The Handbook of Contraception
C UR R E N T ¡ C L I NI C A L ¡ P R A C T I C E
NEIL S. SKOLNIK, MD, SERIES EDITOR
The Handbook of Contraception: A Guide for Practical Management, edited by DONNA SHOUPEAND SIRI L. KJOS, 2006
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The Handbook of Contraception
A Guide for Practical Management
Edited by
Donna Shoupe, MD
Division of Reproductive Endocrinology and Infertility Departments of Obstetrics and Gynecology and Family Medicine
Keck School of Medicine
at the University of Southern California Los Angeles, CA
Siri L. Kjos, MD
Department of Obstetrics and Gynecology David Geffen School of Medicine at University of California at Los Angeles
Los Angeles, CA and
Harbor-UCLA Medical Center Torrance, CA
© 2006 Humana Press Inc.
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All papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not neces- sarily reflect the views of the publisher.
Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication.
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ANSI Z39.48-1984 (American Standards Institute) Permanence of Paper for Printed Library Materials.
Cover Illustration: Fig. 1, Chapter 3, “Oral Contraceptives: Patient Screening and Counseling, Pill Selection, and Managing Side Effects,” by Donna Shoupe.
Cover design by Patricia F. Cleary Production Editor: Amy Thau
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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN: 1-59745-150-9
Library of Congress Cataloging in Publication Data
The handbook of contraception : a guide for practical management / edited by Donna Shoupe, Siri L. Kjos.
p. ; cm. -- (Current clinical practice) Includes bibliographical references and index.
ISBN 1-58829-599-0 (alk. paper)
1. Contraception--Handbooks, manuals, etc. 2.
Contraceptives--Handbooks, manuals, etc.
[DNLM: 1. Contraception--methods. 2. Contraception--standards.
3. Contraceptive Devices. 4. Practice Management,
Medical--standards. WP 630 H236 2006] I. Shoupe, Donna. II. Kjos, Siri L. III. Series.
RG136.H28 2006 613.9'43--dc22
2006000941
Dedication
This book is dedicated to Wendene Wilson Shoupe
v
Series Editor Introduction
vii
I opened my series editor manuscript of The Handbook of Contraception: A Guide for Practical Management, edited by Drs. Donna Shoupe and Siri Kjos, on a tiny plane on the way to giving a lecture in Albany, NY. I expected to peruse the manu- script, and found that I could not put it down. The Handbook of Contraception:
A Guide for Practical Management is an incredibly informative and enjoyable read. In keeping with the objective of this series for primary care clinicians, there is a quality in this title that is uncommon among medical textbooks.
The chapters of this book are written with extraordinary intelligence and under- standing, and with attention to practical considerations in the selection and manage- ment of contraceptive options. The authors have reviewed the science behind contraception, including the chemical structure and effects of hormonal contraception, physiology of contraception, efficacy rates, and side effects, as well as the practical considerations that are relevant in helping patients choose between different contra- ceptive options. They do this with a clarity of language and intent that lets the book cover with sufficient detail the full range of questions that any primary care clinician will have regarding any of the traditional or new contraceptive options. Also included in each chapter is a section on “counseling tips,” which explicitly answers many of the questions that clinicians and their patients often have when discussing contraceptive options. For a book so useful and well done, the editors and authors deserve our thanks.
Neil Skolnik, MD
Preface
ix
With so many contraceptive options currently available, and such a broad scope of issues to address, matching a patient to her best contraceptive method is more challenging today than it has ever been. To address this challenge, The Handbook of Contraception: A Guide for Practical Management is designed to give the modern health care provider up-to-date information on safety, side effects, advantages, and disadvantages of each method, as well as guidance in selecting appropriate users and practical counseling tools. An effort has been made to cover the currently avail- able methods and those that are expected to be available shortly, and to emphasize the growing list of noncontraceptive benefits associated with each method. An extensive reference list allows interested readers to further investigate issues of interest.
The first chapter in The Handbook of Contraception: A Guide for Practical Manage- ment is an overview of current contraceptive use in the United States, with a compari- son of the effectiveness and cost of the various methods. Chapters 2 through 8 discuss hormonal methods of contraception, including combination oral contraceptives, the contraceptive patch, the contraceptive vaginal ring, progestin-only pills, and the new progestin implant. Chapter 7 on long-acting injectable contraceptives and Chapter 8 on intrauterine devices compare the two current options in each category. Chapter 10 on barriers separately covers male condoms and vaginal spermicides, and then compares, as a group, the various cervical barrier methods. Chapter 11 covers behav- ioral methods of contraception including abstinence, and Chapter 12 discusses emer- gency contraceptive options. Chapter 13 reviews the research methods of sterilization that are currently under investigation, and the many methods that have been abandoned for various insurmountable reasons, as well as an extensive review and description of current methods of sterilization, including the newly approved hysteroscopic method. Chap- ters 14 and 15 are designed to guide the reader on factors to consider when selecting the correct contraceptive method for adolescents, perimenopausal women, postpartum mothers, and medically compromised women.
