Henry Hugh Gebbie was an Ayrshire boy whose family ran a lace mill in Darvel, the birthplace of Sir Alexander Fleming. He qualified from Glasgow and immediately did national service in Germany before becoming a partner in the …

Increasing demands for long-acting reversible contraception (LARC) within NHS Lothian had led to long waits for women requesting intrauterine contraception (IUC). As insertion of LARC to reduce unplanned pregnancy was viewed as a top priority, the Sexual and Reproductive Health (SRH) Service in Lothian wished to simplify access to this highly effective method of contraception. The aim was to improve the pathway to insertions, and reduce the number of visits required to the Chalmers Sexual Health Centre. There is evidence to suggest that multiple visits for IUC insertion can create a barrier to uptake of the method.1 ,2 In common with most other UK services, we traditionally insisted that women attend two appointments: the first for counselling about IUC followed by a second booked appointment for insertion of a device at a clinic dedicated to IUC insertion. In an attempt to streamline this process, it was first agreed that the Chalmers Centre would insert IUC at all general SRH clinics; this would be at the morning, afternoon and evening drop-in and booked clinics rather than solely at dedicated IUC insertion clinics, as had previously been the case. Women requiring emergency intrauterine device (IUD) insertion are identified at triage and seen at same-day appointments. In an effort to reduce waiting times, we then offered women the option of a telephone consultation as an alternative to attending in person for the clinic counselling appointment. Women booking an appointment for an IUC consultation for elective insertion were given a convenient time when they would be telephoned by a specialist nurse, and if they were suitable, they would then be given a …

Background UK policy documents advocate integrated approaches to sexual health service provision to ensure that everyone can access high-quality treatment. However, there is relatively little evidence to demonstrate any resultant benefits. The family planning and genitourinary medicine services in Lothian have been fully integrated and most care is now delivered from a purpose-built sexual health centre. We wished to study the views of staff on integrated sexual and reproductive care. Methods Staff completed anonymous questionnaires before and after integration, looking at four main aspects: the patient pathway, specific patient groups, their own professional status, and their working environment. The surveys used a mixture of five-point Likert-type scales and open-ended questions. Results Over 50% of staff completed the surveys on each occasion. Six months after the new building opened, staff attitudes about the integrated service were mixed. Staff reported more stress and less opportunity for specialisation but there was no change in their sense of professional status or development. There were concerns about how well the integrated service met the needs of specific patient groups, notably women. These concerns co-existed with a verdict that overall service quality was no worse following integration. Conclusions Staff views should form an important part of service redesign and integration projects. Although the results from the Lothian surveys suggest a perceived worsening of some aspects of the service, further evaluation is needed to unpick the different problems that have appeared under the catch-all term of ‘integration’.

INTRODUCTION:The intrauterine device (IUD) and intrauterine system (IUS) are widely used forms of long-acting reversible contraception. Occasionally, IUD/IUS users have an ultrasound scan that shows a low-lying IUD/IUS or an IUD/IUS is found incidentally on scan to be low-lying within the uterus. No formal guidelines exist on the clinical implications of this scenario or the most appropriate management. We report here on a systematic review of the literature. METHODS:A search of the online database PubMed was performed to identify articles relating to low-lying or malpositioned IUD/IUS. RESULTS:A total of 1101 articles was identified, and 15 were determined to be relevant to the research question. DISCUSSION:There is little published evidence to determine the nature and extent of the clinical relevance of a low-lying IUD. We recommend individualised management of these women, with particular caution in younger women and those with a history of previous IUD/IUS expulsion. Consideration may be given to attempting to readjust the IUD/IUS position, but if removal is performed, immediate replacement is essential if provision of alternative effective contraception has not been established.

Perimenopausal women have low fertility but must still be advised to use contraception until natural sterility is reached if they are sexually active. Patterns of contraceptive use vary in different countries worldwide. Long-acting reversible contraceptive methods offer reliable contraception that may be an alternative to sterilisation. Hormonal methods confer significant non-contraceptive benefits, and each individual woman should weigh up the benefits and risks of a particular method. No method of contraception is contraindicated by age alone, although combined hormonal contraception and injectable progestogens are not recommended for women over the age of 50 years. The intrauterine system has particular advantages as a low-dose method of effective hormonal contraception, which also offers control of menstrual dysfunction and endometrial protection in women requiring oestrogen replacement. Condoms are recommended for personal protection against sexually transmitted infections in new relationships. Standard hormone replacement therapy is not a method of contraception.

Turner syndrome (TS), the result of a structurally abnormal or absent X chromosome, occurs in one in 2 000 live born females. The phenotype is highly variable, but short stature and gonadal dysgenesis are usually present. The main objective in adults with TS is health surveillance, but TS still causes a reduction in life expectancy of up to 13 years, with cardiovascular disease, congenital or acquired, as the major cause of an early death. While it has been established that all women with TS should undergo in‐depth cardiovascular examination at diagnosis, advice on the cardiovascular management of women with TS is limited. Here, we provide a summary of our current practice within a multidisciplinary team, supported by our expertise in various aspects of cardiovascular risk management, and the evidence from research where it is available, with the aim of providing optimal support to our patients with TS.

