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Rapid Responses: Rapid Responses published:
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Bad Business Option
- Laurie R Davis (1 September 2007)
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Voicing women´s experiences
- Sylvia Groth, Éva Rásky, Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsstrasse 6/I, 8010 Graz, Email: eva.rasky@meduni-graz.at (20 September 2007)
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Laurie R Davis, GP South Hermitage Surgery , South Hermitage, Shrewsbury sy3 7js
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Dear Sir, Dr Rose raises the interesting issue of the very low useage of IUCD/IUS in the United States. In a private healthcare system,it would be a bad income generating option to give a contraceptive with very little follow up for 5-10yrs.It wouldn't generate many clinic visits or prescriptions.So it would be in the Gynaecologists financial interest to continue to discourage their useage, whilst to continue recommending annual cervical smears and mammograms in low risk women. Financial incentives and disincentives to doctors must be a factor in the wide variation in international useage. Yours Sincerely Laurie Davis Competing interests: Father of a IUCD failure |
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Sylvia Groth, executive secretary of the women´s health center in Graz 8010 Graz, Joanneumring 3, Éva Rásky, Institute of Social Medicine and Epidemiology, Medical University Graz, Universitaetsstrasse 6/I, 8010 Graz, Email: eva.rasky@meduni-graz.at
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Dear editor, this is an experience based letter supported by the evidence of research data. As a long time women’s health activist and counsellor and as a physician of social medicine, we are strangely affected by the article of Sally B. Rose on Pain and Heavy Bleeding with Intrauterine Devices. Given the general safety, availability and low cost of NSAIDs, Rose advocates its use while having the devices in place. Instead of analysing risks and benefits of intrauterine devices Rose elaborates on the utility of painkillers (NSAIDs) needed to counter, or rather endure, possible and frequent side effects of intrauterine devices. Both copper devices and levonorgestrel intrauterine systems are known to cause menstrual changes and pain. The latter IUD is documented to cause reduction of libido, acne, mood changes, pelvic bleeding and pain, ovarian cysts and breast tenderness in a considerable number of women, up to 25% of the users (Backman, 2004; Backman, 2005; Lethaby et al., 2006; Suhonen, 2004; Vercellini, 2005). Such research results are supported by a non representative online questionnaire evaluation of 1700 women reporting their experiences with the levonorgestrel intrauterine system (http://www.fgz.co.at/Angebot.198.0.html). Reiterating the efficacy and cost effectiveness of IUDs without taking into account the large number of documented adverse effects and direct experiences reported by women is not in the best interest of the users. This argument is exacerbated by the fact that women in developing countries have far fewer financial means, contraceptive options and medical support in case of adverse effects. It is not NSAIDs which help. It is adhering to informed consent prior to use. This includes information on adverse affects. And it encompasses taking serious women´s experiences by implementing an adverse reaction reporting system of health professionals and of consumers. (http://www.hc-sc.gc.ca/dhp- mps/medeff/report-declaration/form/index_e.html ) References Backman T. Benefit-risk assessment of the levonorgestrel intrauterine system in contraception. Drug Safety 2004, 27: 1185-1204. Backman T, Rauramo I, Jaakkola K, Inki P, Vaahtera K, Launonen A, Koskenvuo M. Use of levonorgestrel-releasing intrauterine system and breast cancer. Obstetrics and Gynecology 2005; 106: 813-817. Lethaby AE, Cooke I, Rees M.. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD002126. DOI: 10.1002/14651858.CD002126.pub2 Rose, SB. Pain and heavy bleeding with intrauterine contraceptive devices. BMJ 2007; 335: 410-411. Suhonen S, Haukkamaa M, Jacobsson T, Rauramo I. Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study. Contraception 2004; 69: 407- 412. Vercellini P, Viganó P, Somigliana E. The role of the levonorgestrel- releasing intrauterine device in the management of symptomatic endometriosis. Current Opinion in Obstetrics and Gynecology 2005, 17; 359- 36. Sylvia Groth
Éva Rásky
Competing interests: None declared |
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