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| |    Depo-Provera and Other Long-Acting Progestin Contraceptives by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Wouldn't the perfect birth control method be something that was 100 percent effective, didn't interfere with sex, didn't require any extra effort, lasted as long as you wanted it to, and then could be discontinued to allow a desired pregnancy? Well, rejoice: Injectable and implantable contraceptives have many of these desirable characteristics. All these long-acting methods don't require any participation by the patient, so perfect use vs. typical use has no bearing on their effectiveness. Typically, pregnancy rates in a year are calculated as 100 minus the effectiveness rate, with a number range that takes into account how consistently (or inconsistently) the contraceptive was used. But when it comes to Depo-Provera, the failure rate is about 0.3 percent in a year of use--period. Both Depo-Provera (also called depo-medroxyprogesterone acetate or DMPA--or, informally, simply "the shot") and Norplant (subdermal levonorgestrel) deliver into your system a low dose of a progestin, one of the major female hormones. When administered continuously like this, progestin prevents sperm from passing through the cervix, inhibits ovulation, and makes the uterine lining inhospitable for implantation of an embryo--all major factors in preventing pregnancy. That's the upside. The downside? Both of these contraceptives won't prevent sexually transmitted infection (that's where condoms come in). And both cause irregular menstrual cycles. In fact, some women lose their periods all together. Medically this is OK, since the uterine lining gets thin from the hormones and doesn't need to be shed regularly, but some women find the absence of their period disconcerting. Some users have a bit of bleeding every day for months, but overall the amount of bleeding is less than if you were having regular cycles. Your practitioner can help regulate your bleeding with some pills and can check your blood count if there is concern about anemia. But if the idea of having irregular cycles disturbs you, this may not be the best choice of birth control for you. In general, women who are happy with these methods are people who cannot or will not take birth control pills. If you are doing fine on the Pill, you'll probably find that it has fewer side effects and is almost as effective. But for women who cannot take birth control pills for medical reasons, these two progestin-only methods often are a safe alternative. This article also includes information on a new injectable method that is just coming onto the market. Depo-Provera (99.7 percent effective) Depo-Provera is a long-acting progestin given as a shot into your arm or buttock once every three months. That's it. Its effectiveness in preventing pregnancy starts to wear off after three months, but the medication may remain in your body for up to a year. If you develop constant bleeding with this birth control method, your practitioner can give you some pills that usually will stop the bleeding for a while. By the second year of use, many women have no periods at all. One concern for many women who are considering using or are using Depo-Provera is weight gain. On average, women gain about five pounds during the first year of use, so if you're using this method, it's a good idea to pay extra close attention to your eating habits and to get into an exercise routine. Advantages:
Norplant is a group of six little plastic progestin-filled rods that are inserted under the skin of your arm, under local anesthesia, in the office or clinic. The rods allow a small amount of hormone to continuously enter your system and provide contraception for five years after insertion. Conversely, as soon as they are removed (with another minor surgical procedure), fertility promptly returns. Advantages:
A new injectable contraceptive, called Lunelle, will be available soon. It contains estrogen plus progestin and needs to be taken once a month. The main benefits of Lunelle are that it may not cause some of the menstrual side effects of the progestin-only methods and it doesn't stay in your system as long as Depo-Provera. Since Lunelle does contain estrogen, this method won't be an option for people who for medical reasons should not take estrogen. It may appeal to women who could potentially take birth control pills, but who have trouble remembering to take their daily dose.
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