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Two tenacula cause equal pain and bleeding on IUD/IUS insertion

Anything that makes effective contraception more acceptable for people who need it interests us at the journal. So what about the type of forceps used to grasp the cervix when inserting an intrauterine device (IUD) or intrauterine system (IUS) – does this make any difference to pain or bleeding? Apparently not, according to a randomised controlled trial (RCT) in this issue. Reporting on a comparison of Littlewoods forceps with a single-toothed tenaculum, Speedie et al. find no significant difference in outcomes between the two groups apart from higher mean visual analogue scale scores for pain 10 minutes after insertion in the tenaculum group. And as the authors point out, even this statistical difference may not be clinically significant given pain scores were already very low. See page 241

In a linked editorial (page 239), Rebecca Allen observes that tenaculum type seems to be joining a slew of interventions found relatively ineffective in a recent Cochrane systematic review. These include nonsteroidal anti-inflammatory drugs (NSAIDs), some topical lidocaine agents, and misoprostol for cervical ripening. So, how can we counsel women and help them through the IUD insertion process?, Allen asks.

Prescriptions of contraceptives for non-contraceptive use are increasing, in the UK

Those contraceptive pills which occupy the grey area in prescribing between contraception and non-contraceptive uses such as treatment for acne or hirsutism, subject to more restrictive prescribing guidelines, can risk either being used inappropriately, or underused where they are appropriate. Data on how contraceptives are used outside their product licence are generally limited, so we were interested in the retrospective analysis in this article which tries to address this, using the UK primary care database, The Health Improvement Network (THIN). Looking at the diagnosis or indication recorded in connection with new prescriptions of pills containing cyproterone acetate, levonorgestrel (LNG) and drospirenone (DRSP), respectively, from 2002 to 2010, the authors report a marked …

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