Woman's Hour - Breast cancer drug approved, Women and contraception, Grief and music

Episode Date: April 11, 2025

A new type of drug for one of the most common types of breast cancer is now going to be available in the NHS in England. In Wales, the drug is approved for use but its funding is still to be decided, and the drug hasn't been approved for use in Scotland and Northern Ireland yet. Some 3,000 women a year could benefit after a clinical trial showed it can slow the progression of the disease. Nuala McGovern discusses how the drug works and who could benefit with Dr Liz O'Riordan, a former breast cancer surgeon who herself has had breast cancer and is currently in remission.Emily MacGregor is a music historian and trombonist. After the sudden death of her father, a jazz guitarist, she found she wasn’t able to bear the sound of music. The very thing that once connected them became a source of pain and silence. In her new book, While the Music Lasts, she explains how she reconnected with her father through the pieces left on his music stand, from tangos to Handel, Cádiz to Coltrane. She joins Nuala to talk about how she learnt to navigate grief and how she discovered the joy of music again.Between 2021 and 2022 the number of women having abortions rose by 17%. A recent study in the BMJ reported that, amongst women having abortions, the number of women using hormonal contraception fell from 18.8% in 2018 to 11.3% in 2023. Over the same period, the number of women undergoing abortions who were not using any contraception when they conceived went up by 14%. So are women turning their backs on hormonal contraceptives? Does this change lie with the contraceptives themselves, women’s access to contraception or could there be other factors like the increase in the use of fertility apps? Nuala speaks to Dr Paula Briggs, Consultant in Sexual & Reproductive Health, and journalist Barbara Speed.In 2014, the Church of England passed the necessary laws to allow women to become bishops. For some, this was a controversial decision. In an attempt to smooth that change the five guiding principles were introduced which allowed those who felt unable to accept women’s ministry to flourish within the church. Now WATCH, Women and the Church, are calling for those provisions to be removed. Nuala speaks to Reverend Martine Oborne, Chair of WATCH, and Dr Ros Clarke, Associate Director of Church Society. Presenter: Nuala McGovern Producer: Emma Pearce

BBC Sounds music radio podcasts. Hello, I'm Nuala McGovern and welcome to Woman's Hour from BBC Radio 4. Just to say that for rights reasons, the music in the original radio broadcast has been removed for this podcast. Hello and welcome to the programme. Well, as you were just hearing in the news bulletin there, this has been called a great success story for British science. The new drug just approved for use by the NHS expected to help thousands of women with

advanced breast cancer. We're going to get into the details this hour. Also today, falling out of love with music when you're a musicologist, Emily McGregor will be with us to speak about her memoir of music, grief and joy. It is a beautiful book. Plus, we'll discuss women in the Church of England. A campaign to end the provisions to provide for those unable to accept women's ministry in the church was launched by the group Women and the Church, called WATCH.

We're going to hear the debate for and against. And contraception. I want to hear your stories this morning. Do you feel like you have enough options? What did or do you choose and why? Well, the British Pregnancy Advisory Service has issued a report that says in the 60 years since the pill first ushered in the sexual revolution, there has been remarkably little contraceptive innovation.

Some might disagree with that. We'll hear views about what is on offer, including the rise of fertility awareness apps. Is that something you use? Why? Also, how has it worked for you? Well, you can text the program, the number is 84844 on social media,

we're at BBC Woman's Hour, or you can email us through our website. For a WhatsApp message or a voice note, the number is 03700 100 444 looking forward to hearing all of your stories but I mean begin with that good news that we're mentioning a new type of drug for one of the most common types of breast cancer it's now going to be available on the NHS in England. In Wales the drug is approved for use but its funding is still to be decided so its availability may differ to England.

The drug has not been approved for use in Scotland or Northern Ireland yet. There are thousands of women that could benefit from this pill. This is after a clinical trial showed it can slow the progression of the disease and shrink tumours in a quarter of people. Here to tell us more is Dr. Liz O'Riordan. She is a former breast cancer surgeon and she herself has had breast cancer and is currently in remission. Great to have you back with us Liz. Welcome this morning. First the name of the drug and also how it works. So the name of the drug is Capivacetib but it's also known as TruCap and it's

incredible how it works. Cells in your body have proteins that send signals to make them grow and one of those proteins is called AKT and the body phosphorylates it a bit like having a pen and clicking it which switches on and what that does is send a signal to cells saying grow, repair, heal all the damage. Now in some cancers that are sensitive to estrogen they have a mutation in one of three genes and they're AKT, PIC3CA and P10 and those genes mean that that protein or that pen is permanently clicked on so it's constantly telling cells grow grow grow grow grow which is really bad if you've got cancer. Now this new drug cap capybacetib, stops that pen being clicked, it stops that protein being activated. So the cells have lost one of the signals telling them to grow.

