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Abstract
There have been exciting new developments and research related to currently available contraceptives. In addition, in the last seven years, emergency contraception has gone from behind the counter to being FDA-approved for use. This issue addresses the most important clinical leaps in contraception and family planning in the last decade, with emphasis on new options for long-term, reversible contraception and emergency contraception. Information is also included to address the impact of Affordable Health Care and legal aspects of sterilization.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Contraception\r | i | ||
Copyright\r | ii | ||
Contributors | iii | ||
CONSULTING EDITOR | iii | ||
EDITORS | iii | ||
AUTHORS | iii | ||
Contents | vii | ||
Foreword: Contraceptive Needs—A Gateway to the Obstetrician-Gynecologist's Office\r | vii | ||
Preface: Contraception\r | vii | ||
Increasing Use of Long-Acting Reversible Contraception to Decrease Unplanned Pregnancy\r | vii | ||
Immediate Postpartum Intrauterine Contraception Insertion\r | vii | ||
Immediate Intrauterine Device Insertion Following Surgical Abortion\r | vii | ||
Therapeutic Options for Unscheduled Bleeding Associated with Long-Acting Reversible Contraception\r | viii | ||
Contraceptive Coverage and the Affordable Care Act\r | viii | ||
Over-the-Counter Access to Oral Contraceptives\r | viii | ||
Providing Contraception to Adolescents\r | viii | ||
Safety and Efficacy of Contraceptive Methods for Obese and Overweight Women\r | ix | ||
Contraceptive Method Initiation: Using the Centers for Disease Control and Prevention Selected Practice Guidelines\r | ix | ||
Why Stop Now? Extended and Continuous Regimens of Combined Hormonal Contraceptive Methods\r | ix | ||
Does the Progestogen Used in Combined Hormonal Contraception Affect Venous Thrombosis Risk?\r | x | ||
Emergency Contraception: Do Your Patients Have a Plan B?\r | x | ||
Sterilization: A Review and Update\r | x | ||
OBSTETRICS AND GYNECOLOGY CLINICS\r | xi | ||
FORTHCOMING ISSUES | xi | ||
RECENT ISSUES | xi | ||
Foreword : Contraceptive \rNeeds— A Gateway to the Obstetrician-Gynecologist’s Office | xiii | ||
Preface: Contraception \r | xv | ||
Increasing Use of Long-Acting Reversible Contraception to Decrease Unplanned Pregnancy | 557 | ||
Key points | 557 | ||
INTRODUCTION | 557 | ||
EFFICACY OF LONG-ACTING REVERSIBLE CONTRACEPTION VERSUS SHORT-ACTING METHODS | 558 | ||
BARRIERS TO USING LONG-ACTING REVERSIBLE CONTRACEPTION | 559 | ||
Women | 559 | ||
Providers | 561 | ||
Health Care Systems | 561 | ||
RESULTS OF INCREASED USE OF LONG-ACTING REVERSIBLE CONTRACEPTION | 562 | ||
Contraceptive CHOICE Project | 563 | ||
Iowa | 564 | ||
Colorado | 564 | ||
SUMMARY | 564 | ||
REFERENCES | 565 | ||
Immediate Postpartum Intrauterine Contraception Insertion | 569 | ||
Key points | 569 | ||
INTRODUCTION TO IMMEDIATE POSTPARTUM INTRAUTERINE CONTRACEPTION | 569 | ||
WHAT IS POSTPARTUM INTRAUTERINE CONTRACEPTION? | 570 | ||
WHY PLACE POSTPARTUM INTRAUTERINE CONTRACEPTION? | 570 | ||
HOW IS AN IMMEDIATE POSTPARTUM INTRAUTERINE CONTRACEPTION PLACED? | 571 | ||
WHAT IS THE RATE OF EXPULSION WITH IMMEDIATE POSTPARTUM INTRAUTERINE CONTRACEPTION? | 578 | ||
WHAT ARE OTHER COMPLICATIONS WITH IMMEDIATE POSTPARTUM INTRAUTERINE CONTRACEPTION? | 579 | ||
