Contraception for the Medically Challenging Patient Rebecca H. Allen Carrie A. Cwiak Editors 123 Contraception for the Medically Challenging Patient Rebecca H. Allen (cid:129) C arrie A. C wiak Editors Contraception for the Medically Challenging Patient Editors Rebecca H. Allen, MD, MPH Carrie A. Cwiak, MD, MPH Department of Obstetrics Department of Gynecology and Gynecology and Obstetrics Warren Alpert Medical School Emory University School of Medicine of Brown University Atlanta , GA , USA Providence , RI , USA ISBN 978-1-4939-1232-2 ISBN 978-1-4939-1233-9 (eBook) DOI 10.1007/978-1-4939-1233-9 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2014945758 © Springer Science+Business Media New York 2014 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To Dr. Uta Landy and Dr. Philip Darney, whose dedication to women’s reproductive health and a new generation of providers has established and fostered an incredible community of experts through the Fellowship in Family Planning, of which we are proud graduates. And to our families, who patiently endured all the hours we spent planning, writing, and editing. Foreword F amily planning saves lives and improves women’s health and well-being by delaying childbearing, spacing pregnancies, reducing unintended pregnan- cies and abortions, and allowing women to choose when and how often preg- nancy is desired [1]. In 2014, women, men, and couples in the United States have more Food and Drug Administration (FDA)-approved contraceptive methods available to them that at any time in the past. However, around half of pregnancies in the United States are unintended—a percentage that has not change in the last two decades [2, 3]. Further, half of unintended pregnancies occur among women not using contraception, demonstrating that there remains an unmet need for contraception in the United States [4]. Overall, contraceptive use in the United States is fairly high; in 2006–2010 (the most recent national data available), 62 % of women ages 15–44 reported current use of contraception [5]. However, 11 % of women determined to be at risk of unintended pregnancy were not using any method of contraception [5]. Among those using contraception, only a small percentage (~6 %) used the most highly effective, long-acting, reversible methods—intrauterine devices and implants [5, 6]. While unintended pregnancies themselves can lead to negative conse- quences for both mother and infant [7], risks may be compounded in women who have medical conditions. Certain medical conditions, such as diabetes, hypertension, and obesity, are increasing in prevalence among US women of reproductive age [8]. For many women with medical conditions, unintended pregnancies may worsen the condition and involve particularly high maternal and perinatal risks. There is a critical need to avoid or delay pregnancy until disease management is optimal. M ost women, even those with chronic medical conditions, can safely use most methods of contraception. All women should be able to choose from the complete range of FDA-approved methods to fi nd one that best fi ts their needs. Health care providers caring for women with medical conditions may be concerned about the effects of contraception on the medical condition, and therefore may avoid providing contraception or addressing family planning needs. However, this must be balanced against the fact that certain adverse outcomes and disease progression are likely to be greater during pregnancy than during contraceptive use [9]. To address these concerns, the World Health Organization (WHO) in 1996 published the fi rst evidence-based guid- ance on Medical Eligibility Criteria for Contraceptive Use, which provided recommendations for safe use of contraceptive methods for women with vii viii Foreword medical conditions [10]. The goal of this guidance is to maximize access to the full range of contraceptive methods, while keeping necessary safety restrictions in place, based on the best available scientifi c evidence. The US Centers for Disease Control and Prevention has adapted the WHO guidance to create the U S Medical Eligibility Criteria for Contraceptive Use , 2 010 (US MEC) for best implementation by US health care providers [11]. The US MEC includes recommendations for over 60 characteristics and conditions. For medical conditions where there is a safety concern about a specifi c method, there are most often several other methods that are safe. The US MEC also highlights certain conditions, such as diabetes, hypertension, human immunodefi ciency virus (HIV), and lupus, for which unintended pregnancy may lead to a high risk of adverse health events, and therefore use of highly effective contraception is particularly encouraged. Contraception for the Medically Challenging Patient expands the con- cepts of the MEC and provides a comprehensive discussion of contraceptive management among women with medical conditions of many organ systems, including cardiovascular, endocrine, neurologic, hematologic, rheumato- logic, gastrointestinal, and psychiatric. This textbook also includes a discus- sion of the assessment of women with medical conditions, management in perimenopause, and interactions between contraception and certain medica- tions. The purpose of this textbook is to provide a complement to the US MEC, with detailed explanation of the safety classifi cations and how they can be used in practice. For many women in the United States, there remains an unmet need for family planning. It is our hope that this textbook will help demystify the pro- vision of contraception among women with medical conditions. We antici- pate that this information will be useful not only to specialists in obstetrics/ gynecology and women’s health, but by all health care providers, including primary care providers and the specialists who take care of women with the medical conditions described here. Finally, we hope that this textbook will encourage health care providers to address the critical need for family plan- ning among all female patients of reproductive age. Disclaimer : The fi ndings and conclusions in this report are those of the authors and do not necessarily represent the offi cial position of the Centers for Disease Control and Prevention. Atlanta, GA, USA Kathryn M. Curtis Naomi K. Tepper References 1 . P opulation Reference Bureau. Family Planning Saves Lives, 4th ed. 2009; http://www. prb.org/pdf09/familyplanningsaveslives.pdf. Accessed 26 Dec 2013. 2 . F iner LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001–2008. Am J Public Health. 104 Suppl 1:S43–8. 3. Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect. 1998;30(1):24–29, 46. Foreword ix 4 . F iner LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sexual Reprod Health. 2006;38(2):90–6. 5. Jones J, Mosher WD, Daniels K. Current contraceptive use in the United States, 2006– 2010, and changes in patterns of use since 1995. National health statistics reports; No. 60. Hyattsville, MD: National Center for Health Statistics. 2012. http://www.cdc.gov/ nchs/data/nhsr/nhsr060.pdf. Accessed 7 Jan 2014. 6. Guttmacher Institute. Contraceptive use in the United States. 2013; http://www.guttm- acher.org/pubs/fb_contr_use.html Accessed 8 Jan 2014. 7. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008;39(1):18–38. 8. Hayes DK, Fan AZ, Smith RA, Bombard JM. Trends in selected chronic conditions and behavioral risk factors among women of reproductive age, behavioral risk factor surveillance system, 2001–2009. Prev Chronic Dis. 2011;8(6):A120. 9. Jensen JT, Trussell J. Communicating risk: does scientifi c debate compromise safety? Contraception. 2012;86(4):327–9. 1 0. W orld Health Organization. Medical eligibility criteria for contraceptive use, 4th ed. Geneva: WHO; 2009: http://www.who.int/reproductivehealth/publications/family_ planning/9789241563888/en/. 11. Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010;59(RR-4):1–86.