And it's just incredible, over the last 20 years from cracking the 3D structure, we now have a drug that can give women with incurable breast cancer that's sensitive to estrogen at least an extra four months of life before their cancer starts to grow again. And so I mentioned in broad strokes Liz some of the figures. How would you describe what has happened in these trials? It is game-changing. There's been an awful lot of new drugs for breast cancers that are triple negative or are sensitive to aseptin but not many for the kind of breast cancer that I have and it is the commonest. And sadly with the drugs, the cancers that are sensitive to herceptin but not many for the kind of breast cancer that I have and it is the commonest. And sadly with the drugs the cancers that are sensitive to hormones they eventually develop resistance and they keep growing and growing. But to find a drug that can shrink

those tumors that can give you an extra at least four months of life without worrying about it is just incredible because every day counts. You've briefly referred to yourself there. I mean, is this a drug that would affect you? Potentially in the future. I've had two local recurrences and I know I have a genetic mutation and it's pretty standard now to test advanced cancers for this. My cancer is likely to come back

and just knowing that there is a drug in the future that can keep me alive for longer, oh, it's incredible. It really, really is. Tell me a little bit more about that feeling, because you're somebody who's so immersed in it, who has been so helpful to so many, always offering information and help and advice and guidance. It's really hard because that fear is always there. You're almost, it's today the day it comes back,

but you don't want it to come back because you don't know how long you have and you worry and when you're immersed in this world we see people dying all the while but there are women like Trisha Goddard who's now on Celebrity Big Brother showing that you can live an incredible life with metastatic breast cancer so every drug that helps me carry on living it's just it's amazing and I hope in the future, this will be rolled out to every woman in the UK who needs it. You also mentioned there briefly 20 years. Yeah. So in 2002, a scientist at the Institute of Cancer Research first developed a 3D structure of this protein

that enabled them to figure how it works and then come up with various drug compounds. And it was AstraZeneca who developed the drug that we now have. This is how long it takes. So I did a PhD, Nuala, back in 2002 the same time looking into a protein that makes thyroid cancer grow. I'm now taking a drug to stop that cancer developing my breast cancer growth. It's just incredible but it takes a long time. Research needs our money so we can keep breaking drugs onto the market. And for somebody like you who's in this world,

did you know this was potentially being announced? Like have you been following it each step of the way for us, for Manny, maybe? We see a headline and we're like, oh wow, as if this is not an overnight success, but you get my drift. Yeah, so I knew there were trials being developed at places like the Marsden and hospitals all over the UK so I knew the results were coming through but then

we're dependent on NICE and drug companies to say yes this drug is worth the money to do it and I had the joy of finding out last night that it was coming out today so I could get videos ready to explain it but you're hoping that the trials will work and it's not going to be a no and oh it's just great when it happens. So let's put this in the context of what else you are seeing, watching, following. Are there other developments that you're excited potentially about? There are, there are vaccines being developed for people who have her2 positive breast cancer that have the potential to slow down the growth. And her again is estrogen? It's called Herceptin,

so it's a nuclear signal that stimulates about 20% of breast cancer cells to grow. You have the three main types of estrogen receptor positives that are fed by hormones, so a lot of women like me are made menopausal, so we have no estrogen to slow down the growth. There's another receptor called HER2, and people have drugs like Herceptin and there are vaccines being developed. Then there are women who don't have those receptors called triple negative and there's been five new drugs for that cancer in the last eight years and there is so many drugs coming through and with personalized molecular medicine based on testing, I'm so excited to see what happens in the future. I mean how do you compare the landscape now compared to 20 years ago?

It's changed completely. Back then hertipositive breast cancer was almost a death sentence. It spread to the brain, it was really really aggressive but now there are so many drugs to slow its growth it's almost a good type of breast cancer to have. People are living for 15 years like Chris Alenga did the founder of Copperfield. It's no longer one or two years when you have metastatic breast cancer. There's a chance it may become a chronic disease in the future or we can actually stop it spreading and I never thought I'd say that 20 years ago. Amazing and Chris Alleng of course such an amazing warrior and a person who grew awareness as well in those years did so

much. What advice would you give to women listening perhaps that have gone through this that are in the thick of it at the moment? Yeah so I'd say if you if you have primary breast cancer that hasn't spread, most women don't get a recurrence and most women don't die of it. Which is great news. Which is fantastic. I don't think we shout this enough, that survival rates have doubled over the last 50 years and more and more people are living longer and longer and longer.

If your cancer has spread, it's worth checking with your oncologist to see if you have a mutation and you might be eligible for this drug. And if you were scared of it coming back like I am, we just don't know what the future holds. It could be next year there's another five drugs that will keep us alive for as long as possible. There is hope. What a lovely message to end on Dr Liz O'Riordan. Thank you very much for coming on. We wish you all the best with your health and everything else. Find Liz online where she describes course, so many of the developments that are happening and the good news stories that are also coming in. You want to get in touch 84844 is one way to do it. Now, it is curious that we don't understand why music can tip us over the edge.

So writes Emily MacGregor in her memoir, While the Music Lasts. Emily is a musicologist and she found that after the sudden death of her beloved father, she wasn't able to listen to music. Music became instead of a source of joy, a source of pain and silence. Well, Emily is in studio with me this morning. Good morning, welcome. Good morning, thanks so much for having me. So your book, the full title, While the Music Lasts, a memoir of music, grief and joy, the grief, as I mentioned, referring to your father.

Can you explain briefly what happened to you? Yes, so my father died very suddenly in 2019. He had pancreatitis and he died within 48 hours of being diagnosed. He'd been fine and he was dead. And after he died, I went into this period where I felt incredibly numb. I think it's very normal. I was incredibly angry. And I just like one of the things I was most angry

with was my was music was classical music. And I found I couldn't listen to it at all. I spent a couple of years just listening to podcasts. And obviously, like not being able to listen to classical music was, well, music was a huge problem given my job. And I mean, there was a line in your book that said after your father died, the day you wake up after he has died, that it was the first day of your rest, of the rest of your life and the first day of a new relationship to music. Did you expect that at all, that your

relationship with music would change after your father died? I know you were not thinking about your father dying at that stage or in your mid-30s. He was only late 60s. Yeah, no, I wasn't, I mean, I wasn't expecting him to die. So I think my relationship with music and how I felt about that came much later. I think it was the shock for the first couple of years. I mean really the first couple of years. And then it was noticing how angry I was with all the rules and all the ways in which I felt I sort of learned to behave. I had like this sense, I think there's this nihilistic thing that