I dedicate this book to my mother, Wendene Wilson Shoupe, who backed me when I needed it the most. When I was living in Boston and applying to medical school, I became fascinated by the menstrual cycle and developed a deep desire to know everything I could about estrogen. But even more, I dreamed of developing the perfect birth control method. Many years later, I am awed by the difficulty of such a task, but I am honored to put together this compilation of how far contraceptive technology has come. Thank you, Mom, for giving me the support, financial help, drive, and love that got me through the tough days in Boston and allowed me to work toward my dreams.
My grateful thanks to Lee Hellmuth, Richard Montz, Rene B. Allen, MD, Marc Kalan, MD, for technical assistance; to Sherry Cochran, Rph, Director of Pharmacy,
x Preface
USC Medical Plaza Pharmacy; Eunju Lee Kwak, RN, Midwife; Blanca Ovalee, Research Coordinator Women and Children’s Hospital Family Planning for access to contraceptive supplies; and to Diane Quan for her excellent coordinating efforts.
Lastly, I support and echo the statements of Felicia Stewart, MD, writing for the authors of the latest edition of Contraceptive Technology, that the commitment and courage of our colleagues is deeply appreciated, and that when dealing with the chal- lenges that we face in reproductive health, working together is the best way to ensure success.
Donna Shoupe, MD
Siri L. Kjos, MD
Contents
xi
Dedication ...v
Series Editor Introduction ...vii
Preface ... ix
Contributors ... xiii
1. Contraceptive Overview ... 1
Donna Shoupe 2. Oral Contraceptives: History, Pharmacology, Metabolic Effects, Side Effects, and Health Benefits ... 13
Donna Shoupe and Daniel R. Mishell, Jr. 3. Oral Contraceptives: Patient Screening and Counseling, Pill Selection, and Managing Side Effects ... 45
Donna Shoupe 4. Progestin-Only Oral Contraceptives ... 67
Donna Shoupe 5. Contraceptive Patch ... 75
Donna Shoupe 6. Contraceptive Ring ... 87
Susan A. Ballagh 7. Long-Acting Progestin Injectables: Comparison of Depo-Provera® With Depo-SubQ Provera 104™... 101
Ronna Jurow and Donna Shoupe 8. Contraceptive Implants: Introducing Implanon®... 117
Philip D. Darney 9. Intrauterine Devices: Comparison of the Copper T Intrauterine Device With the Levonorgestrel Intrauterine System ... 129
Angela Y. Chen and Susie Baldwin 10. Barrier Contraceptives: Male Condoms, Vaginal Spermicides, and Cervical Barrier Methods ... 147
Donna Shoupe 11. Behavioral Methods of Contraception ... 179
Jennefer A. Russo and Anita L. Nelson
12. Emergency Contraceptives ... 195 Donna Shoupe
13. Female Tubal Sterilization: Traditional and Research Methods ... 205 Charles M. March
14. Contraception for Special Populations:
Adolescents and Perimenopausal Women Following Pregnancy
and During Lactation ... 235 Donna Shoupe
15. Choosing the Optimal Contraceptive Method in Women
With Medical Disease ... 255 Siri L. Kjos
Index ... 283 xii Contents
Contributors
xiii
SUSIE BALDWIN,MD,MPH • Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA
SUSAN A. BALLAGH,MD • Conrad Clinical Research Center, Jones Institute for Reproductive Medicine; Department of Obstetrics and Gynecology, Eastern Virginia Medical School, and Jones Institute for Reproductive Medicine, Norfolk, VA
ANGELA Y. CHEN,MD,MPH • Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA
PHILIP D. DARNEY,MD,MSc • Chief, Obstetrics, Gynecology, and Reproductive Sciences, San Francisco General Hospital, University of California, San Francisco, CA
RONNA JUROW,MD • Department of Obstetrics and Gynecology, Keck School of Medicine at the University of Southern California, Los Angeles, CA SIRI L. KJOS,MD • Department of Obstetrics and Gynecology, David Geffen
School of Medicine at the University of California at Los Angeles, Los Angeles, CA; and Harbor-UCLA Medical Center, Torrance, CA CHARLES M. MARCH,MD • California Fertility Partners, Division of Gynecology,
Department of Obstetrics and Gynecology, Keck School of Medicine at the University of Southern California, Los Angeles, CA
DANIEL R. MISHELL, JR.,MD • Department of Obstetrics and Gynecology, Keck School of Medicine at the University of Southern California, Los Angeles, CA
ANITA L. NELSON,MD • Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA; Medical Director, Women’s Health Care Programs, Harbor-UCLA Medical Center, Torrance, CA
JENNEFER A. RUSSO,MD • Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA; and Harbor-UCLA Medical Center, Torrance, CA DONNA SHOUPE,MD • Division of Reproductive Endocrinology and Infertility,
Departments of Obstetrics and Gynecology and Family Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