There is a considerable cost differential between copper intrauterine devices (IUDs) and the levonorgestrel-releasing intrauterine system (LNG IUS) in the UK. Most contraceptive services face financial stringency and it is increasingly important to deliver cost-effective care whilst still offering patient choice. Although all long-acting reversible methods of contraception are cost effective,1 the cheapest copper IUD costs around £10 and lasts for 10 years, in contrast to an IUS that costs around £80 and lasts 5 years. Both are usually offered to all women but there could be significant cost savings to the National Health Service if more women used …

As more women survive reproductive cancers, menopausal symptoms following treatment can be a significant problem affecting quality of life and wellbeing. Hormone replacement therapy may or may not be contraindicated. Women often receive conflicting information about their management from different specialists. The aim of this study, based in a regional menopause clinic, was to examine referral patterns and symptom profiles of women with cancer or at high risk of cancer; to identify areas of need where a more integrated approach to management might be required; and to reach a local consensus across disciplines involved in the care of these women regarding prescribing of hormonal therapies. A retrospective case record review of all women attending Edinburgh Menopause Clinic for one 12-month period in 2011/2012 for management of cancer-related menopausal symptoms was undertaken. The results of the review were discussed at a multidisciplinary meeting and regional guidance on the management of these women was agreed. There has been an immediate improvement in communication between departments and the quality of information received in referral letters.

Obesity is increasing in most western countries and rises significantly with age. Obese women are as sexually active as women of normal weight, and new sexual relationships in the older reproductive years are becoming more commonplace and still require effective contraception. Continuation of pregnancy in a woman over 40 carries health risks which are exacerbated by the presence of obesity. A high proportion of pregnancies in women over 40 are unplanned and end in therapeutic abortion. The prevalence of obesity and the high rates of contraceptive use amongst older women mean that any increase in associated risk is likely to be of public health concern. There are very few data on the specific risks of contraceptive use in obese older women. As fertility declines with age, all methods become increasingly effective. No single method is contraindicated by age alone but particular caution is required where the use of estrogen containing preparations is considered as the risks associated with estrogen are all also independently associated with increasing age and body mass index. Non-estrogen containing methods are available, whether hormonal, barrier or surgical, which are effective, acceptable and safer in the obese older woman. Some methods of contraception may indeed have particular non-contraceptive benefits for this population.

Background and methodology In sexual health clinics there is debate on whether to call service users ‘patients’ or ‘clients’ and this mirrors an ongoing dialogue in the medical literature. The authors undertook a questionnaire survey in five UK centres of clinic attendees and staff to assess their preference. Results A total of 1428 clinic attendees and 250 staff members completed questionnaires. 61% of attendees who responded preferred ‘patient’, with 23% expressing no preference. Only 9% of respondents preferred the term ‘client’. 148 (59%) of all staff groups preferred the term ‘patient’ followed by 82 (33%) selecting ‘client’. No staff member opted for ‘customer’ or ‘user’ as the preferred term. The difference between preference for ‘patient’ between doctors and nurses was statistically significant, with most doctors preferring the term ‘patient’. Out of a total of 84 nurses, there was equal preference for ‘patient’ and ‘client’ (38 nurses in each group). Comments from attendees and staff who responded generally emphasised the concept of the ‘caring’ role of the health professional towards people attending the services. Discussion and conclusions The majority of people attending sexual health clinics and medical and clerical staff working in these services expressed a preference to retain the title of ‘patient’. The main justification for this appeared to relate to the concept of caring for people. The authors therefore conclude that the terminology in sexual health services should revert to predominantly using the term ‘patient’.

A number of rheumatological diseases predominantly affect women of reproductive age. There has always been concern that the use of oestrogen-containing agents such as combined hormonal contraception and hormone therapy might aggravate these conditions. This article reviews the up-to-date evidence regarding the safety of using these agents in women with various rheumatological diseases, with emphasis on systemic lupus erythematosus and rheumatoid arthritis. In the absence of antiphospholipid antibody or other prothrombotic risk factors, combined hormonal contraception is not contra-indicated in most rheumatological conditions including inactive systemic lupus erythematosus. Moreover, hormone therapy is generally not contra-indicated except for women with active systemic lupus erythematosus disease where its effect on disease flare is less clear and individual judgement is required.

Although women frequently associate skin issues with menopause and hormone replacement therapy (HRT), little work has been done to investigate a possible relationship. A questionnaire was given to women attending a specialist menopause clinic; 87 women responded. Skin problems generally were common, with over 64% of respondents reporting past problems. Around half felt that the menopause had resulted in skin changes; dry skin was the predominant complaint at this stage. However, use of HRT in the short term did not result in any conclusive trends in skin condition in the majority of users.