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Shapiro and colleagues conclude the interesting and enlightening series of articles looking at the evidence around hormone replacement therapy (HRT) and breast cancer risk (page 80). The final part examines the evidence for there being a declining trend in breast cancer incidence as HRT use reduced. Although the two are widely held to be related, they conclude that it is not possible to say either way. In the accompanying commentary (page 72), Nick Panay reviews the whole series of five articles and reminds us that optimising the lives of millions of women going through the menopause should be our priority. See pages 72 and 80

New subcutaneous DMPA injection

Sharon Cameron discusses the new subcutaneous injection of depo-medroxyprogesterone acetate (DMPA), Sayana® Press, which has recently come onto the market in the UK. It seems to be very similar to the intramuscular DMPA, but can be self-administered. Unfortunately, this advantage is not being utilised, as this contraceptive method is not yet licensed for self-administration in the UK. See page 75

The FSRH's 20th anniversary

It is 20 years since the establishment of the Faculty of Sexual and Reproductive Healthcare (FSRH). In celebrating its anniversary there is much to be proud of, and indeed Community Sexual and Reproductive Health is now a specialty in its own right. Readers should find the story of the birth and rise of the specialty interesting and some will be reminded of ‘old times’, while looking ahead to a bright future. See page 78

COCs and the risk of VTE, ATE and cardiovascular death

Syd Shapiro provides another of his incisive reviews of the latest database study of the combined pill and venous (VTE) and arterial (ATE) thromboembolism risk. Unsurprisingly, he finds many of the same problems as in the other studies, and asks the question why do these studies keep being done badly when the methodological flaws have been so well established? See page 89

“Anything for the weekend – and beyond, madam?” Community pharmacies increase OC uptake

Parsons et al.'s evaluation of a community pharmacy delivered oral contraceptive (OC) service in South-East London is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Specially trained pharmacists provided OCs under a patient group direction (PGD), and subsequent evaluation showed that these pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need. Nearly half of all consultations occurred following emergency hormonal contraception supply, and nearly half of clients receiving an initial supply of OCs were first-time Pill users. Based on satisfaction questionnaires from a small subgroup, most clients valued this service, were happy about privacy, and would recommend it. Although the primary aim was to reduce teenage pregnancy , and nearly a quarter of clients were aged <20 years, the study shows that women aged 20+ years also require this service and should not be overlooked when formulating policies for service provision. See page 97

Psychosocial factors affect semen quality

Semen quality appears to be declining and this cross-sectional study in China casts light upon some factors that may be associated with that decline. The research team analysed the semen of 1346 healthy 20–40-year-old Chinese men, capturing their psychological, social and behaviour profiles via questionnaire. It appears that stress, social class and underwear made from man-made fibres all play a significant part in declining semen quality. See page 102

New female condom, the ‘Woman's Condom’ – will the Chinese go for it?

The need for products that simultaneously protect against unwanted pregnancy and STIs, including HIV, has prompted interest in the development of multipurpose prevention technologies, including new variants of the female condom. In this issue, Coffey and colleagues describe their survey of initial reactions to the ‘Woman's Condom’ (which obtained marketing approval in China in 2010) by potential user groups in Shanghai. Their study demonstrates the importance of assessing the potential acceptability of new products in a range of populations, with differing expectations, needs and culture-specific influences. Their findings are of particular value to programme/service providers, in order to identify the most likely adopters of this new type of female condom. See page 111

There's a tale in this sting

What was the background to last year's Care Quality Commission inspections of all English abortion services? Why were medical and nursing colleagues reported to their regulatory Councils and why is a Metropolitan Police investigation still ongoing? Sam Rowlands’ commentary on ‘The policing of abortion services in England’ provides a fascinating and detailed account of the regulatory framework of abortion services in England and the unexpected consequences of a national newspaper's ‘sting’ operation on certain clinics in February 2012. It suggests that the regulation of abortion goes further than the Law requires and that this is now out of step with progress in abortion practice, leading to unnecessary restriction for women with unwanted pregnancies in accessing the support they need. See page 121

Role of ambulatory hysteroscopy in reproduction

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review aims to summarise the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation. See page 127

LAM: why ignore this useful option?

In this interesting personal view article, the authors explore and elaborate on the reasons why health care providers and the public are hesitant in recommending/adopting the lactational amenorrhoea method (LAM), a valuable short-term postnatal contraceptive option. These include ignorance about the LAM criteria for correct use, mistrust of the method's effectiveness despite a strong evidence base, inconsistencies in the advice given to breastfeeding women in the UK by health practitioners and public bodies (e.g. the National Health Service, Royal College of Obstetricians and Gynaecologists), and lack of awareness about potential benefits. The authors stress the need for better national information material for patients, and for health professionals to provide clear and consistent advice, in line with FSRH guidance. Information about LAM and its effectiveness should be routinely offered alongside all other postpartum options. See page 136

Internet: good or bad?

2013 marks the 30th anniversary of the Internet. Our Consumer Correspondent looks at whether this technological miracle is a ‘good idea’ for the health profession. See page 139

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