Unpacking Health Headlines: Contraception, Brain Tumours, and GLP-1 Medications and Smear Test Changes

Recent social media claims about contraception and health risks require careful examination, as medical headlines often lack crucial context that healthcare professionals need to provide to patients.

• The claim that "contraceptive injections increase brain tumour risk" refers specifically to benign intracranial meningiomas, with risk increasing from 0.01% to 0.04%
• Average age of women in the depo-contraceptive/meningioma study was 57.6 years, when guidelines already recommend switching from depo around age 50
• GLP-1 medications (like Ozempic and Mounjaro) require reliable contraception during use and for two months after discontinuation
• Mounjaro specifically decreases oral contraceptive effectiveness, requiring either non-oral contraception or barrier methods during titration periods
• UK cervical screening now moves to 5-yearly for HPV-negative results due to HPV vaccination success reducing cervical cancer by 90%
• Scotland reports zero cervical cancer cases in women vaccinated since the 2008 HPV vaccination programme began
• Any concerning symptoms warrant immediate investigation rather than waiting for routine screening appointments
• Self-testing options for cervical screening are being piloted to improve the current 64-65% uptake rate

I'll link all resources mentioned in the description. Feedback and suggestions are welcome through the anonymous message function above the description.

BMJ Study Depo - Use of progestogens and the risk of intracranial meningioma: national case-control study | The BMJ

FSRH Statement Depo - FSRH CEU Statement: Response to new study by Roland et al (2024) | FSRH

Pfizer Statement Depo - Medroxyprogesterone_acetate_-_Risk_of_meningioma_and_measures_to_minimise_this_risk_-_to_publish.pdf

FSRH Statement GLP-1 and oral contraception - CEU-statement-GLP-1-agonists-and-contraception.pdf

FSRH Patient info leaflet GLP-1 - Patient-information-GLP-1-agonists-and-contraception.pdf

UK Gov info GLP-1 - GLP-1 medicines for weight loss and diabetes: what you need to know - GOV.UK

BMJ Extention to Cervical Screening - Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data | The BMJ

Eve Appeal Info Smears - Cervical screening moving to every five years in England  - The Eve Appeal

HPV Self testing study info - HPValidate cervical screening self-sampling study publishes final results – UK National Screening Committee

Chapters

• 0:00 Introduction to Recent Medical Changes
• 1:56 Depo Contraceptive and Brain Tumour Risk
• 6:03 GLP-1s and Contraception Interactions
• 11:17 Smear Testing Going Five-Yearly

Transcript

Ashleigh: 0:06

Hello and welcome to Generally Practising with me, Ashleigh. So another big week for changes and things, and I wanted to cover a few things that I've seen actually on social media. Now, I don't really use social media all that much, aside from following some of the professional bodies and sort of faculty and professional pages. I really only use my social media for the forums, the you know, the practice and forums. I don't use it personally a huge amount at all. But I have seen a lot relating to women's health recently and so I wanted to cover things that I've seen sort of relating to depo-contraceptive and benign intracranial meningioma, depo-contraceptive and benign intracranial meningioma, glp-1s and contraception and, very briefly, july changes. Obviously, everyone got together and decided that all the changes would be great to implement all in one go.

Ashleigh: 1:40

Okay, so I'll kick off with something I saw on a non-medical social media platform sharing that, and I quote, contraceptive injection increases your risk of brain tumour. So I thought I'd unpick this. Firstly, this is a normally benign and relatively rare type of tumour called a benign intracranial meningioma. So the study Roland et al 2024, was conducted to look into the use of progestxyprogesterone acetate, cdepo and promagestone was found to be associated with an increased risk of meningioma. The study did find no increased risk associated with the intrauterine contraceptive system, but the progesterone-only oral contraceptive was not included in the study, so nothing for oral, you know, like you'd use a gastro. So as a result of this, the Faculty of Sexual and Reproductive Health therefore produced a response and they concluded that, while the case study shows a small increase in risk of meningioma in women using certain progesterones, the average age of the woman in the study was 57.6 years old, and the number of women exposed to medroxyprogesterone acetate so your depo was low. Interestingly, if you look at the study, the baseline risk for meningioma with no progesterone use was 0.01% and with the use of the depo was 0.04%. So the FSRH will continue to monitor the evidence regarding progesterone use and the risk of meningioma, and so at the minute, their recommendation relating to our practice is that, well, no significant change in practice is recommended. They do suggest that this information is included in discussions with patients regarding risk and benefit of various contraceptive methods. It is also worth noting, as we remember, that the FSRH would anyway recommend we counsel patients to move on from depo use to another method after the age of 50. And so quite interesting that the average age of women in the study was 57.6. So that might be relevant, possibly. We obviously wait for further studies and further research.

Ashleigh: 4:50

Pfizer, who obviously manufacture our Depo contraceptives, have advised that Depo for contraceptive use is ceased if diagnosed with meningioma. What we would traditionally call Depo in terms of contraception is actually used in oncology for other indications and so in those instances Pfizer recommended that that's assessed on a case-by-case basis and it wouldn't be us making those decisions anyway. That's going to be secondary care, but I just thought that was something I have actually had a patient ask me. I have actually had a patient ask me because she had seen on social media platforms this about, you know, depo and brain tumour risk. She'd seen that, so she asked when she came for a depo. Okay, I'll look into that a little bit more and was able to show her the FSRH's response and have that discussion with her. Okay.

