A CLINICAL GUIDE FOR Contraception Fifth Edi ti o n Leon Speroff, M.D Professor Emeritus of Obstetrics and Gynecology Oregon Health & Science University Portland, Oregon Philip D Darney, M.D., M.Sc Professor of Obstetrics, Gynecology and Reproductive Sciences San Francisco General Hospital University of California, San Francisco San Francisco, California Speroff Darney_FM.indd i 8/26/2010 6:15:44 PM Acquisitions Editor: Sonya Seigafuse Product Manager: Nicole Walz Vendor Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Kim Schonberger Design Coordinator: Stephen Druding Production Service: SPi Technologies © 2011 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business © 2005 by Lippincott Williams & Wilkins Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in China Library of Congress Cataloging-in-Publication Data Speroff, Leon, 1935– A clinical guide for contraception / Leon Speroff, Philip D Darney — 5th ed p ; cm Includes bibliographical references and index ISBN 978-1-60831-610-6 (pbk.) Contraception I Darney, Philip D II Title [DNLM: Contraception—methods WP 630] RG136.S63 2011 613.9¢4—dc22 2010033304 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 Speroff Darney_FM.indd ii 8/26/2010 6:15:50 PM DE DI CATION This Fifth Edition is published 50 years after the introduction of the birth control pill to American women and their clinicians We dedicate this book to the creative, courageous, and generous women and men who worked together to develop the first modern method of contraception The pill brought women, including our seven daughters, new freedom, equality, and opportunity We hope that the next 50 years will see an ever wider choice of contraceptives help all the world’s women to lead healthier, happier lives Speroff Darney_FM.indd iii 8/26/2010 6:15:50 PM Speroff Darney_FM.indd iv 8/26/2010 6:15:50 PM CONTENTS Preface 10 11 12 13 14 vii Contraception in the United States Oral Contraception 19 Special Uses of Oral Contraception 153 Emergency Contraception • The Progestin-Only Minipill Vaginal and Transdermal Estrogen-Progestin Contraception 167 Implant Contraception 183 Injectable Contraception 217 Intrauterine Contraception 239 Barrier Methods of Contraception 281 Natural Family Planning: Periodic Abstinence and Withdrawal 315 The Postpartum Period, Breastfeeding, and Contraception 327 Clinical Guidelines for Contraception at Different Ages: Early and Late 351 Sterilization 381 Induced Abortion and Postabortion Contraception 405 Interpreting Epidemiologic Reports and Contraceptive Eligibility Criteria 429 Epilogue 439 Index 441 v Speroff Darney_FM.indd v 8/26/2010 6:15:50 PM Speroff Darney_FM.indd vi 8/26/2010 6:15:51 PM PREFACE C ontraception, socially recognized and accepted only in the last 50 years, is both an essential and a complicated part of modern life Contraception has separated sex from procreation and has provided couples greater control and enjoyment of their lives It is a critical element in limiting population, thus preserving our planet’s resources and maintaining quality of life for ourselves and our children Contraception is both a personal and a social responsibility The above accomplishments could not be achieved by the simple contraceptive methods employed before the late 20th century Greater effectiveness and ease of use required more complicated methods, associated with greater consequences to our health Intensive study of these issues has yielded an enormous wealth of information, making an informed choice possible but not easy In this book, we have distilled and formulated the information essential for the intelligent use of contraception The current state of knowledge and variety of contraceptive options allow clinicians and patients to select methods best suited to an individual’s personal, social, and medical characteristics and requirements But even now, science is still sometimes inadequate, and medical judgments must be made without the comfort of scientific support In these situations, we have expressed our opinion, reflecting our knowledge and our clinical experience We hope our text will help all health care professionals who have assumed the social responsibility of assisting couples to use