Latest edition of CT book targets dramatic changes

By Deborah Kowal, MA, PA

Readers looking for the latest reference on family planning methods and practice can obtain the 18th edition of Contraceptive Technology, to be published this summer.

Since the last edition, family planning has undergone a marked transition. The menu of contraceptive options has expanded and offers women effective methods for short-term or long-term protection, as well as for coverage for unprotected intercourse. New data clarify the relationship between hormonal contraceptive use and the risks for breast cancer and cardiovascular problems. New findings about hormone therapy shift the risk/benefit equation for many women.

One of the pivotal chapters covers combined hormonal contraceptives. New sections on the patch and the vaginal ring are written by Robert Hatcher, MD, MPH, professor of gynecology and obstetrics and the Emory University School and Medicine, and Anita Nelson, MD, professor and medical director of Women’s Health Care Clinic at Harbor-University of California at Los Angeles (UCLA) Medical Center. They include information about counseling women whose patches have come off or who forgot to insert a ring when scheduled. Instructions for missed pills have been updated and streamlined. Hatcher and Nelson describe the new formulations and the management guidance for extended pill regiments. The chapter describes the three methods for initiating pills, included the recommended Quick Start method.

Two chapters are completely rewritten: intra-uterine devices (IUDs) and impaired fertility. David Grimes, MD, MPH, vice president of biomedical affairs at Family Health International and clinical professor of obstetrics and gynecology at the University of North Carolina School of Medicine, reassures providers and users on the safety of the IUD. He examines the research on infection and fertility and bleeding. The chapter covers the indications and precautions, insertion instructions, and management guidance for the new levonorgestrel intrauterine system (IUS), in addition to the progesterone IUD. The chapter on impaired fertility, written by John Marshall, MD, clinical professor of obstetrics and gynecology at the UCLA School and of Medicine, and Nelson, gives a straightforward approach to the office-based work-up of the infertile couple. The team gives an overview of more advanced assisted reproductive technology so clinicians can counsel those patients who may need referrals.

The most widely cited and reprinted information in the book comes from the table on contraceptive failure rates during the first year of use. James Trussell, PhD, professor of economics and public affairs and director of the Office of Population Research at Princeton (NJ) University, reviewed the published literature to calculate the probability of failure among typical and perfect users. The difference between these two probabilities reveals the consequences of imperfect use. It depends on how much a method will forgive imperfect use and how hard it is to use that method perfectly. Trussell gives rates for new methods, including the Evra patch (Ortho-McNeil Pharmaceuticals, Raritan NJ) and NuvaRing (Organon USA, Roseland NJ). The Women’s Health Initiative study prompted many experts to reconsider conventional menopause management. Sorting out the reports and the therapeutic and non-therapeutic alternatives, Nelson and Felicia Stewart, MD, co-director of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, present prudent approaches for symptomatic women. The authors also review the available research on herbal regimens.

Willard Cates Jr., MD, MPH, president and chief executive officer of the Institute for Family Health, Family Health International, Durham, NC, updated the chapter on reproductive track infections with the new treatment guidelines for sexually transmitted diseases and new amplification tests that increase screening sensitivity. In the spermicide chapter, Cates reports the latest research on nonoxynol-9 (N-9) showing the lack of HIV and sexually transmitted infection (STI) protection. In the barrier methods chapter, he brings in the new Lea’s Shield (Yama, Millburn NJ) and the FemCap (FemCap Inc., Del Mar, CA).

Advances in rapid test technology add to the HIV prevention and control armament. Felicia Guest, MPH, CHES, director of training at the Southeast AIDS Training and Education Center of Emory University School of Medicine, describes these technologies and suggests appropriate counseling points. She re-examines the issues for HIV-infected men and women who need to select suitable contraceptive methods.

The nearly 900-page reference book covers the latest research and practice guidance for all the contraceptive methods and for the many issues related to family planning and women’s health. Here is just a short listing:

  • Providers counseling about or providing abortion can benefit from comprehensive new information on early abortion options, including new medication methods (Mifeprex, Danco Laboratories, New York City) that, in many states, can be provided by advance practice clinicians.
  • Emergency contraception has become mainstream, especially with the ease of Plan B (Barr Laboratories, Pomona, NY). The chapter outlines new and simplified rules for emergency contraceptive use and promotes advance provision.
  • The Implanon implant (Organon USA, Roseland NJ), expected to be approved soon, has extensive coverage in the progestin-only methods chapter, which also covers the latest on Depo-Provera (Pharmacia Corp., Peapack, NJ).
  • Do condoms work? Lee Warner, PhD, epidemiologist at the Centers for Disease Control and Prevention, Marcus Steiner, PhD, senior epidemiologist with Family Health International, and Hatcher thoroughly assess the data. With the concern about N-9 and STI risk, they also discuss whether there is any place for the spermicidal condom.
  • The chapter on education and counseling presents patients with pointers on "how to pick a partner."
  • Some of the trickiest dilemmas a clinician needs to sort through include dysfunctional uterine bleeding, polycystic ovarian syndrome (PCOS), and pelvic masses, which are covered in the chapter on menstrual problems and common gynecological concerns.
  • The new Standard Days method streamlines fertility awareness techniques, which makes the rules simpler to follow and interpret while at the same time enhancing efficacy. The various fertility awareness-based methods are compared, and easy-to-understand instructions are provided for users.
  • The new interpretative readings of Pap smears and the new recommendations for mammography are detailed.

Deborah Kowal, MA, PA, Adjunct Assistant Professor, Rollins School of Public Health, Emory University, Atlanta, is Executive Editor and Co-Author, Contraceptive Technology.

[Editor’s note: Contraceptive Technology is available at a cost of $59.95 plus $9.99 for shipping/ handling (total $69.94) by calling Bridging the Gap at (706) 265-7435 or through]