Ashleigh: 6:04

So on to GLP-1s and oral contraceptives. Think, first and foremost, the most important thing that we should be telling any patients that are taking GLP-1 medications, regardless of indication for that use. We should be advising that they are avoiding pregnancy, that they have a reliable method of contraception, and that really is because it's currently not advisable to fall pregnant on a GLP-1 and to use reliable contraception for two months after ceasing these medications, although technically that does vary slightly depending on the specific brand of GLP-1. However, to avoid confusion, the maximum time advised to defer trying to conceive is two months and so because that's the longest recommended interval between ceasing and trying to conceive is two months and so because that's the longest recommended interval between ceasing and trying to conceive. That's what I've been discussing with patients and it really is because there just isn't enough safety data available at the minute and some potential risks, most commonly relating to low birth weights, that have been found in animal studies. So, again, there's been a lot in the media about, you know, glp-1s and patients taking these for weight loss accessing them privately, and now the instance of pregnancy is a result of this, and so it really is recommended that we inquire about the potential use of GLP-1s at all contraception initiation or review appointments.

Ashleigh: 7:55

Now, specifically, monjaro, which is Terzepatide, is the specific brand of GLP-1 that has been found to decrease the effectiveness of oral contraception. So the other brands, azempic and Wagovi there hasn't been as much data there to suggest that they also have this effect, although, again, you know it's having the conversations with patients, and so, for Monjaro specifically, the recommendation is to either actually switch to a non-oral method of contraception while they're using that of contraception while they're using that, or to use barrier methods for four weeks after initiation and for four weeks after each dose titration. Now, bearing in mind how these medications are titrated up, that's going to be a lot of barrier method use, and so I'd really be counselling patients on if they are confident that that is going to be a sustainable way of ensuring pregnancy prevention for them. Now the FSRH have compiled quite a nice patient information leaflet that I think is really quite useful and obviously, as with all the other bits and bobs that I've sort of talked about, I'll pop a link to that in the description. But I think practice-wise we need to think how we ensure we're asking about GLP-1 use in routine consultations with patients and then, within your own individual practices, deciding how you're going to record if these patients are taking these medications, as not only can this impact contraception, but the presence of those medications can influence other prescribing decisions, and also we know that there's various side effects associated with them, so it can also aid in diagnosis as well if we're aware that patients are taking these medications, and so I do think it is important to decide within your own practice how you're going to record if patients are taking these medications as a air quote hospital issue drug. Now, I know they're not issued by the hospital often they're private but we felt that that was the only way that we're gonna. We can record it on EMIS as a medication and that way it allows the. The emus is prescribing support regarding interactions. You know that the flags and the pop-ups for things, uh, so that would flag up any potential issues there, um, and it'll it'll sort of list on the medications but it's not actually prescribed by the practice and we do make make that very clear in the annotation that it is for information only. But I would just have a way within your practice of recording these medications if they are used, so that we're aware when we're having consultations with patients that there could be some interactions with the medications. So smear testing Now July seems to be the month for changes with the child ins and everything, so smears change into five yearly for those who are HPV negative, and it is really important to note that this is only for HPV negative samples, negative um samples.

Ashleigh: 11:44

So previously, obviously anybody under um 50, so sort of you know um they would be recalled every three years. Now this is going to be every five years, so all smears will be five yearly if they are HPV negative. If they're HPV positive, then the the recall is systems that are in place aren't going to change for those higher risk patients. Now I do have to be honest. I was a little bit taken aback to see this information for the first time saying that it was going to be five yearly on NHSUuk's social media page. So I personally think that it was fairly poor that that were the timing of that public post being before the official webinar for professionals who take smears. But hey ho, obviously there was a lot of negative response to that on social media and I think we really need to look at why these changes have come about.

Ashleigh: 12:59

So, having read a little around this and obviously this is before the, the webinars come out, so I might have to amend some of this after so I'm going to be fairly vague, but I have done a little bit of reading around this and this change has been driven essentially by the effective implementation of the human papilloma virus vaccination campaign, which started back in 2008 and has successfully reduced instances of cervical cancer. Super interesting, the HPV vaccination programme has cut instances of cervical cancer by 90% in England and, even more interesting, scotland has not reported a single case of cervical cancer in women vaccinated since the vaccination programme commenced in 2008. So that's fantastic in itself. Now, actually, primary HPV screening has been found to be 20% more sensitive than traditional cytology screening, and so this has led to better detection.

Ashleigh: 14:11

It is also important to remember that HPV associated cancer changes take a long time to develop. It can be sort of over 10 years those changes take to develop, um, and so it is that persistent HPV infection, uh, that does significantly increase the risk. But, as always, as we would do with any other condition, if somebody has concerning symptoms, um, then that warrants investigation, not routine screening. If we're remembering that the smear campaign is a routine, it's a screening, it's, you know, it's essentially designed to catch people that don't yet have symptoms. So any concerning symptoms, then we should be investigating that and we should be doing sort of onward referrals as appropriate for investigations, sort of onward referrals as appropriate for investigations.

Ashleigh: 15:11

Again, interestingly, unfortunately, the uptake for smear testing in the UK sits at sort of around a 64-65% uptake on the screening test. So there is further consideration for self-testing and the NHS has already undertaken some pilots, some studies and looked at the potential implementation of this. And while we don't have anything as of yet I don't know if we'll find out more in the webinar about that being rolled out there is the potential that soon that will be offered as well. So, as always, I will link as much as I can in the descriptions to help with finding resources. Any feedback or suggestions would be gratefully received. You can use the send a message function above the description. Don't worry, it's not a real text and it is all anonymous. I do hope this has been helpful and happy practicing.