happens after a major loss, where all the things you think mattered stop mattering and you start to see all the rules you've internalized and that hold you down and keep you in your place for what they are. And I guess I was super angry with that and so that realizing that all those rules you know aren't always all they're cracked up to be was something that really helped me improve my relationship with music further down the line. Your father was a jazz guitarist I should say as well so it was a real bond between the two of you as well as it being a major part of your day-to-day life. It was really I suppose from when you were a little girl. For sure yeah my dad as you say was a jazz

guitarist he also played classical music as a guitarist although he had complicated attitudes towards classical music in general and we found it all tricky and elitist but no music was very much the sound track to me growing up it was what encouraged me to to be curious to be curious about the world and I was very much encouraged to go into music what was your dad's name he was called Phil tell me a little bit about him my My dad was, I mean, I think he was amazing because he was my dad. He was the best. Yeah, and he was someone you could call up whenever you wanted and he'd always be interested in what you thought. He was also totally infuriating. In what way? He sort of, he saw the world laterally in a way that I think

people, even people who see the world laterally would struggle to understand how my dad saw the world. Like he had no time at all for bourgeois norms. Like if he finished eating a banana and he was like holding the banana skin, he would just put it down wherever, like didn't matter if he was putting it down on top of a laptop. That was like very much the vibe of my dad. Yeah. He, you know, he was everywhere obviously, even after he died. Particularly, I get this picture of the home with piles of books and newspapers and also a music stand full of sheet music that he was working on that became a source of pain, of course, for you as well. But tell me a little bit about how important that stand became in this journey that you went through.

Yes, so when we got back from the hospital that day, the house was exactly as he'd left it because he'd just sort of been almost teleported out of life and that was very hard. And there was this music that he'd been working on that week that he'd been rehearsing and it was called Rumores de la Caleta by Isaac Albainith. It took me a long time to go back to that music, to look at that music on the stand. It's a very beautiful flamenco inspired piece from southern Spain and when I did finally listen to other people's recordings of this, I found it really hard because they didn't play it like he did. And I felt I was beginning to lose my ability to hear him playing the music.

I do have a little clip of it. Is it okay if I play some of it? Yeah, of course. Yeah, I just want to let people know as well. I was listening to this while reading your book. There is a playlist at the beginning that accompanies the book. Such a beautiful way to read. We can talk about that because I often have a problem listening to music while I'm reading, but not in this particular instance. Let's listen to a little bit of that track, Remoris de la Caleta, Isaac Albanis, but played here by David Russell. So beautiful. So listening to that, reading what you were going through

with your father, played there by David Russell, Rum Aorais de la Caleta by Isaac Albanese. But that's not your dad playing, so I'm wondering what that did. I think it just emphasised actually in lots of ways. It's like the closest thing you can get to him being in the room, but it's not him being in the room. It's like the outline of something next to it. But isn't that grief in a room, but it's not him being in the room. It's like the outline of something next to it. But isn't that grief in a way, I think, because you can come oh so close to the person and feel their presence or see the items that belong to them, but it's not them, which can be quite jittering. It doesn't make, it's like all the things don't make sense without that person there who's the

organizing principle around which like they all belong. And it's the same with music. It's yeah, it's close to having him, but it's very much not the same. You tried to, and I'm using your words in a way here in one of your chapters, like almost embody him in a way in trying to figure out where he went, what made him tick. You actually went down to Andalucía, down to Seville and Cadiz where that piece was written. Did you find solace? Sort of. So I travelled, yeah, I travelled to Spain. I stayed with very old friends and I visited the actual beach that this piece is about. Well, at least I thought at the time that it was the actual beach.

Turned out it wasn't, it was a different beach. So that was a sort of interesting challenge to my kind of academic way of approaching, in some ways approaching my grief. I don't know quite what I thought I was going to get out of going to Spain. It was a place, my father just before he died had suggested a family holiday, Seville.

So I think I sort of wanted to try and recreate that. I think it was a way of trying to hold on to his memory in a way that I think was actually just never going to be what I wanted it to be. But because I did go, I had this amazing opportunity to spend time with my friends and it became clear to me that what really mattered was actually continuing to deepen and build relationships and being open to the fact that life's all about change. And, you know, I don't know what to do with that, but it's okay. So you begin seeing this glimmer. I'm also interested in your thoughts on what you think music does to our sense of time. I think it's very interesting because it can pull us back, you know, it pulls us back into a past.

When we hear something. When we hear music, yeah, particular music that we associate with a particular time in our lives. It pulls us back into a past, but it pulls us back into a past where we, like, we can feel a future because music is always pushing us forward when we're listening, when we're inside a musical experience. And I think, personally, that's one of the reasons that music is so powerful in terms of connecting us to people we've lost because we feel ourselves in that moment in the past while we're listening, when we were you know teenagers or in

our early 20s, whenever it was. But we feel ourselves in that moment anticipating a future. You went to the Royal Albert Hall, no surprise there in a way, you're a musicologist, you played the trombone, music was a huge part of your life, but it was there that you realised you'd fallen out of love with music and I'm wondering what that was like after being a musicologist and it being part of your identity. Absolutely, yes. I was at the Royal Albert Hall listening to a Proms concert and they