HOW TO DECIDE IF A PATIENT IS APPROPRIATE FOR IMMEDIATE POSTPARTUM INTRAUTERINE CONTRACEPTION | 579 | ||
REFERENCES | 581 | ||
Immediate Intrauterine Device Insertion Following Surgical Abortion | 583 | ||
Key points | 583 | ||
BACKGROUND | 583 | ||
CONTINUATION AND EXPULSION | 584 | ||
PREPROCEDURE PREPARATION | 584 | ||
Sexually Transmitted Infection Screening | 584 | ||
Antibiotic Prophylaxis | 585 | ||
Abortion Complications | 585 | ||
INTRAUTERINE DEVICE INSERTION AFTER FIRST TRIMESTER SURGICAL ABORTION | 585 | ||
Sounding (Assessing Uterine Size) | 585 | ||
Intrauterine Device Placement Technique | 585 | ||
INTRAUTERINE DEVICE INSERTION IMMEDIATELY AFTER SECOND TRIMESTER SURGICAL ABORTION | 586 | ||
Intrauterine Device Placement Technique | 587 | ||
ULTRASOUND GUIDANCE | 587 | ||
BLEEDING PATTERNS | 587 | ||
FOLLOW-UP | 588 | ||
SAFETY AND COMPLICATIONS | 588 | ||
Perforation | 588 | ||
Delayed Complications | 589 | ||
PATIENT EXPERIENCE | 589 | ||
SUMMARY | 589 | ||
REFERENCES | 589 | ||
Therapeutic Options for Unscheduled Bleeding Associated with Long-Acting Reversible Contraception | 593 | ||
Key points | 593 | ||
INTRODUCTION | 593 | ||
COPPER INTRAUTERINE DEVICE | 594 | ||
Interventions for Heavy Bleeding | 594 | ||
Nonsteroidal antiinflammatory drugs | 595 | ||
Antifibrinolytic agents | 596 | ||
Antidiuretics | 596 | ||
Summary of Recommendations for Heavy Bleeding with the Copper Intrauterine Device | 596 | ||
LEVONORGESTREL INTRAUTERINE DEVICE | 596 | ||
Treatment of Irregular Bleeding | 597 | ||
Nonsteroidal antiinflammatory drugs | 597 | ||
Antifibrinolytic agents | 597 | ||
Estrogen | 598 | ||
Antiprogestins | 598 | ||
Selective progesterone receptor modulators | 598 | ||
Summary of Recommendations for Unscheduled Bleeding with the Levonorgestrel Intrauterine Device | 598 | ||
ETONOGESTREL IMPLANT | 598 | ||
Treatment of Irregular Bleeding | 599 | ||
Nonsteroidal antiinflammatory drugs | 599 | ||
Matrix metalloproteinase inhibitors | 600 | ||
Antiprogestins | 600 | ||
Combination therapy: antiprogestins, estrogen, and matrix metalloproteinase inhibitors | 600 | ||
Summary of Recommendations for Unscheduled Bleeding with the Etonogestrel Implant | 601 | ||
SUMMARY | 601 | ||
REFERENCES | 602 | ||
Contraceptive Coverage and the Affordable Care Act | 605 | ||
Key points | 605 | ||
INTRODUCTION | 605 | ||
The Affordable Care Act, Preventative Health Care, and Contraception | 605 | ||
Medicaid Expansion and Family Planning | 607 | ||
Contraceptive Coverage Mandate Goal: Reducing Barriers to Effective Prevention | 607 | ||
STATUS OF THE CONTRACEPTIVE COVERAGE MANDATE IMPLEMENTATION: PROGRESS AND DELAYS | 608 | ||
No-Cost Contraceptive Coverage Expansion | 608 | ||
Medicaid Expansion and Expanded Contraceptive Access | 608 | ||
Limitations and Inconsistencies with Mandate Compliance | 608 | ||
Grandfathered plans | 608 | ||
Inconsistencies in compliance | 609 | ||
Legal Challenges to the Affordable Care Act | 609 | ||
Overall Challenges to Affordable Care Act Implementation | 610 | ||
Contraceptive Coverage Mandate Legal Challenges | 611 | ||
Challenges brought by nonprofit organizations | 611 | ||
Challenges brought by for-profit institutions | 613 | ||
Discussion | 613 | ||
REFERENCES | 614 | ||
Over-the-Counter Access to Oral Contraceptives | 619 | ||