safe, effective contraception Leon Speroff Portland, Oregon Philip D Darney San Francisco, California vii Speroff Darney_FM.indd vii 8/26/2010 6:15:51 PM Speroff Darney_FM.indd viii 8/26/2010 6:15:51 PM Contraception in the United States F ertility decreases as societies become more affluent This decrease is a response to the use of contraception and abortion During her reproductive lifespan, the average !Kung woman, a member of an African tribe of hunter-gatherers, experienced 15 years of lactational amenorrhea, years of pregnancy, and only 48 menstrual cycles.1 In contrast, a modern urban woman will experience 420 menstrual cycles Contemporary women undergo earlier menarche and start having sexual intercourse earlier in their lives than in the past Even though breastfeeding has increased in recent years, its duration is relatively brief and its contribution to contraception in the developed world is trivial Therefore, it is more difficult today to limit the size of a family unless some method of contraception is utilized Today, more women younger than age 25 in the United States become pregnant than their contemporaries in other Western countries.2–4 The U.S teenage pregnancy rates are twice as high as those in England, Wales, and Canada and eight times as high as those of the Netherlands and Japan.5 The differences disappear almost completely after age 25 This is largely because American men and women after age 25 utilize surgical sterilization at a high rate It is not true that young American women want to have these higher pregnancy rates About 82% of all pregnancies among American teenagers are unintended.6 Increasing effective contraceptive use among young Americans began to have an impact in 1991 In the 1990s, the teenage pregnancy rate reached the lowest rate since estimates began in 1976, a 21% decline from 1991 to 1997 for teenagers 15 to 17 years and a 13% decline for older teenagers.7 Overall, there was a 17% decline in teenage birth rates and a 12.8% decline in teenage-induced abortions from 1991 through 1999 From 1995 to 2002, 14% of the decline in teen pregnancy was a consequence of decreased sexual activity among U.S teenagers; however, 86% of the decline was attributed to an increase in the use of effective contraception.8 In 2004, the proportion of induced abortions in the United States obtained by teens reached a low of 17%.9 After a 14-year 34% decline, birth rates for teenagers began to increase in 2005, the first increase since 1991 The rate increased 5% between 2005 and 2008.10 There is appropriate concern that this increase reflects difficulties in contraceptive access, affordability, and correct use In addition, in recent Speroff Darney_Chap01.indd 8/25/2010 3:48:54 PM A Clinical Guide for Contraception years, fewer teens have received instruction regarding contraception.11 The evidence overwhelmingly indicates that abstinence programs have not had a positive impact on teen sexual behavior, including the delay of the initiation of sex or the number of sexual partners.12 In contrast, comprehensive sex education programs that include contraception are effective and not increase the frequency of sex or hasten the initiation.13 Nearly half of all pregnancies (49%) in the United States are unplanned, and about 40% of these are aborted.6,14 American teenagers abort about 34% of their pregnancies, and this proportion is similar to that seen in other countries.5 But older American women, aged 20 to 34, have the highest proportion of pregnancies aborted compared with other countries, indicating that an unappreciated, but real, problem of unintended pregnancy still exists beyond the teenage years In fact, American women older than age 40 have had for the last decades a high ratio of abortions per live births, a ratio very similar to that of teenagers.9 Delaying marriage prolongs the period in which women are exposed to the risk of unintended pregnancy This, however, cannot be documented as a major reason for the large differential between young adults in Europe and the United States The available evidence also indicates that a difference in sexual activity is not an important explanation The major difference between American women and