Table of Contents
Chapter
Values in Family Planning Felicia H. Stewart, MD 1
The Menstrual Cycle Robert A. Hatcher, MD, MPH Anne Brawner Namnoum, MD 7
Menstrual Cycle Regulation 8
The Integrated Cycle 10
Fertilization and Implantation 14
Choosing a Contraceptive: Efficacy, Safety, and Personal Considerations James Trussell, PhD 19
Efficacy: "Will it Work?" 22
Safety: "Will It Hurt Me?" 34
Noncontraceptive Benefits 38
Personal Considerations 41
Medical Eligibility Criteria Kathryn M. Curtis, PhD Herbert B. Peterson, MD 49
Methodology 50
How to Use the Recommendations 52
Keeping Criteria Up to Date 55
Abstinence and the Range of Sexual Expression Deborah Kowal, MA, PA 81
The Range of Sexual Expression 83
Indications for Abstinence or Other Forms of Sexual Expression 84
Instructions for Using Abstinence for Contraception or STI Protection 85
Emergency Contraception Felicia Stewart, MD James Trussell, PhD Paul F.A. Van Look, MD, PhD, FRCOG 87
History 88
Future Potential for Emergency Contraceptive Use 90
Mechanism of Action 94
Effectiveness 96
Advantages and Indications 97
Side Effects 99
Cautions 100
Providing Emergency Contraception 102
Instructions For Using Emergency Contraception 109
Intrauterine Devices (IUDs) David A. Grimes, MD 117
Options in the United States 118
Effectiveness 119
Mechanism of Action 120
Advantages of Intrauterine Contraception 121
Disadvantages of Intrauterine Contraception 122
Providing the IUD 128
Managing Problems and Follow-Up 139
Contraceptive Implants Elizabeth G. Raymond, MD, MPH 145
Effectiveness 146
Mechanism of Action 147
Advantages 148
Disadvantages and Cautions 149
Providing the Method 152
Managing Problems and Follow-Up 154
User Instructions 154
Injectable Contraceptives Alisa B. Goldberg, MD, MPH David A. Grimes, MD 157
Effectiveness 158
Mechanism of Action 158
Advantages 159
Disadvantages and Cautions 161
Providing DMPA 168
Managing DMPA Problems and Follow-Up 169
Instructions for Using DMPA 170
Progestin-Only Pills Elizabeth G. Raymond, MD, MPH 181
Effectiveness 181
Mechanism of Action 182
Advantages 183
Disadvantages and Cautions 184
Providing the Method 186
Managing Problems and Follow-Up 188
User Instructions 188
Combined Oral Contraceptives Anita L. Nelson, MD 193
Hormones in Combined Oral Contraceptives 194
Mechanisms of Action 197
Effectiveness 198
Cost 199
Oral Contraceptive Formulations 200
Advantages and Indications 201
Non-Contraceptive Applications for COCS 209
Disadvantages and Health Complications 210
Providing Oral Contraceptives 224
Managing Side Effects 240
Instructions for Using Oral Contraceptives 249
Contraceptive Patch and Vaginal Contraceptive Ring Kavita Nanda, MD, MHS 271
Contraceptive Patch 271
Description of Method 271
Effectiveness 272
Mechanism of Action 272
Advantages 272
Disadvantages and Cautions 274
Providing the Method 276
Managing Problems and Follow Up 279
User Instructions 280
Vaginal Contraceptive Ring 282
Description of Method 282
Effectiveness 282
Mechanism of Action 283
Advantages 283
Disadvantages and Cautions 285
Providing the Method 287
Managing Problems and Follow Up 289
User Instructions 291
Male Condoms Lee Warner, PhD, MPH Markus J. Steiner, PhD, MSPH 297
Mechanism of Action 298
Effectiveness Against Pregnancy 299
Advantages and Indications 301
Disadvantages and Cautions 301
Special Issues 302
Providing Condoms-Counseling 304
Managing Problems and Follow-Up 308
Instructions for Using Condoms 308
Vaginal Barriers And Spermicides Willard Cates Jr., MD, MPH Elizabeth G. Raymond, MD, MPH 317
Mechanism of Action 318
Effectiveness 322
Advantages 324
Disadvantages 326
Cautions 327
Providing Vaginal Barrier Methods 327
Managing Problems and Follow-Up 332
Instructions For Using Vaginal Barriers/Spermicides 333
Coitus Interruptus (Withdrawal) Deborah Kowal, MA, PA 337
Mechanism of Action 338
Effectiveness 338
Advantages and Indications 338
Disadvantages and Cautions 339
Instructions for Using Coitus Interruptus 341
Fertility Awareness-Based Methods Victoria H. Jennings, PhD Marcos Arevalo, MD, MPH 343
Mechanism of Action 343
Effectiveness 344
Advantages and Indications 346
Disadvantages and Cautions 347
Providing Fertility Awareness-Based Methods 349
Instructions for Using Fertility Awareness-Based Methods 349
Female and Male Sterilization Amy E. Pollac, MD, MPH, FACOG Lisa J. Thomas, MD, FACOG Mark A. Barone, DVM, MS 361