were playing a Mozart piano concerto and I honestly couldn't think of anything more pointless than sitting in this concert hall with 5,000 people who were all behaving themselves, like sitting really quietly. I just felt like there was this sort of grand stupid and I actually was feeling like, you know what, I want to just stand up and shout that this is all pointless because I have this sense that, like, what would really happen? You know, the worst happened, my dad's died, people can die. Like, if I stand up and people are cross with me because I've shouted in the middle of a concert, like, the consequences didn't feel like they really existed, which was a very, it was in lots of ways, like, quite a profound thing to realise

when I'd spent so much of my life following rules. But that is a big, that is a big loss as well as that of your father, that of the importance of music within your life. Absolutely, yeah. I didn't really know, I think in lots of ways it was sort of a moment that shook the foundations of my identity. I didn't really know who I was anymore if I didn't have music. And I was also struck by some other aspects you mentioned briefly there you listen to podcasts but that you immersed yourself in TV that helped with the grief but not reading or music. What do you think that is? I think TV moves you forward in a way that's distracting.

That was my sense. I watched a lot of thrillers. I watched a lot of crime. I watched a lot of things where there was a lot of plot. But yes, it was mostly about being taken somewhere else in a way that I didn't have control of. Whereas reading, you're in control. Like you determine the time frame. You also need a concentration. I also read that you don't like the word,

or hate, what did I read that? The word grief. Yes, I always felt like it was sort of, it just feels like quite clunky and like a word I never thought would really apply to me. I think I come from a family where there's quite a lot of distaste for, I don't want to say emotions, but like, like it's quite a... Can be emotions. But it's quite, it feels like when I say it, it feels like there's something clogging my throat. It feels like a word that doesn't apply to me and it feels like a word that couldn't possibly apply to my father. He was like too cool for the idea of grief, I think. Because you have to be so vulnerable if

you're grieving. Exactly. There is, when you were looking, I think it was when you were putting the music together for the funeral perhaps, you were at a laptop and you said you're not sure why it seemed so important to be in control. Yeah, absolutely. Have you reflected on that? Because I think a lot of people do try and be in control after something terrible has happened, as if that's a laudable goal. Well, I think that part of the being in control played out in why I couldn't listen. Like that was why I couldn't listen to music. Because you would lose control. Exposed too much vulnerability. Yeah. Yeah. It was why, you know, I didn't want to hang out with my friends. Why I just wanted to sit by myself watching television. Yeah. I want to read a message that's just come in from Zoe in Cumbria. She says, my dad and I shared a love of music and it was an important part of our relationship.

After he died, it took me eight years to start listening to music and stop avoiding it. Finally, after 10 years, I've started to listen to what he and I used to and enjoy it. What did it take for you? It took listening to it, but that sounds obvious, but it took travelling to a space where I had felt close to him. So I went to the town of Sherbourne where we'd been on a music summer school together. I'd worked on it, he'd taken a jazz course and being in a space where I felt like I could properly engage with his memory but by myself on my own terms it was an amazing space. I was in Sherbourne Abbey, it's cavernous, It's enormous You get this sense of your own transience, even though I'm not religious

It's this feeling that you're like existing on a in a layer at the very top of history and you're gonna pass too And just listening listening there. It was incredibly moving. It was incredibly sad. But since that point I felt more able to it was incredibly sad. But since that point I felt more able to listen to music and I think it's helped me to let go of a lot of the baggage I had associated with music as an expert and as a trained classical musician and come back to music through a sort of lens of curiosity. But you're not playing the trombone I understand. I'm not playing the trombone no. Why?

I have too, I still have too much baggage associated with the trombone. The trombone is an instrument that if you want to be like at a really high level you need to be practicing one or two hours a day and I just, if I play I just feel like really frustrated with the sound that I make. Maybe you're more like your dad than I realise. Because just to give people the backstory, you haven't read your book yet, that your dad never really, I was going to say blew his own trumpet. But he never really, you know, put forward what a great musician he was. I didn't really know what a great musician he was because he never said.

But it should have been obvious from listening to him play. But like he wasn't doing the things that I associated with being a good musician. He wasn't doing grade exams. He'd never done any of that like institutional stuff. And so, you know, it was almost a surprise to learn after he died, like what an incredible musician everyone thought he was, like what a natural he was. I am sorry for your loss. I wonder, I mean, some people do feel there is, which I think you do too, there's a before and after, a big loss. And I wonder what you want people to take away

or learn perhaps from what you've gone through. I think that the rules that you think, like that you maybe don't even notice are there, that you've internalised, they don't matter all that much. And you can, like, in terms of playing music, you can play, like, it's all about curiosity and exploration and play. Like, the words in playing music, it's about play, it's about exploring. And I think, I don't know, like, I came back to music in this new and curious way and I think that can apply to anyone. Lots of us have an instrument that we started learning when we were a child or sold or locked

away in an attic. And the fun, sometimes we think that we can't call ourselves musicians, but the fun is in the process. Definitely. I'm sure that resonates with a lot of people that play you know, play in whatever respect that they would never call themselves a musician. Yeah, but you don't have to, you don't, like, I think we need to re-evaluate our ideas around achievement in relationship to music. The fun is in the process, like so many things in life. Like it's about doing it. Sure, maybe one day, you know, if you work really hard

for years and years and years, you'll play a concerto in a concert hall, but that happens to hardly anybody. Like the joy is in connecting with people and communicating and exploring and just like seeing what noises you can make like that. That is the fun of music. Let's see what noises we can make. Yeah, but that is it. Really beautiful book as I've mentioned a couple of times. Thank you so much for coming into us. That is Emily MacGregor and her memoir is While the Music Lasts. I want to turn to contraception. I've been asking for your experiences.