European women is that American women under age 25 are less likely to use any form of contraception Significantly, the use of oral contraceptives (the main choice of younger women) is lower in the United States than in other countries Why are Americans different? The cultures in areas such as the United Kingdom and the Scandinavian countries are certainly very similar with similar rates of sexual experience A major difference must be attributed to the availability of contraception In the rest of the world, contraceptive services can be obtained from more accessible resources and relatively inexpensively Major American problems are the enormous diversity of people and the unequal distribution of income in the United States These factors influence the ability of our society to effectively provide education regarding sex and contraception and to effectively make contraception services available In 1966, a report from NASA placed our technological achievements into historical perspective.15 Eight hundred lifespans can bridge more than 50,000 years But of those 800 people ■ ■ ■ ■ ■ ■ 650 spent their lives in caves, only the last 70 had a truly effective means of communication, only the last saw the printed word, only the last could measure time with precision, only the last used an electric motor, and the majority of items which make up our current world were developed within the lifespan of the 800th person The era of modern contraception dates from 1960 when intrauterine devices (IUDs) were reintroduced and oral contraception was first approved by the Speroff Darney_Chap01.indd 8/25/2010 3:48:56 PM 436 A Clinical Guide for Contraception Speroff Darney_Chap14.indd 436 8/25/2010 3:09:46 PM Interpreting Epidemiologic Reports and Contraceptive Eligibility Criteria 437 Speroff Darney_Chap14.indd 437 8/25/2010 3:09:46 PM 438 A Clinical Guide for Contraception Speroff Darney_Chap14.indd 438 8/25/2010 3:09:47 PM EPILOGUE A nd so we reach our final paragraph We so with optimism This book documents, within a tick of planet Earth’s time, tremendous accomplishments in contraception These accomplishments reflect initiative, creativity, and dedication There is reason to believe, as we do, that these human traits will persevere, and we will meet the contraceptive challenges of the future 439 Speroff Darney_BM.indd 439 8/27/2010 4:45:36 PM Speroff Darney_BM.indd 440 8/27/2010 4:45:37 PM INDEX A Abortion 153 complications of induced abortion acute hematometra 415 cervical laceration 415 cervical stenosis 418 delayed bleeding 417 delayed complications 416 dysfunctional uterine bleeding 418 ectopic pregnancy 415–416 excessive bleeding, immediately after aspiration 414–415 infection 417 longer-term complications 413 psychological sequelae 413–414 risk of breast cancer 414 uterine perforation 415 counseling and informed consent 407 medical methods for first-trimester abortion methotrexate 410 mifepristone 408–410 misoprostol 408 prostaglandin 411 regimen with the least side effects and cost 409 surgical abortion technique 408 uterine aspiration 416, 417 Möbius’s syndrome 411 number performed in the United States 9, 406 patient preparation 406 patient selection 411 postabortion 419 postoperative care 411 rates of induced 153 second trimester 418–419 teenage induced 1, 352 Acne 105, 159, 196, 357 Actinomyces 256 Adenomas liver 75 pituitary prolactin-secreting 114 prolactin-secreting 92 Anaphylaxis 224 Anemia 88 Anovulation and bleeding 366 Antibiotics 105 Arterial thrombosis 61 hypertension 70 myocardial infarction 62, 71 smoking 55, 59, 70 stroke 64, 71 Attributable risk, defined 433 B Backup method 192 Bacterial vaginosis IUD 255 metronidazole 417 oral contraception 95 spermicide 302 Barrier methods of contraception 281 cervical cap 297 FemCap 297 insertion 299 Lea’s Shield 297 Ovés 298 Prentif Cap 297 removal 299 condoms 303 use of in U.S contraceptive Sponge 300 “Protectaid” 300 “Today” 300 diaphragm 285 benefits 286 care of the diaphragm 289 chlamydia 286 choice and use of 286 efficacy 285 fitting 288 gonorrhea 286 insertion 290 pelvic inflammatory disease 286 reassessment 289 removal 293 side effects 286 timing 289 trichomonas 286 tubal infertility 286 urinary tract