Key points | 619 | ||
INTRODUCTION | 619 | ||
WOMEN’S INTEREST IN ACCESS TO HORMONAL CONTRACEPTION WITHOUT A PRESCRIPTION | 620 | ||
EVIDENCE REGARDING THE SAFETY AND EFFECTIVENESS OF OVER-THE-COUNTER ACCESS TO ORAL CONTRACEPTIVES | 621 | ||
EVIDENCE REGARDING ONGOING USE OF ORAL CONTRACEPTIVES IN AN OVER-THE-COUNTER ENVIRONMENT | 622 | ||
ADDITIONAL AREAS OF CONCERN RELATED TO A FUTURE OVER-THE-COUNTER ORAL CONTRACEPTIVE | 623 | ||
Cost and Insurance Coverage | 623 | ||
Adolescents and Over-the-Counter Access to a Future Oral Contraceptive | 623 | ||
Preventive Screening | 624 | ||
Lost Opportunity to Counsel About Long-Acting Reversible Contraception Methods | 624 | ||
Lack of Familiarity with Progestin-Only Pills | 625 | ||
PHARMACY ACCESS TO HORMONAL CONTRACEPTION | 625 | ||
SUPPORT FOR OVER-THE-COUNTER ACCESS TO ORAL CONTRACEPTIVE AMONG PROFESSIONAL MEDICAL AND NURSING GROUPS | 625 | ||
SUMMARY | 626 | ||
REFERENCES | 627 | ||
Providing Contraception to Adolescents | 631 | ||
Key points | 631 | ||
INTRODUCTION | 631 | ||
ADOLESCENT HEALTH | 632 | ||
Cognitive Development | 632 | ||
High-Risk Behavior | 632 | ||
THE ADOLESCENT REPRODUCTIVE HEALTH VISIT | 632 | ||
Confidentiality | 633 | ||
Sexually Transmitted Infections | 633 | ||
Sexual Behavior and Contraception | 633 | ||
CONTRACEPTIVE OPTIONS IN ADOLESCENTS | 633 | ||
Long-Acting Reversible Contraception | 633 | ||
Etonogestrel Implant | 634 | ||
Levonorgestrel Intrauterine Devices | 634 | ||
Copper Intrauterine Device | 634 | ||
Special Considerations for Use of Intrauterine Devices Among Adolescents | 635 | ||
Sexually Transmitted Infection Testing and Pelvic Inflammatory Disease | 635 | ||
Postpregnancy Insertion | 635 | ||
Progestin-Only Methods | 636 | ||
Depot medroxyprogesterone acetate | 636 | ||
Progestin-only pills | 636 | ||
Combined Hormonal Contraception | 636 | ||
Noncontraceptive benefits | 636 | ||
Side effects | 636 | ||
Combined oral contraceptives | 637 | ||
Contraceptive patch | 637 | ||
Contraceptive ring | 637 | ||
Barrier Methods | 637 | ||
REPRODUCTIVE HEALTH EDUCATION | 638 | ||
ACCESS TO CONTRACEPTION FOR ADOLESCENTS | 638 | ||
State Laws and Consent | 638 | ||
Insurance | 638 | ||
School-Based Health Centers | 638 | ||
Medicaid and Title X | 638 | ||
Examples of Successful Programs for Adolescents | 639 | ||
SUMMARY | 639 | ||
REFERENCES | 639 | ||
Safety and Efficacy of Contraceptive Methods for Obese and Overweight Women | 647 | ||
Key points | 647 | ||
INTRODUCTION | 647 | ||
DEFINING OVERWEIGHT AND OBESITY | 648 | ||
EPIDEMIOLOGY OF OBESITY AND UNINTENDED PREGNANCY IN WOMEN OF DIFFERENT BODY MASS INDEX GROUPS | 648 | ||
CONTRACEPTIVE USE AND SEXUAL BEHAVIOR IN WOMEN OF DIFFERENT BODY MASS INDICES | 649 | ||
CONTRACEPTIVE EFFICACY IN OVERWEIGHT AND OBESE WOMEN | 649 | ||
Pharmacokinetics, Pharmacodynamics, and Efficacy | 649 | ||
Intrauterine devices | 649 | ||
Implant | 650 | ||
Injectable progestins (depo medroxyprogesterone acetate) | 650 | ||
Oral contraceptives | 650 | ||
Vaginal ring | 651 | ||
Transdermal patch | 651 | ||
CONTRACEPTIVE RISKS RELATED TO OBESITY | 652 | ||
Guidance from the Medical Eligibility Criteria | 652 | ||
Risks for Venous Thromboembolism | 652 | ||
EFFECTS OF CONTRACEPTION ON WEIGHT | 653 | ||
SUMMARY | 654 | ||
REFERENCES | 654 | ||
