Depo-Provera and Other Long-Acting Progestin Contraceptives

November 21, 2009

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Depo-Provera and Other Long-Acting Progestin Contraceptives

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.

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, implantable, and intrauterine hormonal 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. For example, when it comes to Depo-Provera, the chance of pregnancy is about 0.3 percent in a year of use--period.

Depo-Provera (also called depo-medroxyprogesterone acetate or DMPA?or simply "the shot"), implantables (which are inserted under the skin) and hormonal intrauterine devices deliver into your body 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? These contraceptives won't prevent sexually transmitted infection (that's where condoms come in). And all of these systems can 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. If the idea of having irregular cycles disturbs you, this may not be the best choice of birth control for you.

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.

In general, women who are happy with Depo-Provera are those who cannot or will not take birth control pills. If you are doing fine on the Pill, the Patch or the Ring, you'll probably find that your method has fewer side effects and is almost as effective. But for women who cannot take estrogen-containing contraceptives for medical reasons, this progestin-only method may offer a safe alternative.

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:

Depo-Provera is highly effective.

All it requires is getting a shot every three months.

Women who don't get periods often see the lack of bleeding as a blessing.

Disadvantages:

If you don't like how you feel on it, you are unfortunately stuck with it for up to a year; there is no way to remove it from your body.

In addition to a small initial weight gain, some women continue to put on a few pounds every year thereafter.

Researchers currently are studying the possibility that long-term use of this medication may increase the risk of osteoporosis (brittle bones).

If you decide you want to get pregnant, it may take more than a year to regain your fertility.

Implantables (99.9 percent effective)
Norplant is a group of six little plastic progestin-filled rods that are inserted under the skin of the 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. This method has not been available in the U.S. for a few years, but similar versions with fewer rods are in the pharmaceutical pipeline.

Advantages:

The contraceptive effect lasts a long time.

It's highly effective.

Disadvantages:

Some people are bothered by the menstrual irregularities.

An office visit is necessary for a healthcare practitioner to insert and remove it.

You may experience mild discomfort at the insertion site.

Removal can sometimes be difficult and require more than one visit to the clinic.

Intrauterine delivery system (99.9% effective)
Mirena is a type of intrauterine device that contains a progestin hormone. This hormone is slowly released from the IUD, with contraceptive results that last at least five years.

Advantages:

It's highly effective.

The contraceptive effect lasts a long time.

Many women have no periods after the first year

Disadvantages:

Some people are bothered by the menstrual irregularities.

An office visit is necessary for a healthcare practitioner to insert and remove it.

You may experience discomfort at the time of insertion.

Rarely, a serious pelvic infection can occur within a week or two after insertion. Having a cervical infection with gonorrhea or chlamydia at the time of insertion increases this risk.


RELATED INFORMATION

			Barriers and Spermicides for Birth Control
			The Events of Ovulation
			Birth Control

Created February 25, 2001
Reviewed and revised August 12, 2004

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