{"paper_id":"8cdd6b4f-6022-45cb-8752-16e50dbd0f9c","body_text":"Y onder\nMenstrual cups and IUD\ndisplacement, deprived area\nGP retention, endometriosis\ndiagnosis, and patient\nassertiveness\nMenstrual cups and IUD\ndisplacement. Menstrual cups are an\nincreasingly popular alternative to\ntampons and sanitary pads for a number\nof reasons, including reduced cost and\nenvironmental impact. Some concerns\nhave been raised, however, about a\npossible link to intrauterine device (IUD)\ndisplacement, either via the suction\neffect on removal of the cup or\nby accidental IUD string pulling. This\nFrench case-control study aimed to\nmeasure the association between IUD\ndisplacement and menstrual cup use.1\nIn 731 patients followed up post-IUD\ninsertion, 47 (6.4%) had their IUD in a\nnon-adequate position on transvaginal\nultrasound. The proportion of menstrual\ncup users in those with adequate IUD\nposition was 17.1% compared with\n40.4% in those with a non-adequate\nIUD position, with an adjusted odds\nratio of 3.13 (95% confidence  interval\n= 1.55 to 6.25). This may be something\nworth counselling patients on in coil\nfits,  though of note this sample was\npredominantly copper IUD users so it’s\nunclear if the same results would be\npresent in those with hormonal IUDs,\nthough it seems likely they would.\nDeprived area GP retention. The inverse\ncare law persists in UK primary care, with\nfewer full-time equivalent GPs per unit\nof population in the most compared to\nthe least deprived areas. Rather than\nexploring push factors causing doctors\nto leave organisations in deprived\nareas, which are well documented, this\nqualitative study in England explored\nthe factors that made them want to\nstay.2 Participants were recruited from\nfour areas, with 100 doctors interviewed.\nOne overarching theme was autonomy\nand opportunity enabling retention. A\nsecond was the importance of feeling\nvalued in retention, with a particularly\ninteresting quote reflecting  on the\noverall concept: ‘Retention: what does\nthat mean? Does it mean having someone\nin a job forever, even though they’re\nmiserable? Is it retaining them for a year,\nis it retaining them for 5 years? I wouldn’t\nuse the word retention. I think I would\nsay “nurture and sustain”: that’s what I\nwould use. You don’t retain your kids, do\nyou? You nurture and you sustain them\nand support them.’\nEndometriosis diagnosis. Diagnostic\ndelays in endometriosis are common,\nwith estimates of time from first\nsymptoms to diagnosis ranging from 2 to\n13 years. This Australian mixed-methods\nsurvey study aimed to explore whether\npeople with endometriosis felt diagnosis\nwas important and to understand why\npatients felt diagnostic delays occurred.3\nParticipants were recruited via social\nmedia as well as endometriosis and\npelvic pain organisation websites. The\nmean reported diagnostic delay was\n12.3 years but was shorter for those\nwhose year of first  GP presentation\nwas later, suggesting diagnostic delays\nwere shortening over time. The\nmost commonly reported reason for\ndiagnostic delay selected by 85%\nof participants was ‘Doctor dismissal/\ndisbelief’. Almost all participants felt\nformal diagnosis was important for\nreasons including internal and external\nvalidation, targeted treatment, and\npreparation for potential fertility issues.\nPatient assertiveness. This study in the\nNetherlands aimed to investigate the\nrole of assertive behaviour from patients\nin video-recorded GP consultations,\nand whether patient assertiveness\ninfluenced  outcomes.4 Behaviours they\nwere interested in included disagreeing,\nmaking a request, making a decision,\nstating a preference, introducing a new\ntopic, and offering a suggestion. Patients\nexhibited two assertive behaviours per\nappointment on average, with two-thirds\nof these initiated by the patient. The most\ncommon behaviour was introducing a\nnew topic, which occurred in almost half\nof consultations and was patient-initiated\nin over 90% of cases, for example, in\na consultation for a skin problem: ‘And\nthen I had another question, I’ve had\nheavy legs for a long time’. Patients who\nreceived treatment (planned follow-up or\na prescription) or a referral to secondary\ncare were more frequently assertive than\npatients with other outcomes.\nAlex Burrell\n(ORCID: 0000-0003-0800-3452) GP in Bristol\nand Associate Editor at BJGP Open.\nEmail: alex.burrell@bristol.ac.uk\nThis article was first  posted on BJGP Life on 7 Jul\n2025; https://bjgplife.com/yonderaug25\nDOI: https://doi.org/10.3399/bjgp25X743025\nReferences\n1. Claire J, Mir S, Dumortier I, et  al. The use of a\nmenstrual cup as a risk factor for displacement\nof intrauterine devices: a case-control study.\nContracept Reprod Med 2025; 10(1): 33.\n2. Brewster L, Mumford C, Patel T, et al.\nRetaining doctors in organisations in\nsocioeconomically deprived areas in\nengland: a qualitative study. BMJ Open\n2025; 15(5): e100694.\n3. Mosterd D, Evans S, Van Niekerk L, et al. “A\nname to the pain”: a mixed methods analysis\nof diagnostic delay and perceptions of\ndiagnosis importance in Australians with\nendometriosis. J Psychosom Res 2025; 193:\n112143.\n4. Cariot L, Noordman J, Leemrijse C, et al.\nPatient assertiveness and visit outcome in\nprimary care: an observational study. Patient\nEduc Couns 2025; 137: 108789.\nY onder: a diverse\nselection of primary\ncare relevant research\nstories from beyond the\nmain stream biomedical\nliterature\nLife & Times\nBritish Journal of General Practice, August 2025 LIFE & TIMES  | 369","source_license":"CC0","license_restricted":false}