If you want to get in touch, again, the number to text is 84844 on social media, we're at BBC Woman's Hour, or you can email us through our website for a WhatsApp message or voice note. That number is 03 700 10444. Many of you getting in touch already. I can see I'll read some of your messages in just a moment. We are focusing today on hormonal contraception and fertility tracking apps. There are many more methods of contraception including the barrier methods but we will touch on them briefly. But

part of this story is that we know between 2021 and 2022, the number of abortions performed in England and Wales rose by 17%. A recent study by the British Pregnancy Advisory Service, published in the British Medical Journal, found that significantly fewer abortion patients report using effective methods of contraception. They also reported an increased use of fertility awareness-based methods. Now here are some of the figures from that study. Among women having abortions hormonal contraception use fell from 18.8% in 2018 to 11.3% in 2023. So we're looking at a drop of 7.5%. Over the same period the number of women undergoing abortions who were not using any contraception when they conceived went up by 14%. So the question may be are

women turning their backs on hormonal contraceptives? If so, why? Does this lie with the contraceptives themselves, women's access to contraception, or could there be other factors like changing attitudes or the increased use of fertility apps? It is a very personal decision. It's one we can discuss now with Dr Paula Briggs, consultant in sexual and reproductive health and the journalist Barbara Spej. You're both very welcome to the programme. I'm curious, Paula, have you seen a change in attitudes towards contraceptives over the past few years?

Yeah, I think there's definitely been a move away from hormonal contraception and I find that quite hard to understand because HRT seems to be very popular and these hormones are not dissimilar. Obviously HRT doesn't provide contraception but there are newer combined pills for example which have virtually the same hormones in them so it does seem difficult to understand. I mean the demographics would be different for those on HRT and younger women of course, which we can get to as well. But I want to bring in Barbara because you wrote a piece for The Guardian that you said contraception, and I quote, is going backwards.

Why do you say that? So yeah, I was really with, I mean that headline is kind of focusing on the the drop-in Uptake and I really want to emphasize that that I think there are lots and lots of options around and what? Seems to have happened is perhaps after that questioning greater questioning of hormonal contraception that we seem to be seeing People seem to maybe be going to other methods But perhaps going to nothing at all and that is what I was trying to get out there, that what is this kind of lost group who seem to, as we're seeing this growing group of people

who were on no form of contraception. And it's worth emphasizing that that survey, that no main form of contraception didn't include apps, it didn't include fertility awareness, that is people, it didn't include condoms. That's people saying, I am using nothing, which feels like quite a stark place for us to be. Paula, your thoughts on that? I think, yes, there are people not using contraception.

And I think the assumption often is that they will not become pregnant. And I think when we were talking before about HRT, the number, the increase in the number of women having or presenting for abortion is across the board. So, it's women in their teens, 20s, 30s and 40s. And particularly that group, the older women who may perceive themselves to be perimenopausal, they're still fertile.

And there are some fantastic hormonal contraceptive choices with added non-contraceptive benefits. And that would address some of the gynecological conditions which are difficult for women to get treatment for so it's a really important conversation that we're having. Now let me turn to some of the specifics on this. We know that what a woman wants from a contraceptive for example can

change over time, we're kind of touching on that a little, but perhaps one of the issues might be the contraception a woman uses at one point of her life might be appropriate for another. So if it's a teenager or young people, Paula, what do you think might be the best contraception available? Well the contraceptive method they want and I think personal choice is so important. So that kind of understandable discussion about the contraceptive menu is very important. We know that long acting reversible contraceptive methods are associated with a lower failure rate because you take the user out of the equation and that includes intrauterine

devices whether they're copper or they have a hormonal core, injectable contraception and implants but if the individual doesn't want them or they're not counselled properly about bleeding patterns for example they're not going to keep it and actually sometimes I think women do not want to be dependent on a health care professional for their contraception. And that might be one of the reasons why they're turning to apps because they can access these without any medical intervention. Barbara, you're nodding there.

Yeah, I think that that definitely resonates in that, you know, if I think about my own experience, I have kind of went on what was really an odyssey of trying different things and they and a few things genuinely didn't work for me I couldn't have a coil fitted because and my body reacted extremely strongly my blood pressure was dropping they had to kind of cancel the procedure I had an in-arm implant that also didn't work for me it really messed with me. A piece of spaghetti you said sticking out of your arm. Very technical term there. And so what I remember really distinctly at each of those points was really great care

from the medics around me, but nobody kind of jumping in and saying, right, what's the next choice? What do we try next? And getting that feeling of discouragement of just, okay, back I go to Google, I need to go on the NHS website and try and work this out. And so again, I'm sure that's due to kind of time pressures and, and obviously the health services is really struggling, but I think a bit more just conversation and helping women with what can be

a real search for the right thing for them, I think would maybe help to bridge some of this gap. I'm just some of the comments that are coming in. Just want to read a couple of them to you. I tried natural contraception in my 20s but sadly fell pregnant at the time, became homeless, I opted to get the copper coil, synthetic hormonal options have always made my mood super unstable, many physical problems, while getting my IUD inserted I also obtained a CPTSD for the experience, it's due to come out but I can't make it to the doctors without

getting a panic attack, I regret choosing this option. I mean, coming back to that, Paula, it kind of ties in with the health care professional, perhaps, or why people are not followed up with or more options offered to them in certain cases. I think it depends where you go to seek contraceptive advice. You know, it could be a specialist service, a sexual health service, brook advisory service, or it could be the GP. And you know, in general practice, there will be some amazingly well-trained

and capable GPs, but you know, general practice is so wide, it's difficult for everyone to be an expert on everything. And I think, you know, when we talk about the pill, and I think we have to recognise that the pill was probably the single most significant advance of the 20th century because it liberated women and it gave them freedom, it gave them choices and the women at that time tolerated unbelievable side effects because they were just so glad to be in control of their fertility. But following on from that, the pill is not one thing. It's at least, I don't know, 20 plus different hormonal combinations.

