This document is one of two evidence-based cornerstones of the World Health Organization's (WHO) new initiative to develop and implement evidence-based guidelines for family planning. The first cornerstone, the Medical eligibility criteria for contraceptive use (third edition) published in 2004, provides guidance for who can use contraceptive methods safely. This document, the Selected practice recommendations for contraceptive use (second edition), provides guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate. The recommendations contained in this document are the product of a process that culminated in an expert Working Group meeting held at the World Health Organization, Geneva, 13-16 April 2004.

Medical Eligibility Criteria for Contraceptive Use reviews the medical eligibility criteria for use of contraception, offering guidance on the safety and use of different methods for women and men with specific characteristics or known medical conditions. The recommendations are based on systematic reviews of available clinical and epidemiological research. It is a companion guideline to Selected Practice Recommendations for Contraceptive Use. Together, these documents are intended to be used by policy-makers, program managers, and the scientific community to support national programs in the preparation of service delivery guidelines. The fourth edition of this useful resource supersedes previous editions, and has been fully updated and expanded. It includes over 86 new recommendations and 165 updates to recommendations in the previous edition. Guidance for populations with special needs is now provided, and a new annex details evidence on drug interactions from concomitant use of antiretroviral therapies and hormonal contraceptives. To assist users familiar with the third edition, new and updated recommendations are highlighted. Everyone involved in providing family planning services and contraception should have the fourth edition of Medical Eligibility Criteria for Contraceptive Use at hand.

Extensive basic research and clinical trials have in some aspect of reproductive physiology, gyne been conducted on inert and medicated intrauterine cology, or family planning. There is in this volume devices. In the last decade, substantial progress has an attempt to provide a total coverage of current been made in understanding the modes of action progress in medicated intrauterine devices. The and the physiological mechanisms of IUDs - pro volume is intended for a broad readership, includ gress resulting from modern techniques and in ing physicians, medical workers, medical personnel, strumentation in microanatomy, immunology, pa and administrators in family planning. It is hoped thology, endocrinology, biochemistry and biophy that this volume will serve as a stimulus to basic sics. Such studies, however, are scattered in such a scientists and clinicians concerned with intrauterine wide spectrum of journals that the clinician and devices to intensify their research toward better family planner can hardly keep up to date with the contraceptive techniques. advances. An attempt is made in this volume to coordinate physiological and clinical parameters. Little is September 1980 known about the possible role of diet, diseases and environmental factors. E. S. E.

The mechanism of action, safety, and efficacy of IUDs were reviewed by a WHO Scientific Group in 1986. The Scientific Group concluded that the IUD should continue to be supported, in both developed and developing countries, as a safe, reliable method of fertility regulation. The newer copper-releasing devices are comparable to oral contraceptives in terms of safety and efficacy. When compared to women who use other reversible methods of contraception, IUD users have the lowest mortality resulting from deaths directly attributable to those methods or to the consequences of unwanted pregnancy. In the past decade, research has concentrated on the development of new devices that have both higher continuation rates and lower rates of expulsion and removal for bleeding abnormalities. An important recent concern has been the possible increased risk of pelvic inflammatory disease (PID) and subsequent tubal infertility associated with IUD use. However, it now appears that methodological problems have caused the IUD-associated risk of PID to be overestimated. The increased risk with IUDs seems to be limited to the 1st 4 months of use. No increased risk of tubal infertility has been found among IUD users in stable, monogamous sexual relationships. The use of a copper IUD after the 1st pregnancy is not associated with secondary infertility due to tubal disease. Finally, the newer copper IUDs have low rates of ectopic pregnancy.

Despite the common perception that medicine is becoming specialty driven, there are many reasons for primary care providers to offer women’s health procedures in an office setting. Women feel more comfortable having procedures done by prov- ers whom they already know and trust. Continuity of care is still valued by patients, who trust their primary care providers to work with them as collaborators in the decision-making process. Women have found that their options for care have become limited, not by their own decision, but by the lack of training of their p- vider. In rural areas, the barriers of time, expense, and travel often prevent many women from obtaining necessary care; yet many of the procedures that these women are requesting are relatively easy to learn. Positive experiences are shared by women who then refer friends and family by word of mouth. This book has been designed to assist not only the clinician performing the pro- dures covered, but also the office staff with setting up the equipment tray prior to p- forming the procedure and with preparing office documents and coding information needed to complete the procedure. Most procedures covered can be done with a mi- mum investment in equipment and require minimal training.

The Requisites in Obstetrics and Gynecology is a series of volumes that offers a concise overview of the field of obstetrics and gynecology in the following areas: High Risk Obstetrics, General Gynecology, Gynecologic Oncology, and Reproductive Endocrinology and Infertility. Each volume contains the core material that is fundamental to each area and includes a presentation that allows the user to absorb the information quickly and thoroughly. This volume is devoted to General Gynecology, which covers care of the female patient outside of pregnancy or during the initial weeks of pregnancy. Topics include gynecologic imaging, family planning, congenital and developmental abnormalities, abnormal uterine bleeding, and pelvic floor disorders.