infections 286 vaginal irritation 286 female condom 307 history 281 origin of the word condom 282 postcoital douching 302 441 Speroff Darney_Index.indd 441 8/25/2010 2:42:14 PM 442 Index Barrier methods of contraception (continued) preeclampsia 285 protection against STIs and PID 285 risk of toxic shock syndrome 285 spermicides 300, 301 congenital abnormalities 303 efficacy 302 postcoital douching 302 protection against sexually transmitted infections 302 spontaneous miscarriages 303 Breast cancer 80 BRCA1 and BRCA2 mutations 83 depot-medroxyprogesterone acetate 235 induced abortion 414 levonorgestrel system 253 lobular and ductal breast cancer 83 medroxyprogesterone acetate 224 oral contraception and the risk of 80, 84 Breast disease 80, 113, 116 Breast examinations 96 Breastfeeding breast physiology 328 contraception and 336 lactation 330 antibodies are present in breast milk 332 bone loss in lactating women 331 in breastfeeding women 331 cessation 333 contraceptive effect 333 human placental lactogen (hPL) 329 let-down 332 mechanism of action 334 during pregnancy 330 prolactin levels 330, 331 role for oxytocin 332 viruses are transmitted in breast milk, 332 prevalence of 327 C Cancer See specific types Other cancers colorectal cancer 84 melanoma 85 molar pregnancy 85 Candida 95 Carbohydrate metabolism 73 hemoglobin A1c 73 insulin sensitivity 73 Cardiovascular disease among past users of oral contraception 54 Speroff Darney_Index.indd 442 arterial thrombosis 61 coagulation system 53 incidence of diabetes mellitus or impaired glucose tolerance 73 prescribing oral contraception for the overt diabetic 50 progestin-only 220, 367 venous thromboembolism 55 Cervical cancer 78 human papillomavirus (HPV) 78 IUD 370 Cervical cap See Barrier methods of contraception Chang, Min-Chueh 31 Coagulation system 53 Colorectal cancer 84 Colton, Frank 26 Condoms See Barrier methods of contraception Confidence interval (CI) 432 Contraception changes in use by U.S women efficacy failures future 13 generic products 49 global warming 12 history 19 impact of the worldwide use 10 impacts of use and nonuse 11 induced abortion in United States life-table analysis litigation and 13 Pearl index potency 50 STIs 12 use by age use in the United States Contraception for adolescents acne 357 adolescent pregnancies in the United States 351 barrier methods 359 communication with adolescents 355–356 contraceptive continuation for adolescents 363 diabetes mellitus in adolescents 358 emergency postcoital contraception 362 intrauterine devices (IUDs) 360 long-acting methods for adolescents 361 NuvaRing 359 oral contraception for 357 Ortho-Evra 359 pelvic exam delays 359 8/25/2010 2:42:16 PM Index D Dalkon Shield 241 Demographics, change in female 14 Depot-medroxyprogesterone acetate 217, 340 effect on bone density 226 effect on future fertility 228 metabolic effects 226 problems with 222 amenorrhea 222 anaphylaxis 224 breakthrough bleeding 223 breast cancer 224 menstrual bleeding 222 normal menses to return 224 reasons for discontinuing 223 risk of cervical carcinoma 225 weight gain 223 Depression 76, 113 Desogestrel 39 Speroff Darney_Index.indd 443 Diabetes mellitus adolescents 358 depot-medroxyprogesterone 221 gestational diabetes 108 insulin-dependent (see Insulindependent diabetes mellitus) IUD insertion 258 non-insulin-dependent (see Non-insulindependent diabetes mellitus) oral contraception 73, 108 Diaphragm See Barrier methods of contraception Dienogest 42 Diethylstilbestrol 154 Djerassi, Carl 25 Drospirenone 42 E Eating disorders 113 Ectopic pregnancy 192 Elcometrine 209 Emergency contraception 154, 157 Emergency postcoital contraception 362 antiemetic 156 copper IUD 157 diethylstilbestrol 154 efficacy 155 hot line 154 levonorgestrel alone 154 mechanism 155 mifepristone 157 Norlevo 154 Plan B 154 progesterone receptor modulators 157 risk of venous thromboembolism 156 treatment method 155 ulipristal acetate 157 web site 154 Endometrial cancer depot-medroxyprogesterone acetate 226 IUD 253, 370 Norplant 197 oral contraception 77, 116 Endometriosis depot-medroxyprogesterone acetate 222 levonorgestrel IUS 248 oral contraceptives 116 dysmenorrhea 117 low-dose estrogen-progestin contraception 