Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Menstrual cups and IUD displacement
Menstrual cups are an increasingly popular alternative to tampons and sanitary pads for a number of reasons, including reduced cost and environmental impact. Some concerns have been raised however about a possible link to intrauterine device (IUD) displacement, either via the suction effect on removal of the cup or by accidental IUD string pulling. This French case-control study aimed to measure the association between IUD displacement and menstrual cup use.1 In 731 patients followed up post-IUD insertion, 47 (6.4%) had their IUD in a non-adequate position on transvaginal ultrasound. The proportion of menstrual cup users in those with adequate IUD position was 17.1% compared to 40.4% in those with a non-adequate IUD position, with an adjusted odds ratio of 3.13 (95% CI 1.55-6.25). This may be something worth counselling patients on in coil fits, though of note this sample was predominantly copper IUD users so it’s unclear if the same results would be present in those with hormonal IUDs, though it seems likely they would.
Deprived area GP retention
Menstrual cups are an increasingly popular alternative to tampons and sanitary pads for a number of reasons, including reduced cost and environmental impact.
The inverse care law persists in UK primary care, with fewer full-time equivalent GPs per unit of population in the most compared to the least deprived areas. Rather than exploring push factors causing doctors to leave organisations in deprived areas, which are well documented, this qualitative study in England explored the factors that made them want to stay.2 Participants were recruited from four areas with 100 doctors interviewed. One overarching theme was autonomy and opportunity enabling retention. A second was the importance of feeling valued in retention, with a particularly interesting quote reflecting on the overall concept: “Retention: what does that mean? Does it mean having someone in a job forever, even though they’re miserable? Is it retaining them for a year, is it retaining them for 5 years? I wouldn’t use the word retention. I think I would say “nurture and sustain”: that’s what I would use. You don’t retain your kids, do you? You nurture and you sustain them and support them.”
Endometriosis diagnosis
Diagnostic delays in endometriosis are common, with estimates of time from first symptoms to diagnosis ranging from two to thirteen years. This Australian mixed-methods survey study aimed to explore whether people with endometriosis felt diagnosis was important and to understand why patients felt diagnostic delays occurred.3 Participants were recruited via social media as well as endometriosis and pelvic pain organisation websites. The mean reported diagnostic delay was 12.3 years but was shorter for those whose year of first GP presentation was later, suggesting diagnostic delays were shortening over time. The most commonly reported reason for diagnostic delay selected by 85% of participants was ‘Doctor dismissal/disbelief’. Almost all participants felt formal diagnosis was important for reasons including internal and external validation, targeted treatment, and preparation for potential fertility issues.
Diagnostic delays in endometriosis are common, with estimates of time from first symptoms to diagnosis ranging from two to thirteen years.
Patient assertiveness
This study in the Netherlands aimed to investigate the role of assertive behaviour from patients in video-recorded GP consultations, and whether patient assertiveness influenced outcomes.4 Behaviours they were interested in included disagreeing, making a request, making a decision, stating a preference, introducing a new topic, and offering a suggestion. Patients exhibited two assertive behaviours per appointment on average, with two thirds of these initiated by the patient. The most common behaviour was introducing a new topic, which occurred in almost half of consultations and was patient-initiated in over 90% of cases, for example in a consultation for a skin problem: “And then I had another question, I’ve had heavy legs for a long time”. Patients who received treatment (planned follow-up or a prescription) or a referral to secondary care were more frequently assertive than patients with other outcomes.
References
1. Claire J, Mir S, Dumortier I, Liard R, Yavchitz A, Le Cossec C, Picard H. The use of a menstrual cup as a risk factor for displacement of intrauterine devices: a case-control study. Contracept Reprod Med. 2025 May 6;10(1):33. doi: 10.1186/s40834-025-00366-3. PMID: 40329407; PMCID: PMC12053853.
2. Brewster L, Mumford C, Patel T, Chekar CK, Lambert M, Shelton C, Lawson E. Retaining doctors in organisations in socioeconomically deprived areas in England: a qualitative study. BMJ Open. 2025 May 8;15(5):e100694. doi: 10.1136/bmjopen-2025-100694. PMID: 40345694; PMCID: PMC12067819.
3. Mosterd D, Evans S, Van Niekerk L, Skvarc D, Leonardi M, Stanley K, Mikocka-Walus A. ‘A name to the pain’: A mixed methods analysis of diagnostic delay and perceptions of diagnosis importance in Australians with endometriosis. J Psychosom Res. 2025 May 7;193:112143. doi: 10.1016/j.jpsychores.2025.112143. Epub ahead of print. PMID: 40347539.
4. Cariot L, Noordman J, Leemrijse C, van Ginkel M, van Dulmen S. Patient assertiveness and visit outcome in primary care: An observational study. Patient Educ Couns. 2025 Apr 17;137:108789. doi: 10.1016/j.pec.2025.108789. Epub ahead of print. PMID: 40253736.
Featured Photo by Reproductive Health Supplies Coalition on Unsplash