Female Sterilization 362
Effectiveness 362
Mechanism of Action 364
Advantages and Indications 364
Disadvantages and Cautions 365
Providing Female Sterilization 370
Managing Problems and Follow-Up 378
Male Sterilization 380
Effectiveness 380
Mechanism of Action 381
Advantages 381
Disadvantages and Cautions 382
Providing Male Sterilization 384
Managing Problems and Follow-Up 389
User Instructions for Vasectomy 392
Postpartum Contraception and Lactation Kathy I. Kennedy, DrPH James Trussell, PhD 403
Postpartum Infertility 404
Lactational Infertility 404
Contraceptive Benefits of Lactation 406
Postpartum Sexuality 408
Initiating Contraceptive Use Postpartum 410
Postpartum Contraception for the Nonbreastfeeding Woman 413
Postpartum Contraception for the Breastfeeding Woman 414
Breastfeeding: Advantages to the Infant 420
Breastfeeding and HIV 421
Breastfeeding: Effects on the Mother 422
Instructions for and Information About Breastfeeding 422
Contraceptive Research and Development Henry L. Gabelnick, PhD Jill Schwartz, MD Jacqueline E. Darroch, PhD 433
Contraceptive Research Overview 433
Current Contraceptive Research 439
Improving Use-Effectiveness 447
The 21st Century 447
Menstrual Disorders and Related Concerns Anita L. Nelson, MD Susie Baldwin, MD, MPH 451
Dysmenorrhea 452
Secondary Dysmenorrhea 454
Menorrhagia 456
Amenorrhea 461
Oligomenorrhea 466
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) 469
Menstrually Induced Exacerbations of Other Medical Problems 476
Endometriosis 479
Chronic Pelvic Pain 481
Reproductive Tract Infections, Including HIV and Other Sexually Transmitted Infections Jeanne M. Marrazzo, MD, MPH Felicia Guest, MPH, CHES Willard Cates, Jr., MD, MPH 499
Magnitude and Risks of RTI 500
RTI Risk Assessment, Prevention and Risk Behaviors 502
Assessment, Diagnosis, and Treatment of RTI 505
Special Considerations Regarding HIV/AIDS in the Reproductive Health Setting 511
Alphabetical Catalogue of Reproductive Tract Infections 532
Female Genital Tract Cancer Screening Michael S. Policar, MD, MPH 559
Screening for Cervical Cancer 561
Ovarian Cancer Screening 581
Breast Cancer Screening 583
Pregnancy Testing and Management of Early Pregnancy Mary Fjerstad, NP Felicia Stewart, MD 591
Essential Pre-Pregnancy Information for Everyone 592
Preconception Care Services 594
Pregnancy Evaluation 596
Pregnancy Test Options 602
Ultrasound in Very Early Pregnancy 609
Managing Problems in Early Pregnancy 618
Education and Counseling 628
Abortion Maureen Paul, MD, MPH Felicia H. Stewart, MD 637
Legal Status of Abortion 638
The Public Health Impact of Legal Abortion 639
Characteristics of Women Who Obtain Abortions 639
Methods of Abortion 642
Providing Abortion Services 649
Managing Post-Abortion Complications 660
Impaired Fertility Anita L. Nelson, MD John R. Marshall, MD 673
Probability of Pregnancy 674
Requirements for Fertility 676
Overview of Causes of Infertility 677
Further Evaluation of The Woman 681
Prognosis 686
Targeting Therapies for Infertility 686
Longer Term Impacts of Assisted Reproductive Technologies 692
Menopause and Perimenopausal Health Anita L. Nelson, MD Felicia H. Stewart, MD 699
Definitions: Perimenopause, Menopause, Post-Menopause 699
Perimenopause 701
Menopause 705
Postmenopausal Symptoms 708
Effect of Hormone Therapies on Other Aspects of Postmenopausal Health 724
Side Effects of Postmenopausal Hormone Therapy 732
Postmenopausal Hormone Therapy Choices 733
Summary 735
Contraceptive Efficacy James Trussell, PhD 747
No Method 748
Typical Use Of Spermicides, Withdrawal, Fertility Awareness-Based Methods, Diaphragm, Male Condom, Oral Contraceptive Pills, and Depo-Provera 748
Perfect Use of the Sponge and Diaphragm 749
Typical Use of the Sponge 750
Female Condom 750
Perfect Use of Withdrawal and Spermicides 750
Perfect Use of Fertility Awareness-Based Methods 752
Perfect Use of the Male Condom 752
Perfect Use of the Oral Contraceptive Pills, Depo-Provera, and Implanon, and Typical Use of Implanon 753
Evra and NuvaRing 753
IUD 754
Sterilization 754
Contraceptive Continuation 755
The Lactational Amenorrhea Method (LAM) 756
Appendix
Webpages with Active Links to Many Other Websites 827
Network of Professional Organizations 829
Pharmaceutical Websites and Phone Numbers 833
Hotlines and Websites 836
Index 841