And the person that you're talking about there with the copper and tree shrine advice, she may benefit from some of the newer pills which contain natural estradiol, estetrol, which is a safer estrogen. And so I think it would be great to have better conversations with women about different hormonal combinations and ones which specifically add additional benefits,

reduction in bleeding, that's often associated with a reduction in pain and help managing things like polycystic ovarian syndrome, fibroids, endometriosis, all of these common gynaecological problems which it's difficult for women to access good care for. And I should repeat of course to go to your GP for further information and advice on any of these particular methods. But I do want to go back again to the various demographics. We spoke about younger people, you talked about the contraception that suits them. I mean it could be the same advice perhaps given to these other

groups but it can be different as things change. For example women who are interested in conceiving in the near future Paula. Yeah I think if you want to conceive in the near future, Paula? Yeah, I think if you want to conceive in the near future, you don't necessarily want to have to go somewhere to have a copper IUD or a hormonal IUD removed or an implant removed. You don't want to wait for your injection to wear out because that can take up to a year, although it only provides 12 weeks contraceptive cover.

And so the pills do offer a lot more flexibility. And in addition to newer combined pills, we also have newer progesterone only pills. And when we take estrogen out of hormonal contraception, that reduces the risk for women who have risk factors, which includes migraine, being overweight, having high blood pressure or a family history of blood clots. So I suppose the point I'm making is there are lots and lots of different choices. It may be that LARC, long-acting reversible contraception, is better for teenagers if they want it. As women sort of move into their late 20s, early 30s and they're hoping to conceive, then they

go with a user-dependent method. And there is a higher failure rate with that, but if a pregnancy is on the agenda, then method failure is less problematic. Yeah, possibly. And of course, there are barrier methods as well. We're not concentrating on them as much today. Comment coming in, hormones are literally the basis of who we are as people. Messing with them can make you feel like a completely different person. Myself and many of my female friends have given up hormonal contraceptives because we've had too many periods in our life feeling mentally awful because of them. What do you make of that comment, Barbara?

And then I'll come back to Paula. Yeah, I think it's it's a it's a anecdotal anecdotally. I've heard that from a lot of people. I've spoken to you and when I've done reporting on this subject, this comes up a lot. And I think it's worth emphasizing that those really serious mood side effects will affect kind of a reasonably small proportion of people but if those people aren't then helped to find another alternative or if somebody who is looking for their own research looks online, there's a kind of negative aggregation effect where you're going to hear a lot more of those stories than you are going to hear about

stories where it went well. So I think it's a shame that people sort of left in that situation without kind of a positive way to go. Because you may have a self-selecting group of people on any particular chat area etc within various sites. Paulie you're nodding ahead listening to that. Yeah, I mean, I'm just thinking about women with premenstrual disorders who have real difficulty tolerating their own reproductive cycle. And actually, sometimes we use combined hormonal contraception pills with a specific progesterone, the drosperinone, to manage some of their symptoms. So whilst I do appreciate what the listener is talking about, it may

just be that she hasn't been offered the right combination of hormones to suit her. So it doesn't mean that she can't have any hormonal contraception. But that is the path that she has taken. How easy Barbara was it to access appropriate contraceptives do you think? I found it reasonably easy but again my memory is of quite intensive research and booking of appointments on my part so again it did feel like something had to dedicate a lot of time and thinking to and again there might have been quite a wait for an appointment for the implant

for example and so again I can imagine especially with a very busy life or caring responsibilities it can be hard to kind of chase down all those leads as it were especially as wait times get a bit longer and GP services get even busier. We contacted NHS England to find out how best to access appropriate care and Dr. Claire Fuller of the NHS The National Medical Director of Primary Care said contraception should not be a taboo subject if you need support or advice Please come forward because NHS clinicians are on hand to offer their impartial expertise and have recently improved access to services They go on to say oral and long-lasting reversible contraception Which Paula mentioned is available from GPs, sexual health clinics and some

women's health hubs, while oral contraception is also offered at thousands of NHS pharmacies across England without the need to speak to a GP first. But Paula, what do you make of that, people accessing contraception without speaking to a GP? They don't need to speak to a GP, they might speak to a nurse or a pharmacist but I think having a conversation with somebody who has had training and who understands the different choices and the different combinations of hormones is important because otherwise you may make a decision that's not maybe based on the

the best information. I think you know we've kind of touched on what happens on social media and I think misinformation is commonplace and people would be better to speak to a healthcare professional of some description. I mean with that it is quite interesting, Barbara, you diving a little bit more into fertility apps. You can log periods on your phone, the app lets you know when to have sex or avoid having sex, depending on what you want to, whether you want to conceive or not. How do you understand the rise in popularity as it seems to be?

I think it's really interesting, and I do think it comes back to that point around where these conversations are happening and where people get their information because it's worth saying that the app use for contraceptive use specifically is quite small, it's maybe 4% of women using that, however, especially among younger age groups, like 70% are using an app to track their period. And so I do think if you're reaching a bit of a limit with your hormonal contraception, or you're not sure where to go next, you have these apps that feel quite familiar to you. I know that on social media, I'm served adverts for the, for these contraceptive apps all the time. They are kind of targeting women like me.

