Zieman Mimi - Managing Contraception

Bridging the Gap Communications

P.O. Box 79299

Atlanta, GA 30357

www.managingcontraception.com

Phone 404-875-5001

FAX 404-875-5030

COPYRIGHT INFORMATION

Managing Contraception 2012 by Mimi Zieman and Robert A. Hatcher and Bridging the Gap Foundation. The extent to which this book is used to help others is now in your hands.

If we used an entire table, figure, or direct quote from another publication, you must request permission to use that information from the original author and publisher.

Suggested formal citation:

Zieman M, Hatcher RA. Managing Contraception . Tiger, Georgia: Bridging the Gap Foundation, 2012.

IMPORTANT DISCLAIMER

The authors remind readers that this book is intended to educate health care providers, not guide individual therapy. The authors advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem. Under no circumstances should the reader use this handbook in lieu of or to override the judgment of the treating clinician. The order in which diagnostic or therapeutic measures appear in this text is not necessarily the order that clinicians should follow in each case. The authors and staff are not liable for errors or omissions.

Eleventh Edition, 2012-2014

ISBN 978-1-4675-3640-0

Printed in the United States of America

Bridging the Gap Foundation

On 165 pages, we cannot possibly provide you with all the information you might want or need about contraception. Many of the questions clinicians ask are answered in the textbook Contraceptive Technology or in detail on our website. Visit us regularly at: www.managingcontraception.com

Mimi Zieman, MD

Clinical Associate Professor of Gynecology and Obstetrics

Emory University School of Medicine

Robert A. Hatcher, MD, MPH

Professor Emeritus of Gynecology and Obstetrics

Emory University School of Medicine

As we move from a pocket-sized book to an e-book, and soon to an app, we want to thank the following individuals who contributed mightily to previous editions of Managing Contraception:

Carrie Cwiak, MD, MPH

Philip D. Darney, MD, MSc

Mitchell D. Creinin, MD

Harriet R. Stosur, MD

Technical and Computer Support:

Digital Impact Design, Inc., Cornelia, Georgia

Don Bagwell, Jason Blackburn, Terry Hulsey and Anna Poyner

Bridging the Gap Foundation Tiger, Georgia

OUR MISSION

The mission of Bridging The Gap Foundation is to improve reproductive health and contraceptive decision-making of women and men by providing up-to-date educational resources to the physicians, nurses and public health leaders of tomorrow.

OUR VISION

Our vision is to provide educational resources to the health care providers of tomorrow to help ensure informed choices, better service, better access to service, happier and more successful contraceptors, competent clinicians, fewer unintended pregnancies and disease prevention.

We hope this e-book will make important information accessible to more people.

www.managingcontraception.com

Examples of questions answered on this website:

I received a Mirena IUD on the 13th of October. My question is: From October 28th through November 4th I have been having a period. Its been 8 days. Is that normal ?

My reply on November 4th:

Bleeding days exceed days with no blood for the first month using Mirena (not for everyone, but this is on average). You may have still more days of spotting or bleeding in the days or weeks ahead. I hope the bleeding is becoming less over time. In time, women using Mirena have 90% LESS blood loss than women of the same age using no hormonal method of contraception. This difference between the first month or so and later on has led to the advice given by a wise person:

Terri Wynn-Hipps is a nurse midwife in Ft. Bragg, North Carolina. She has inserted close to 200 IUDs in the past year. 85% of her last 100 insertions have been Mirena IUDs. You can see that whatever she is telling women in advance of inserting an IUD clearly is not discouraging her patients from choosing Mirena. So, how does Terri Wynn-Hipps from Ft. Bragg, North Carolina deal with the spotting, bleeding and cramping in the first month after Mirena insertion? SHE TELLS WOMEN: You may dislike it for a month but then you will love it for 5 years.

(Contraceptive Technology Conference-Atlanta, Georgia October 29, 2009)

CONTENTS

FIGURES

TABLES

HOW TO USE MANAGING CONTRACEPTION

This guide is designed to give up-to-date, immediate clinical information that is evidence-based. For more comprehensive information, we refer you to Contraceptive Technology , an in-depth textbook, which is available through the website ( www.managingcontraception.com ) or in CD-ROM format.

Managing Contraception can also be used as a teaching tool.

Medical, nursing or public health students OR residents can receive Managing Contraception along with a handout that has self-learning questions at the beginning of their clerkship or rotation.

The questions can be divided and assigned to the students in advance of the lecture. Students can prepare answers to the questions and present to the class during the interactive lecture.

If you desire to give the lecture in one session, it takes approximately 1 1/2 hours to present. Alternatively, the lecture can be split into 2-3 shorter sessions.

Have fun with it! Bring examples of different birth control methods to show, props, etc.

DEDICATION

Nothing short of a miracle

Its kind of fun to do the impossible, Walt Disney once said. Gina Secura and Jeffrey Peipert are competent, smart, warm, loving people. They are serious researchers who care. Jeff and Gina have been the architects, engineers and laborers in the field of what may well come to be known as the most ambitious contraceptive research project ever carried out.

This edition of Managing Contraception is dedicated to Gina Secura and Jeffrey Peipert. For the past 5 years Jeffrey Peipert has directed and Gina Secura has coordinated the efforts of over 135 people at the St. Louis CONTRACEPTIVE CHOICE PROJECT at Washington University (usually called Wash U). Three numbers provide a glimpse into the magnitude and excellence of this project.

1. 9,256 women were entered into the three year project. Each of these individuals was hoping to avoid an unwanted pregnancy.

2. When the first patient completed her three years, 6000 precious items of information had been collected about her!

3. 75% of women have chosen to use one of the three Long Acting Reversible Contraceptives. About 50% of women received the Mirena or levonorgestrel IUD; 15% received an Implanon Implant and 10% received the Copper T 380 A IUD called ParaGard. Prior to the CHOICE project, 1-2% of women were receiving an IUD and under 1% were having an Implanon implant inserted at the clinics throughout St. Louis that would participate in the CHOICE project.

Gina Secura grew up in Anaheim, California, majored in biology at U.C. Santa Barbara and received both a masters degree and a PhD in public health at St. Louis University. For 5 years she did HIV research at the CDC in Atlanta before moving back to St. Louis.