Family Planning and Sexual Health

Lead: Professor Judith Stephenson

Currently, there are two major initiatives underway

UK Clinical Research Network of Community Based Sexual Heath Services

Contraception related research in the UK is a neglected area. A newly established UK Clinical Research Network of Community Based Sexual Health Services aims to address this gap by conducting high quality, multicentre studies to help understand people’s contraceptive choices, optimise use and develop/strengthen the infrastructure for clinical research in this subspecialty.

The Network will:

• Harness expertise of leading clinicians and scientists to address research questions that guide clinical practice.

• Centralise academic and administrative co-ordination

• Engage more effectively with the pharmaceutical industry.

• Focus initially on optimising use of contraception in order to reduce the risk of unintended pregnancy and abortion.

Studies in Progress

Combined Oral Contraception (COC) is a very effective and commonly used form of contraception, but up to 50% of women discontinue the pill each year. Problematic bleeding patterns are a common reason for stopping the pill.

We are conducting a multi-centre trial (RfPB funded) to examine the effect of “tailored” (i.e. extended use with pill free intervals triggered only by bothersome break through bleeding) vs. standard use of Microgynon 30 to determine the effect on continuation rates and side effects at one year.

We hypothesise that “tailored” use of the pill will produce the desired combination of fewer withdrawal bleeds overall and less irregular bleeding.
We are conducting a survey of all Contraceptive Service Leads in England, Scotland and Wales to describe aspects of abortion care that are or could be delivered by Community Services. The survey will identify perceived barriers to and views on developing better abortion care in community based Sexual and Reproductive Health Services.
IUD/IUS are highly effective, long-acting, reversible methods of contraception, and increasing uptake of these methods among women in the UK and elsewhere will reduce unintended pregnancies. Fear or experience of pain during insertion constitutes an important barrier to uptake of these methods. Reliable evidence about reducing pain or discomfort during insertion is essential 1) to improve the experience for women having an IUD/IUS fitted and advise them appropriately, and 2) to provide more evidence based guidelines for health care professionals in IUD/IUS insertion.

We are setting up a double-blind trial of local analgesic gel vs. placebo gel to reduce pain/discomfort during IUD/IUS insertion.

Future Developments

There is a lack of evidence to substantiate the difference in perceived and actual side effects of different combined oral contraceptives. However, the cost of different brands varies ten-fold.

We have applied for HTA funding to conduct a triple-blind trial of the three most commonly prescribed COC formulations in the UK, to determine the best first and second-line formulations in terms of lowest side effects, discontinuation at six months and risk of unintended pregnancy.

STI/PID

Pelvic inflammatory disease (PID) is a major problem in women’s health, leading to serious complications such as tubal infertility, chronic pelvic pain and ectopic pregnancy.

One of the established causes of PID is genital Chlamydia infection. The DH has invested heavily in a National Chlamydia Screening Programme (NCSP) to reduce the risk of PID but efforts to monitor the impact of the NCSP are severely hampered by the notoriously imprecise diagnosis of PID that is based on non-specific symptoms and signs.

We are using basic science methods to identify biomarkers of acute PID (using serum proteomics) and link pathological changes in the upper genital tract to gene expression analysis and immunological responses to infection. This work is combined with microbiological research to study the role of other putative infectious agents and clinical research with advanced imaging techniques (MRI) to further improve the diagnosis of acute PID.

Through this translational research programme, we aim to discover non-invasive biomarkers of PID, advance the clinical management of PID and pave the way for robust assessment of the public health impact of NCSP.