117 progestational drugs 117 prophylaxis 119 progestin-only contraceptive methods 189 443 school-based programs 354 teaching of abstinence 354 teenage sexual activity in the United States 352 teenage smoking 358 transdermal contraception for 359 vaginal contraception for 359 vaginal nonsteroid contraceptives 361 web sites for adolescents and clinicians 356 weight gain 357 Contraception for older women anovulation and bleeding 366 barrier methods 371 benefits to emphasize with older women 365 change from steroid contraception to postmenopausal hormone therapy 368 IUD for older women 369 levonorgestrel-releasing IUS (Mirena) 370 older smokers 366 postmenopausal hormonal regimen 367 preventive health care 371 progestin-only minipill 368 risk of idiopathic venous thrombosis in users of progestins 367 steroid contraception for the transition years 365 Copper IUD 244, 253 Crohn’s disease 114 Cyclofem 230 8/25/2010 2:42:16 PM 444 Index Epidemiologic reports clinical reports case report 430 case series 430 confounders and biases of importance 431–432 criteria 433 observational studies case-control studies 430 cohort studies 429–430 cross-sectional studies 430 odds ratio 432 randomized controlled trials 429 terms commonly used attributable risk 433 confidence interval (CI) 432 number of individuals needed 433 odds ratio 432 P value 432 relative risk 432 Estrogen 36 adrenal gland 85 component of combination oral contraceptives 36 liver 74 thyroid 85 Ethinyl estradiol 36 Etonogestrel 168 F Factor V Leiden mutation carrier frequencies in the American population 60 clotting factors 53 heterozygotes for the 54 homozygotes for the 54 prevalence 54 prothrombin 54 venous thromboembolism and thrombophilias 60 Failure rates of contraception lowest expected and typical Fellner, Otfried Otto 19 Fertility effects, future 194, 228 IUD removal 265 oral contraception 87 tubal infertility 95 Fertility rate 10 Filshie clip 392 G Galactorrhea 228 Gallbladder disease 75, 110 Speroff Darney_Index.indd 444 Garcia, Celso-Ramon 34 Gastroenteritis 51, 101 Gestodene 39, 40 Gräfenberg ring 240 H Haberlandt, Ludwig 19 Healthy user effect 57, 58 Heart disease congenital 113 valvular 113 Hemoglobin Alc 73 Hemorrhagic disorders 112 Hepatic disease 111 Hirsutism 105 History of oral contraception 19 Hulka-Clemens spring clip 391 Hypertension 108 pregnancy-induced hypertension 108 women with treated hypertension 70 I Implanon 183, 187 menstrual effects 192 metabolic effects 192 vaginal bleeding patterns 192 Implant contraception 183 absolute contraindications 185 acne and 196 advantages 189 body weight and 188, 192 bone density 194 breastfeeding women and 189 concentrations of etonogestrel 187 cost 190 counseling women 209 disadvantages 190 complicated removals 190 cost 190 disruption of bleeding patterns 190 protection against sexually transmitted infections 190 visible under the skin 190 effects on future fertility 194 efficacy 191 elcometrine 209 galactorrhea and 196 gallbladder disease and 194 Implanon 187 menstrual effects 192 metabolic effects 192 vaginal bleeding patterns 192 indications 185 insertion and removal 197 8/25/2010 2:42:16 PM Index Speroff Darney_Index.indd 445 effect on bone density 226 effect on future fertility 228 efficacy 219 mechanism of action 218 metabolic effects 226 safety margin 217 serum levels of progestins 217 subcutaneous dose 217 timing of the first injection 218 effects on breastfeeding 221 galactorrhea 228 indications 219 patients with seizure disorders 221 relative contraindications 220 risk of ovarian cancer 222 short-term injectable contraceprive 230 Cyclofem 230 Lunelle 230 Mesigyna 230 Norethindrone enanthate 230 sickle cell disease 221 Insertion of Implanon 187 Insulin 73 Insulin-dependent diabetes mellitus copper IUD 258, 370 IUD-related bacterial infection 254 oral contraceptives 74, 109, 113 Intrauterine contraceprion actinomyces 256 adolescents 258 amenorrhea and 252 androgenic side effects 253 bacterial infection 253 bacterial vaginosis 255 congenital anomalies 257 copper IUD 244, 253 magnetic resonance imaging 253 Cu-Fix 246 Dalkon Shield 241 duration of use 24 ectopic pregnancy and 251 efficacy of IUDs 249 endometritis 255 FlexiGard 246 