And so if that all feels very accessible and you can see really easily how it works, I can imagine that compared to trying to book a health appointment that you're not sure where it's going to be, that there is a real draw there for people who are not sure where to go next. Another message that came in, somebody who tried it all, they said, I've tried pill, copper coil, etc. I was using the apps. As it's not foolproof, I got pregnant. It wasn't the right time, so I chose to terminate. I had the Mirena coil inserted. During the procedure I logged my first period on an app, I still wanted to track etc. It didn't prompt or log anything regarding my short pregnancy. For an app designed for women and health

advice I was very disappointed to learn they offered no support or recognized a short pregnancy so how can they accurately track my cycle. So the stories continue to come in, many people on what they have used. Before I let you go, what do you think Paula of fertility apps as a form of contraception and how would you encourage women to find the contraception that's right for them? First of fertility apps it depends on the individual. They work better for women who have a regular cycle. You track your temperature and that has to be done daily.

It's a way of predicting ovulation and sex should be avoided around the time of ovulation. So if you're somebody who responds to a message saying you can't have unprotected sex at that time then they may well work well. But there is I think an increase in desire around the time of ovulation and it may be hard to resist or people may choose to use condoms which are not the best method of contraception. They have problems, they tear and therefore there is a higher failure rate. And women are only going to get pregnant around the time of ovulation, from just before to, you know, the actual window is very short.

So I think in highly motivated women with a regular cycle, not having much sex, they're okay. But really, they're not the best method of contraception, even though they can show that the failure rate is similar to that with the combined pill, that will be in that highly motivated subset of women who use them. So, you know, if pregnancy is definitely not desired, then I would encourage women to consider some of the more reliable options, particularly the long acting methods if they're willing to

consider those. Would that work for post childbirth and premenopausal women? Yeah, definitely. So things like an intrauterine device with Levener gestural in the core, 52 milligrams, that will allow women to surf between reproductive and post reproductive life and with a lot less problems they'll get a 90% reduction in bleeding, it can be used as part of HRT. There's nothing good about bleeding, that's the other thing I think you know the population thinks somehow that having periods is good for

them but it's not and historically women did not have the same number of periods because they were much more likely to be pregnant or breastfeeding so you know that can lead to anemia, depression and I think we can we can improve quality of life by getting the right contraceptive method for the individual and it's about tailoring it to their individual needs. Let me get your take Paul on one more story people might have seen in the papers this morning. A survey of 60,000 women across England in 2023 funded by the Department of Health and Social Care analyzed by academics at the

London School of Hygiene and Tropical Medicine found that 28% of respondents were living with a reproductive morbidity such as pelvic or organ prolapse, uterine fibroids, endometriosis, polycystic ovary system or cervical uterine ovarian or breast cancer. So over a quarter. Surprised? No, I'm not surprised and I feel that these women could have had a reduction in their symptoms by using contraceptive methods which reduce bleeding.

Most progesterone only methods will reduce bleeding significantly. It may take some time, but again like I said they're not associated with risk and for example with endometriosis by reducing or stopping bleeding that will reduce the risk of women developing adhesions and chronic pain. So I think the most important thing for women is that they are supported, that they're seen and they're listened to and that will take a good GP and good collaboration with secondary care. Thank you both so much for speaking to us and for everybody who's getting in touch that was Dr Paula Briggs and also Barbara Speed joining us on Woman's Hour this morning as we speak about contraception. Now over 10 years ago there was jubilation from some quarters when the Church of England,

we're talking about in 2014, passed the necessary laws to allow women to become bishops. For others this was a controversial decision. In an attempt to smooth that change, the five guiding principles were introduced, which allowed those who felt unable to accept women's ministry to, as the Church wrote at the time, flourish within the Church. Now Watch, that's a group for women in the Church, campaigned for equality of women, they say, and men within the Church of England. And they are calling for a date to be set when those provisions, the Five Guiding Principles, should come to an end. I am joined in studio by Reverend Martine Obern from the Chair of Watch.

Good morning. And also Dr. Roz Clark is joining us, Associate Director of Church Society, which describes itself as a fellowship contending to reform and renew the Church of England in biblical faith. But they are at different viewpoints when it comes to the Five Guiding Principles. Welcome to you both. Martín, some people will not be totally familiar with some of these aspects. Maybe you could give us a little bit of context to this campaign. I mentioned 2014, women were allowed to be bishops, but the five

guiding principles were put in place. You're not happy with that. No. The five guiding principles basically say the Church has made a clear decision to ordain women as priests and bishops and everyone needs to accept this, but on the other hand those who don't accept it are still part of the Church and it wants those who don't accept it are still part of the church, and it wants those who don't accept women as priests and bishops to flourish. That's basically it. And then it makes a whole load of provisions which enable churches or church leaders to discriminate against women in various ways. We're not happy about it because it's obviously unjust. I'd

say it's untrue to the Gospel and it's also unsafe. And frankly, discrimination does cause harm. It diminishes people, it erodes self-esteem and it also creates a kind of bedrock of sexism and misogyny. It's also exploitative. The Church is really quite greedy to use women's labour but won't give us the dignity or protection of equality. If I go to number four of the five guiding principles, I won't read them all out, but I imagine this is the one that maybe you're most against. Those unable to receive the ministry of women as bishops or priests are within the spectrum of Anglican teaching and tradition and will be enabled to flourish. Disagreeing with the decision remains a legitimate Anglican position and the Church of England

is committed to allowing those who disagree to flourish within its life and structures. Ros, let me turn to you. You have heard Martine set out her position. You don't agree with that. No, I think the five guiding principles follow on from the House of Bishops statement, which clearly says, as Martine has said, that the decision has been made. And we certainly accept that.

