Managing Contraceptive Pill Patients. (Book Reviews).

Author: Richard P. Dickey, MD, PhD

Publisher: EMIS, Inc, 2003

The scenario is common: after extensive counseling, a woman chooses oral contraceptives for contraception. However, two months later, she returns with side effects; she may be bleeding into the second week of the pill pack or experiencing recurrent nausea.

Her physician realizes that these side effects indicate specific hormonal shortage or excess, but which of the many oral contraceptives should be used next? How can the specific side effect be abated by shifting the balance of estrogen, progesterone, and androgen?

The number of options available to women desiring hormonal contraception has steadily increased since oral contraceptives were introduced in the 1960s. At least 50 name-brand oral contraceptives are available, as well as injected progesterones, injected combination against estrogen and progesterone, a combination patch, a combination vaginal ring, implanted progesterone, and a progesterone intrauterine device. When a woman presents with specific needs, a thorough, but readable, reference is invaluable.

This book is soon to be available in the eleventh edition. Since the first edition came out in 1977, it has provided reliable guidance through the maze of relevant information about oral contraceptives: which of the two estrogens used, which of the twelve progesterones used, the relative estrogen/progesterone/androgen balance of the combination, and endometrial activity--the effect of the combination on the endometrium. In addition, the eleventh edition does not contain many of the old references related to cardiovascular effects of oral contraceptives containing more than 50 [micro]g estrogen. It does include brief discussions of each of the other forms of hormonal contraception: injections, implants, intrauterine devices, rings and patches.

To compile a reference on hormonal contraceptives which is both thorough and readable, yet which can fit in the pocket of a lab coat, requires a touch of genius in being succinct. Dr. Dickey's approach to this challenge is to write brief chapters, nearly all of them in six pages or less, discussing one small aspect of hormonal contraceptive management, but to pack reference information into sixteen tables is the center of the book, and to refer to the primary references throughout the text, 414 references for 154 pages of text and 40 pages of Tables.

Listed are a few titles of the Tables: Composition and Identification of Old Contraceptives, Contraceptive Pill Activity, Oral Contraceptives With Similar Endometrial, Progestational and Androgenic Activities (classes 52 name-brand oral contraceptives into 14 groups, based on endometrial, progestational, and androgenic activities) and Relation of Side Effects to Hormone Content (ie, too much or too little estrogen, progesterone or androgen affect). Chapter titles include Therapeutic Uses of Oral Contraceptives, Cardiovascular System and Oral Contraceptives, and Initial Selection of Oral Contraceptives.

By refining the process of compacting detailed information, Managing Contraceptive Pill Patients is readable and thorough. It belongs on the bookshelf, or in the lab coat pocket, of any physician who prescribes hormonal contraceptives.