Gräfenberg ring 240 GyneFIX 246 history 239 insertion of the IUD 257 after a first-trimester abortion 260 in breastfeeding women 260 timing 260 IUD removal 264 embedded IUDs 265 finding a displaced IUD 265 Lippes loop 241, 243 lowest rates 251 445 complications of insertion 201 difficult removals 205 expulsion 201 infection 201 local reactions 201 removal techniques 202 removal with fingers alone 204 removal with instruments 202 Jadelle 183 levels of sex hormone-binding globulin (SHBG) and 188 mastalgia and 196 treatments for mastalgia 196 mechanism of action 187 metabolic differences comparing Implanon and Norplant 194 modes of action 188 netrorone 209 Norplant (See also Norplant) ectopic pregnancy 192 menstrual effects 192 vaginal bleeding patterns 192 Norplant-2 183 ovarian cysts 196 progestin blood levels 186 protection against sexually transmitted infections 190 reasons for termination 208 relative contraindications 186 return of fertility 189 risk of breast and cervical cancer 197 risk of endometrial cancer 197 risk of ovarian cancer 197 side effects 195 Surplant 209 treatment of bleeding with implants 193 Uniplant 209 user acceptance of contraceptive implants 208 weight change 195 Implants See Implant contraception Injectable contraception absolute contraindications 219 advantages 220 continuation rates 220 effects on breastfeeding 221 patients with seizure disorders 221 risk of ovarian cancer 222 risk of pelvic inflammatory disease 222 risk of thrombosis 220 sickle cell disease 221 depot-medroxyprogesterone acetate 217 comparison of the intramuscular and subcutaneous methods 219 correct dose for 217 8/25/2010 2:42:16 PM 446 Index Intrauterine contraceprion (continued) lowest rates 251 menstrual blood loss 252 menstrual pain 252 Mirena 245 Multiload-375 244, 245 Nova T 244, 245 ParaGard 243 patient selection 257 abnormalities of uterine anatomy 258 diabetes mellitus 258 immunosuppressed patients 258 Wilson’s disease 258 preterm labor and birth 257 progestin-releasing IUD 247 mechanism of action 247 prophylactic antibiotics 264 protection against STIs 254 risk of bacterial endocarditis 254 risk of human immunodeficiency virus (HIV) transmission 255 risk of invasive cervical cancer 253 risk of pelvic inflammatory diseas risks of endometrial cancer 253 septic abortion 257 spontaneous miscarriage 256 subsequent fertility rates 252 Tatum, Howard 243 technique for the levonorgestrel IUD 263 technique for the TCu-380A 260 treatment of menorrhagia 247 treatment with a NSAID 252 use of IUD in the U.S and the world 242 uterine bleeding 252 women with previous ectopic expulsion 250 pregnancies 251 Zipper, Jaime 243 Intrauterine contraception adolescents 360 older women 369 Intrauterine device (IUD) 157 copper 157 insertion 257 using the Irving, Frederick 382 J Jadelle 183 Jaundice 74, 109 L Levonorgestrel 38 Lipoproteins 67 Speroff Darney_Index.indd 446 Lippes loop 241 Litigation and contraception 13 Liver adenomas 75 cancer 80 cholestatic jaundice 74 cholestatic liver disease and 74 peliosis 75 screening test 75 Lunelle 230 Lupus erythematosus 110 M Male sterilization atherosclerosis 398 human immunodeficiency virus (HIV) 399 medical methods 399 gossypol 399 prostate cancer 398 vasectomy 398 methods 399 reversibility 399 Marker, Russell 19 Mastalgia 196 Mastroianni, Luigi 34 McCormick, Katharine Dexter 32 Medroxy-progesterone acetate 41 Melanoma 85 Mestranol 36 Mifepristone 157 Migraine headaches 106 Minilaparotomy 394 Miscarriage 88, 256 Misoprostol 408 Mitral valve prolapse and 110 Möbius’s syndrome 411 Molar pregnancy 85 Mononucleosis and 114 Multiload-375 244, 245 Multiple sclerosis 93 Myocardial infarction in healthy, nonsmoking women 65, 66, 71 hypertension 62 incidence in reproductive age women 63 stroke and 53, 66 N Nestorone 209 Nomegestrol acetate 43, 44 Non-insulin-dependent diabetes mellitus breastfeeding 332 8/25/2010 2:42:16 PM Index O Obesity 112 hormonal contraceptive failure 112 venous thrombosis and 112 Odds ratio 432 Oral contraception absolute contraindications to the use of 95 acne and 105 adenomas and 92, 114 pituitary prolactin-secreting 92, 114 adrenal gland cortisol-binding globulin (CBG) 85 alternative administration vaginal 114 