62 e-Letters

  • Home use of misoprostol: is it really safe and appreciated?

    Regarding the Scottish decision on home abortion of 26th October 2017, Lord J, Regan L, Kasliwal A, et al. claim that "Home use of misoprostol in Scotland is relatively new. The larger abortion services in Scotland report widescale uptake of home use of misoprostol among women and that it is highly appreciated with no negative impact on services." The Scottish “abortion services” consulted are not named and the reference for the bold claim that home use of misoprostol is “highly appreciated” is “S Cameron [co-author], personal communication 2018”. Such statements do not inspire confidence.

    In response to some other claims made in the article: women having better control over timing in practice will mean less precision in timing, since medical supervision is supposed to guarantee ‘correct’ time between drugs and a ‘correct’ route of administration, whether sublingual, buccal or vaginal. If these are departed from, the effectiveness goes down, and the complications go up. This is well-known.

    As regards travel and onset of bleeding, the Creinin paper [1] referred to by the authors had a bleeding onset median time of 2 hours for the standard (misoprostol taken 24 hours after mifepristone), and 3.7 hours when mifepristone and misoprostol were taken together. Others state that the onset of bleeding with the standard regimen was after 2 hours and meant light to moderate spotting at 4 hours after misoprostol [2]. Depending on the travel time, there m...

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  • Comment on "Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review"
    Julie Ancian

    The article of Frances Doran and Susan Nancarrow [1] suggests that there is a need for more research about the barriers to access to abortion services in developed countries. I totally agree with this finding, especially for qualitative research, and would like to provide a point of view from France.

    As part of my doctoral research on the social determinants of reproductive health, I attended the trial of Domin...

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  • "Mandatory counseling" is a misnomer
    Christian Fiala

    Counseling is voluntary by definition. A person being 'counseled' can leave at any time and without any consequences. If 'counseling' is mandatory it becomes in fact a state ordered instruction. Like for example in the case of obligatory military service. We as society should at least have the courage to name things with their correct terminology. And not pretend to 'counsel' women if in fact we force them to listen to an...

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  • Response to Mini-Commentary on 'Would an exclusive contraceptive clinic help meet the needs of patients attending an integrated sexual health clinic?'
    Diana Mansour

    It was interesting to read Sharon Moses' thoughtful commentary questioning the role of an 'express' contraceptive service in a community sexual health clinic and advocating improving contraceptive provision in primary care, the primary provider of contraception in the UK.[1] My colleagues in Newcastle, however, support this service innovation as they feel that women in their late teens and early twenties have been overl...

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  • Comment on 'Abortion care services delivered from a community sexual and reproductive health setting: views of health care professionals': authors' response
    Lucy Michie

    We thank Dr Kell and Ms McMahon for their comments[1] on our article[2] and for sharing their experience of running an abortion service from a community setting. It is reassuring to learn that both staff and patients welcomed this service and that contraceptive provision and sexually transmitted infection diagnosis have improved as a result. We hope other clinicians providing abortion care services may be encouraged to c...

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  • Comment on "Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives": authors' response
    Luis Bahamondes

    We thank to Dr Pillai for her letter[1] about our review article entitled "Practical advice of pain associated with insertion of intrauterine contraceptives".[2] We would like to make the following comments regarding the specific points Dr Pillai raised in her letter.

    1. Dr Pillai suggests that clinicians may wish to sit on a stool with wheels at the side of the couch rather than with the woman at the end of the...

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  • Comment on 'Practical advice for avoidance of pain associated with insertion of intrauterine contraceptives'
    Mary Pillai

    Congratulations are due to the authors for producing much needed guidelines.[1] These are necessarily a consensus owing to the lack of quality studies on pharmacological interventions. Since 2009 I have provided a referral service for intrauterine device (IUD) problems, and currently manage 400-500 referrals per year for failed insertion or removal, or a history of severe pain and/or vasovagal syncope (VVS). Women referr...

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  • Entonox for the relief of pain or anxiety during IUS/IUD fitting
    Eppy Sewell

    Following a 7-month trial on the use of Entonox for the relief of pain or anxiety during intrauterine device (IUD) or intrauterine system (IUS) fitting, we now offer this method of pain relief to all women attending for an intrauterine procedure. It is available to any patient who wishes to use it but its use is entirely optional. Entonox can be used alongside other analgesics and there is no need for the woman to decide...

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  • Comment on 'Abortion care services delivered from a community sexual and reproductive health setting: views of health care professionals'
    Philip Kell

    We read with interest the article by Michie et al. in the October 2013 Journal.[1]

    We are delighted that our colleagues at a sexual and reproductive health meeting are supportive of the concept of running an abortion service from a community setting. In Torbay we have been running such a service for some years originally delivered by BPAS and now delivered, for the last 12 months, by the integrated Torbay Sexual...

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  • Comment on 'Embracing post-fertilisation methods of family planning: a call to action': authors' response
    Elizabeth G Raymond

    Dr Gordon is uncomfortable with a family planning method that exerts its effect after fertilisation.[1] However, a new study, published after our personal view article was already in press, suggests that many women feel differently.

    This study surveyed 1137 women from randomly selected households in five European countries in 2008.[2] Overall, 41% of the respondents said they would consider using a method that...

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