Update on Contraception

Katharine O'Connell White, M.D., M.P.H., F.A.C.O.G.

The benefits of contraception have long been established, yet consistent access to effective birth control remains a challenge for many women. On a global scale, family planning improves maternal and child health, reduces maternal mortality from unplanned pregnancy, and even slows the effects of population growth on climate change. In the United States, barriers to contraception still exist, ranging from variable insurance coverage to health-care access to difficulties with use of the various methods. Another barrier has been physicians' lack of up-to-date knowledge about contraceptive methods. Multiple changes have occurred in the contraceptive marketplace since 2001, the last year a review was published in this journal. We have seen an increase in the variety of methods available and new ways of prescribing older methods; we have also seen some methods leave the market altogether. Comprehensive knowledge of the array of contraceptive methods will facilitate better patient counseling.

This issue of Seminars in Reproductive Medicine highlights the current status of various contraceptives and introduces the new methods that have become available. Dr. Aileen Langston reviews the recent literature on emergency contraception, with an emphasis on its change to over-the-counter status. Dr. Paula Castaño and Lola Adekunle present an overview of the two new methods of transcervical sterilization, both approved by the Food and Drug Administration. Drs. Raegan McDonald-Mosley and Anne Burke explore contraceptive implants, both the implant available in the United States and those on the market abroad. Dr. Noa'a Shimoni reviews intrauterine contraception. She gives special attention to the noncontraceptive benefits of these devices and the expanded eligibility criteria for their use. Dr. Geneviève Roy provides us with the current status of injectable contraception, with an extensive discussion of the current data about its effects on bone health. Drs. Jill Edwardson and Roxanne Jamshidi present a comprehensive look at the contraceptive vaginal ring. Dr. Miriam Cremer and colleagues review the newest formulations of oral contraceptives. They discuss both the changes to the hormone-free interval and drospirenone, the newest progesterone. Dr. Anitra Beasley discusses the challenges of providing contraception for adolescents, postpartum patients, and perimenopausal women, along with the appropriate contraceptive methods for each population. Finally, Dr. Amitasrigowri Murthy highlights the growing impact of obesity on gynecologic care. She reviews the recent information on the effects of obesity on various contraceptive methods and provides a concise overview of surgical obesity management and its particular need for contraception.

Almost all authors in this issue are either current or former fellows of the Fellowship in Family Planning. This program, founded in 1991 by Dr. Phillip Darney at the University of California, San Francisco, has trained >150 physicians. Currently, an additional 40 fellows are in training at 21 programs across the United States. The objective of the fellowship is to develop specialists in clinical practice, training, and research related to all contraceptive methods, sterilization, and pregnancy termination. This group of physicians will likely form the core of our current and future expertise in the field of contraception, and I give heartfelt thanks to all who contributed to this issue.