Contraception, An Issue of Obstetrics and Gynecology Clinics, 1e

This issue of Clinics will focus on innovations in contraception as well as medical and public health barriers to reducing unintended pregnancy. Described in this issue are a number of contraceptive innovations developed over the last few years, including the contraceptive patch and ring as well as the hormonal intrauterine system and hormonal implants. The very effective options, including the IUD and hormonal implants, have appealed to women who previously did not use contraception or used less effective methods. Other contraceptive innovations described include novel approaches to contraception: Treating the need for contraception as an emergency, using "quick start" methods of initiating contraceptives, expanding the profile of women considered good candidates for IUDs, and using extended dosing regimens for hormonal contraceptives. At the systems level, this issue will examine legislation, regulations and funding of contraception, factors that have a major impact on access and use. The last decade has seen both improvements in contraceptive usage and continued barriers to improved access. We suggest ways to improve contraceptive use and access over the years to come. Cover......Page 1 Foreword......Page 2 Preface......Page 4 Family Planning American Style: Why It’s So Hard to Control Birth in the US......Page 7 Content and funding of sex education......Page 8 Support for comprehensive sex education......Page 9 Effectiveness of sex education programs......Page 10 Influence of media on sexual behavior......Page 11 Societal norms and teen pregnancy......Page 12 Antecedents of teen pregnancy in the United States......Page 13 Financial barriers to contraceptive access......Page 14 Federal and state contraceptive equity initiatives......Page 15 Out-of-pocket costs for contraceptives......Page 16 Strategies to reduce insurance barriers......Page 17 Mergers......Page 18 Anticontraception politics......Page 19 Summary......Page 20 References......Page 21 Delayed initiation......Page 24 Inadequate contraceptive counseling......Page 27 Clinician limitations......Page 28 Product labeling, contraceptive misinformation, and prescription requirements......Page 29 Lack of a reversible male contraceptive......Page 31 References......Page 32 Recommendation......Page 35 Monthly reversible hormonal contraception......Page 38 Starting the transdermal patch or vaginal ring......Page 41 A guide to making rational contraceptive choices......Page 42 Case scenario 1......Page 43 Case scenario 3......Page 44 References......Page 45 Extended Cycle Combined Hormonal Contraception......Page 47 Acceptability of reducing the frequency of menses......Page 48 Option: decrease the number of placebo days......Page 50 Option: decrease the number of placebo weeks or withdrawal weeks per year......Page 51 Option: continuous use until breakthrough bleeding, then hormone-free interval......Page 53 Other combined hormonal contraceptive regimens......Page 54 Medical conditions amenable to extended cycle combined hormonal contraceptives......Page 55 Could I be pregnant because I’m not having a period?......Page 56 References......Page 57 Feasibility of incorporating Essure......Page 60 History of transcervical sterilization......Page 61 Sclerosing methods......Page 62 Essure......Page 63 Food and Drug Administration approval studies for Essure......Page 64 Cost of Essure......Page 66 Endometrial ablation and Essure......Page 67 Adiana......Page 68 Quinacrine......Page 69 Erythromycin......Page 72 References......Page 73 Contraceptive Implants: An Overview and Update......Page 76 Implant types......Page 77 Mechanism of action......Page 78 Implant efficacy......Page 79 Effects on carbohydrate metabolism......Page 80 Cardiovascular effects......Page 81 Menstrual irregularity......Page 82 Acne......Page 83 Contraceptive implants and lactation......Page 84 Return to fertility......Page 85 Insertion and removal......Page 86 Role for implants in the United States......Page 87 References......Page 89 Risk of pelvic inflammatory disease......Page 94 Intrauterine contraception available in the United States today......Page 95 Determinants of contraceptive effectiveness......Page 96 Safety concerns......Page 98 Risk of infertility......Page 100 Liability concerns......Page 101 Sexual behavior......Page 102 Nulliparity......Page 103 Endometrial cancer protection......Page 105 Therapeutic indications for the levonorgestrel intrauterine system......Page 106 Helping women choose the right Intrauterine device......Page 107 Timing of interval insertion......Page 108 Postpartum and postabortion insertion......Page 109 Summary......Page 110 References......Page 111 Contraception for Women with Chronic Medical Conditions......Page 115 Anticonvulsant use......Page 116 Summary recommendations......Page 117 Migraine......Page 118 Obesity......Page 119 Diabetes......Page 121 HIV infection......Page 122 Systemic lupus erythematosus......Page 123 References......Page 125 Mechanism of action......Page 129 Evaluating the efficacy of emergency contraception......Page 131 Using emergency contraception as a back-up for other methods......Page 133 Effect on baseline contraceptive use......Page 134 Summary......Page 135 References......Page 136 The Quest for Better Contraception: Future Methods......Page 139 Extended-dose oral contraceptive regimens......Page 147 Nestorone hormonal contraceptives......Page 148 Desogestrel-only oral contraceptive......Page 149 Male hormonal methods......Page 150 Physical barriers......Page 152 Chemical barriers (microbicides/spermicides)......Page 154 Fertility awareness......Page 157 Intrauterine devices......Page 158 Transcervical sterilization......Page 160 Vasectomy......Page 161 Immunucontraception......Page 163 Acknowledgments......Page 164 References......Page 165