amenorrhea and 103 androgenic voice changes 77 anemia and 88 antibiotics and 105 athletes and 115 exercise performance and 115 hidden eating disorder 115 backup method 51 gastroenteritis 101 benign breast disease 113 breakthrough bleeding 101 breast cancer and 80, 84 breast discomfort 76 breast examinations 96 breastfeeding and duration 90 lactation, quantity and quality 90 cardiac anomalies and 86 cervical cancer and 78 Speroff Darney_Index.indd 447 chloasma and 76 choice of pill 97 cholestatic jaundice and 74 coagulation system 53 colorectal cancer 84 congenital heart disease 113 congenital malformations and 86 continuation factors that affect continuation 120 controversy involving new progestin oral contraceptives 51 Crohn’s disease 114 depression and 76, 113 diabetes mellitus 108 discontinuing 87 drugs that affect efficacy 105 eating disorders 113 efficacy 51 elective surgery 109 endocrine effects 85 adrenal gland 85 thyroid 85 endometrial cancer and 77 endometriosis 119 eye and ear diseases 93 fertility and 87 gallbladder disease and 110 gallstones 74 generic products 49 gestational diabetes 108 hemorrhagic disorders 112 hepatic disease 111 hirsutism 105 hyperlipidemia 111 hypertension 108 pregnancy-induced hypertension 108 inadvertent use during early pregnancy 86 inadvertent use during the cycle of 86 infections bacterial STIs 94 cervicitis 95 urinary tract infections 95 viral 93 inflammatory bowel disease and 76, 114 inherited resistance to activated protein C 53, 60 laboratory surveillance 97 lipoproteins and 67 liver adenomas and 75 the liver and 74 liver cancer and 80 lupus erythematosus and 110 mechanism of action 50 medical problems 108 447 copper IUD 258, 370 oral contraception 91, 160 progestin-only minipill 221, 339, 341 Norelgestromin 171 Norethindrone 29 converted to ethinyl estradiol 36 norethindrone family 38 Norethindrone enanthate 230 Norethynodrel 29 Norgestimate 39 Norlevo 154 Norplant 183 body weight and 188, 192 ectopic pregnancy 192 menstrual effects 192 vaginal bleeding patterns 192 Norplant-2 183 Nova T 244, 245 NuvaRing 168, 359 8/25/2010 2:42:16 PM 448 Index Oral contraception (continued) metabolic effects of 53 migraine headaches and 106 stroke risk in migraineurs 107 mitral valve prolapse and 110 mononucleosis and 114 multiple sclerosis and 93 nausea and 76 noncompliance 120 noncontraceptive benefits of 115 obesity 112 hormonal contraceptive failure 112 obstructive jaundice in pregnancy 109 osteoporosis 118 other drug interactions 106 ovarian cancer and 77 ovarian cysts 105, 196 pelvic examinations 96 peptic ulcer disease 76 polycystic ovaries and insulin resistance 113 porphyria and 76 postpartum initiation 88 pregnancy outcome 88 dizygous twinning 88 progestin-only minipill 91 choice of pill 97 missed pills 99 pill taking 98 tailor-making the pill 98 relative contraindications 96 rheumatoid arthritis 118 risk of gallbladder disease 75 risk of venous thrombosis associated with 59 seizure disorders 109 sickle cell disease 109 smoking 67 spontaneous miscarriage 88 starting oral contraceptives 98 St John’s wort 105 thyroid and 85 ulcerative colitis 114 use during puberty 93 use of in U.S uterine bleeding 119 uterine leiomyoma 108 VACTERL complex and 86 venous thromboembolism 55 vitamin supplements 76 weight gain 104 Ortho-Evra 171, 359 Osteoporosis 118 Ovarian cancer 77 Ovarian cysts 105, 159, 196 Speroff Darney_Index.indd 448 P ParaGard 243 Patch detachment, recommendations 173 Pearl index Pelvic examinations 96 Periodic abstinence birth defects 321 chromosomal defects 321 definition 315 efficacy 320 failure rates 321 methods 316 calendar method 316 cervical mucus method 316 CycleBeads 319 hormone monitoring 318 rhythm method 316 standard days method 319 symptothermal method 317 period of maximal fertility implantation 315 ovulation 315 probability of conception 315 spontaneous miscarriages 321 Pincus, Gregory 30 Plan B 154 Pomeroy, Ralph 382 Post abortion 419–421 Postcoital contraception 153 Postpartum period barrier methods 341 contraceptive implants 340 depot-medroxyprogesterone acetate 340 periodic abstinence 341 postpartum choice of contraception 337 the rule of 3’s 338 postpartum IUD 342 postpartum visit 337 resumption