ABSTRACT
OBJECTIVES: The increase in intrauterine devices (IUDs) contraception, and the growing use of reusables menstrual hygiene products such as the menstrual cup, necessitates an assessment of the implications of their co-use. The objectives are to assess whether women with IUDs who use menstrual cups have an increased risk of IUD expulsion and/or a change in the risk of upper and lower urogenital tract infections compared to women who use other menstrual hygiene products. METHOD: An observational, prospective, multicenter study was conducted in France between 2020 and 2023. Participants were recruited by health professionals and data were collected by telephone questionnaire at the time of IUD insertion and at one year. The primary endpoints were the occurrence of IUD expulsion and the occurrence of urogenital tract infections in menstrual cup users compared to non-users. RESULTS: One hundred and three women out of 119 included were analyzed, 25 of them were regular menstrual cup users and five experienced IUD expulsion. Among regular users, 12% experienced IUD expulsion compared to 2.6% among non-users, with no statistically significant difference (Chi2 = 3.65; p = .056). Regarding urogenital tract infections, nine women (36%) of the regular menstrual cup users had urogenital infections, compared with 27 (34,6%) of the non-users or not regular users, with no statistically significant difference. CONCLUSION: The tendency of menstrual cup users to expel their IUDs is a reason for caution, although it is not sufficient to contraindicate co-use. Physicians should therefore systematically screen such co-use and inform patients of the risks and monitoring instructions.
ABSTRACT
BACKGROUND: Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. METHODS: Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. RESULTS: The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor's practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP's position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. CONCLUSION: This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.