We are not campaigning for that decision to be changed, for women to no longer be allowed to be ordained or to be consecrated as bishops. We're simply asking to be allowed to continue to exist within the Church of England, to recognize that in fact the complementarian viewpoint is the majority viewpoint in the Church worldwide, in other denominations and other Anglican provinces. May I stop you there for a second? Could you describe a complementarian for those that aren't here? Yeah, of course. Complementarian theology is the understanding that God has made men and women to be equal in value and in status, but not interchangeable. And therefore that

God has given different roles to men and women, particularly within the Church. And usually we would see that expressed by not having a woman as the overall leader with spiritual responsibility for a congregation or a diocese. You talk about being in the majority globally, but within the Church of England, how would you say you're a representative? No, within the Church of England we're certainly a minority, and obviously that's why things have changed as they've done. I would say there are two main groups within the Church of England that fall into this category, traditional Anglo-Catholics, Complementarian Evangelicals, and together we represent five

or six hundred parishes, so maybe five percent of the total Church of England, congregation total of around 30,000-40,000 people. And what would it mean to you, Roz, if Martine, in fact, was successful in her campaign and that the five guiding principles were raised? Well, frankly, it would mean that many complementarians would no longer be able to continue ministering within the Church of England. It would mean that people would be forced to leave, to look to other denominations, and it would be very concerning, I think, because many of our churches are really thriving and flourishing, in particular amongst

children and young people, whereas in the part of the church that I'm from, the average number of under-18s in our congregations is 33 compared to a national average of one. So it seems to me it would be a really bad move for the church as a whole. So let's throw that, Ros, back to Martine, her concerns. Okay. Well, what I would say is that there's a lot of distortion here in using this term equality, in using the word roles. I mean, the thing is that if you are saying that women can't apply to be a vicar of a particular church, they can't consecrate the bread and wine, they can't preach that churches need a special male bishop if the bishop is female, all these things. If certain roles are available to men but not to women, then there is not equality.

And I think... But I suppose the interpretation of equality is different for you and for Ros. That I get immediately. Yes, but the thing is that we've got four or five percent of churches who are putting these limits on women's ministry, but they are some of the biggest churches in our country and they are, they're not at all transparent about their position on women's ministry. And there are many people, many, many people who go to these churches who know nothing about... What about if they were more transparent about their position on women's ministry? And I know they can be named a certain way and people might be sure about the language around that service that they're attending of actually

what their decisions are when it comes to women's ministry. Would that in any way? I think the thing is that discrimination is not just harmful for for people, but it actually creates an unsafe environment. I mean, all of the recent reports into child sex abuse in the church have flagged up that the church is concerned have been churches which have in some way excluded or diminished women's roles in the ministry of those churches. And on top of that... But we can't in any way prove a causation or a correlation. No, and I just want to say that's not entirely true. There are certainly examples of this in other churches as well.

But hold that stance for a moment. churches as well. But hold that stance for a moment. Furthermore, there is much evidence that understandings of male privilege, there's a correlation with violence against women and girls, and at the moment it's extremely hard for the church to speak into this position, situation, both in this country and around the world, because we're not even keeping the equalities legislation of our own country. What about, Roz, if there was a date in the future? Because I think you are looking in a way to set a date, Martín, and these things, you know, change, we're talking about over time. Over the past few decades there has been massive changes, many would say, within

the Church of England. Would you still push back against it, Roz? I mean, you are in the minority. We are in the minority. I just want to come back on something Martine said there. We absolutely are keeping the Equality Act 2010, in which religion is a protected characteristic as much as sex. And so there is exemption for ministers of religion. For example, there are no female Imams, as far as I'm aware, or other Jewish Orthodox churches don't have female rabbis. This is allowed within the Equality Act. We are not breaking that and we're not specially exempt as the church.

It may be that things change, and I don't want to be as arrogant as to assume that I am right on this issue, but I would point out that it is a relatively new viewpoint that women should be in these positions. And as I say, a minority viewpoint. I would not be as confident as Martín to say that this is therefore wrong and cannot be tolerated anymore. Martín, do you think, I've only got a minute, do you think you'll be successful? Yes, I hope that we will be successful. Give me a date.

The next five years. Roz and Martine will have to have you both back. We shall continue this conversation but it has been really interesting to hear your passion that you have about it. I'm sure many of our listeners as well. I do want to let people know on weekend Woman's Hour tomorrow the latest Doctor Who companion, Verardar Setu, on her new iconic character. We also hear from Isabel Quiroga, one of the lead surgeons in the UK's first successful womb transplant, resulting in the baby of baby Amy Isabel.

Yes, they did give her the second name after that amazing surgeon that helped make it happen. We'll hear all about what it takes to make history from her. Manny, very happy that we are talking about contraception today. Do keep your messages coming and we'll keep reading them. And I'll speak to you tomorrow on Woman's Hour. That's all for today's Woman's Hour. Join us again next time. I'm Joanna Page. I'm Natalie Cassidy.

And we want to tell you all about our podcast. Off the telly. It's basically both of us chatting about what we've been up to. On and off screen. It's just brilliant. Who and what we just can't resist. With plenty of behind the scenes stories and gossip. Yeah. Cracking, we always say cracking now. Really? Everything's cracking. It's definitely the place for what's occurring. Oh Jo, you do that so well. Off the telly. Listen to all new episodes on BBC Sounds.