbers of activated mast cells expressing tryptase are increased more than sevenfold throughout the cycle in endometrial polyps (n = 20) compared with normal endometrium. This novel finding has important implications for growth, development, and symptoms associated with polyps in many different tissues.

Factors predicting uptake of long-acting reversible methods of contraception among women presenting for abortion

Objective: To examine the uptake of long‐acting reversible contraceptive (LARC) methods after abortion among women seeking abortions through a major Australian abortion provider.