of ovulation birth spacing effect of breastfeeding 336 in breastfeeding women 335 nonbreastfeeding women 334 risk of pregnancy 336 steroid contraception and impact on breastfeeding 341 incidence of breastfeeding 338 progestin-only minipill 339 transfer of progestin from the mother’s circulation to her milk 341 Preeclampsia 285 Progestin androgenic and estrogenic activities 37 8/25/2010 2:42:16 PM Index component of combination oral contraceptives 37 Progestin-only minipill 339, 368 acne and 159 diminished libido and 160 efficacy 159 lactating women and 160 medications that increase liver metabolism 161 ovarian follicular cysts 159 pill taking 159 problems 159 serious medical conditions 160 women over age 40 160 Prostate cancer 398 Relative risk, defined 432 Reproduction, after discontinuing oral contraception 87 fertility 87 pregnancy outcome 88 spontaneous miscarriage 88 Rheumatoid arthritis 118 Rice-Wray, Edris 34 Rock, John 33 Rosenkranz, George 24 449 R history Ralph Pomeroy 382 menstrual function and 396–397 ovarian cancer and 387 reversibility 397 sexuality and 396 techniques, female sterilization failure rates, 10-year cumulative 388 Filshie clip 392 Hulka-Clemens spring clip 391 minilaparotomy 394 Silastic (Falope or Yoon) ring 393 transcervical approach 395 tubal occlusion by electrosurgical methods 389 tubal occlusion with clips and rings 390 vaginal techniques 395 St John’s wort 105 Stroke in healthy, nonsmoking women, regardless of age 65, 66, 71 incidence in reproductive age women 66 risk in migraineurs 107 Surplant 209 Syntex 28 T S Sanger, Margaret 32 Sexually transmitted infections (STIs) 12 bacterial 94 bacterial vaginosis 95 candida 95 chlamydial infections 94 and contraception 12 pelvic inflammatory disease (PID) 94 trichomonas 95 tubal infertility 285 urinary tract infections 95 viral 93, 306, 357 Sickle cell disease 221 Silastic (Falope or Yoon) ring 393 Smoking 358 arterial thrombosis 55, 59, 70 former smokers 67, 366 oral contraception 67, 111 Spermicides 300, 301 Sterilization contraceptive sterilization in the U.S counseling 395 efficacy of 385 Speroff Darney_Index.indd 449 Tatum, Howard 243 Teenage pregnancy Thrombosis See also Myocardial infarction; Stroke arterial thrombosis 61 importance of good patient screening 71 obesity and 112 oral contraceptives and, summary 70 Transdermal estrogen-progestin contraception 171 clinical responses 175 norelgestromin 171 Ortho-Evra 171 recommendations for patch detachment 173 Transdermal method 172 Trichomonas 286 U Uchida 382 Ulcerative colitis 114 Ulipristal acetate 157 Uniplant 209 8/25/2010 2:42:16 PM 450 Index U.S medical eligibility criteria 435–438 U.S Preventive Task Force Evidence Grading Scheme 434 women who have a history of 72 Yasmin and 58 Vikela 154 V W VACTERL complex 86 Vaginal estrogen-progestin contraception 167 clinical responses 169 etonogestrel 168 NuvaRing 168 progestin and estrogen levels 169 Vaginal nonsteroid contraceptives 361 Vaginal ring method 168 Valvular heart disease 113 Venous thromboembolism 156 controversial studies 176 impact on clotting parameters 53 progestational agents 54, 56 relative risk and actual incidence of 60 screening for inherited disorders 61 women who have a close family history of 61 Y Speroff Darney_Index.indd 450 Web sites, for Adolescents and clinicians 356 Weight gain 223, 357 WHO’s medical eligibility criteria 434 Wilson’s disease, 258 Withdrawal method 322 World population 10, 11 Yasmin cases of venous thromboembolism in drospirenone (Yasmin) users 58 marvelon and 43 Yuzpe, Albert 154 Z Zipper, Jaime 243 8/25/2010 2:42:16 PM ... 8/25/2010 3:48:58 PM A Clinical Guide for Contraception 16 References Djerassi C, The Politics of Contraception, Vol I The Present, Stanford Alumni Association, Stanford, California, 1979 Westoff... affordability, and correct use In addition, in recent Speroff Darney_Chap01.indd 8/25/2010 3:48:54 PM A Clinical Guide for Contraception years, fewer teens have received instruction regarding contraception. 11... enormous wealth of information, making an informed choice possible but not easy In this book, we have distilled and formulated the information essential for the intelligent use of contraception The