Contraceptive Method Initiation | 659 | ||
Key points | 659 | ||
INTRODUCTION | 659 | ||
METHOD INITIATION | 660 | ||
SPECIAL CIRCUMSTANCES | 663 | ||
Postpartum | 663 | ||
Postabortion | 664 | ||
EXAMINATIONS AND TESTS PRIOR TO INITIATION | 664 | ||
Intrauterine Device | 664 | ||
Combined Hormonal Contraception (Pills, Patches, and Rings) | 665 | ||
FOLLOW-UP | 665 | ||
SUMMARY | 665 | ||
REFERENCES | 666 | ||
Why Stop Now? Extended and Continuous Regimens of Combined Hormonal Contraceptive Methods | 669 | ||
Key points | 669 | ||
INTRODUCTION | 669 | ||
DEFINITIONS | 670 | ||
DEVELOPMENT OF EXTENDED AND CONTINUOUS REGIMEN | 671 | ||
EFFICACY | 672 | ||
SAFETY | 673 | ||
BLEEDING PROFILE | 674 | ||
TREATMENT OF MENSTRUAL SYMPTOMS AND OTHER MEDICAL CONDITIONS | 675 | ||
PATIENT ACCEPTABILITY | 675 | ||
FLEXIBLE AND TAILORED REGIMENS | 676 | ||
NON-ORAL COMBINED HORMONAL CONTRACEPTIVES | 676 | ||
SUMMARY | 677 | ||
REFERENCES | 678 | ||
Does the Progestogen Used in Combined Hormonal Contraception Affect Venous Thrombosis Risk? | 683 | ||
Key points | 683 | ||
INTRODUCTION | 683 | ||
TYPES OF PROGESTOGENS | 684 | ||
PHYSIOLOGY OF COMBINED ORAL CONTRACEPTIVE USE AND VENOUS THROMBOEMBOLISM | 686 | ||
BACKGROUND RISKS | 687 | ||
Confounding Factors | 688 | ||
Risk of Venous Thromboembolism Associated with Starting or Switching a Combined Method | 688 | ||
Prescribing Effect | 689 | ||
THIRD-GENERATION AND FOURTH-GENERATION PROGESTINS: HISTORY OF THE CONTROVERSY | 689 | ||
The First Pill Scare | 691 | ||
The Second Pill Scare | 691 | ||
Contraceptive Ring and Patch | 692 | ||
Prospective Studies | 692 | ||
SUMMARY | 693 | ||
DISCLOSURE OF INTEREST | 694 | ||
REFERENCES | 694 | ||
Emergency Contraception | 699 | ||
Key points | 699 | ||
INTRODUCTION | 699 | ||
PREGNANCY RISK | 701 | ||
THE MOST EFFECTIVE EMERGENCY CONTRACEPTION: THE COPPER INTRAUTERINE DEVICE | 703 | ||
Mechanism of Action | 703 | ||
Safety | 703 | ||
Side Effects | 703 | ||
DEDICATED ORAL FORMS OF EMERGENCY CONTRACEPTION | 704 | ||
Ulipristal Acetate | 704 | ||
Efficacy | 704 | ||
Mechanism of action | 704 | ||
Safety | 704 | ||
Levonorgestrel-Containing Emergency Contraceptive Pill | 705 | ||
Efficacy | 705 | ||
Mechanism of action | 705 | ||
Safety | 705 | ||
THE YUZPE METHOD | 705 | ||
ORAL EMERGENCY CONTRACEPTION INTERACTIONS WITH OTHER MEDICATIONS | 706 | ||
WHEN TO START CONTRACEPTION AFTER EMERGENCY CONTRACEPTION | 706 | ||
INCREASING ACCESS TO EMERGENCY CONTRACEPTION | 706 | ||
SUMMARY | 707 | ||
REFERENCES | 707 | ||
Sterilization | 713 | ||
Key points | 713 | ||
INTRODUCTION | 713 | ||
FEMALE STERILIZATION: LAPAROSCOPY | 714 | ||
Electrocoagulation | 715 | ||
Mechanical Occlusion | 715 | ||
Comparison of Laparoscopic Sterilization Techniques | 716 | ||
Laparoscopic Sterilization Adverse Effects | 716 | ||
Tubal Sterilization Failure After Laparoscopic Sterilization | 716 | ||
FEMALE STERILIZATION: OPEN ABDOMINAL METHODS | 717 | ||
OPPORTUNISTIC SALPINGECTOMY | 717 | ||
FEMALE STERILIZATION: TRANSCERVICAL | 718 | ||
Placement of Microinserts via Hysteroscopy | 718 | ||
STERILIZATION COUNSELING | 719 | ||
STERILIZATION FAILURE | 720 | ||
STERILIZATION CONTRAINDICATIONS | 720 | ||
MALE STERILIZATION | 720 | ||
STERILIZATION REVERSAL | 721 | ||
STERILIZATION COST | 721 | ||
SUMMARY | 721 | ||
REFERENCES | 721 | ||
Index | 725 |