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Pregnancy Miracle

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Depo-Provera

Depo-Provera is another progestin-only birth control method. It is an injection that protects against pregnancy for 3 months. Although Depo-Provera has been available for years in over 90 other countries and has been used by millions of women, it did not receive FDA approval in the United States until 1992. Since then it has become an extremely popular contraceptive, and at some women's clinics it rivals the Pill in the number of women using it.

The progestin used in the injection, Depo-medroxyprogesterone acetate (DMPA), inhibits ovulation by suppressing the amounts of luteinizing hormone and follicle-stimulating hormone that a woman's body usually produces in order to ovulate. Like other progestins, DMPA also makes the uterus inhospitable to any possible fertilized egg, and thickens the cervical mucus so it discourages the passage of sperm.

After the injection, the DMPA acts like a timed-release "depot" of progestin in the muscle. Low levels are released constantly into the circulation until the depot is exhausted.

Depo-Provera injections are given once every 3 months to maintain contraceptive impact and are more than 99 percent effective. Studies thus far show no serious side effects from the use of DMPA.

Like the other progestin-only methods, however, Depo-Provera generally causes many months of irregular bleeding, usually followed by no bleeding at all.

Like all hormonal methods, injections of DMPA do not protect against AIDS or other sexually transmitted diseases.

EFFECTIVENESS AND REVERSIBILITY

Depo-Provera is highly effective as long as you are consistent in returning to the clinic for your next shot. When it is discontinued, however, normal fertility may not return as readily for some women as it does when other progestin-only methods are stopped.

Failure Rate

The failure rate for Depo-Provera is less than 1 percent. The injection (150 mg) is designed to last a little longer than 3 months, just in case it is not possible to return to the clinic or physician's office exactly on schedule.

Reversibility

The effects of Depo-Provera do not disappear as rapidly as the other progestin-only methods, and a number of months may pass after the last injection before fertility is restored. Studies found that 68 percent of the women who did become pregnant after discontinuing Depo-Provera did so within 12 months. Almost all women conceived within 18 months after the last injection. Women with lower body weights became pregnant sooner than women with higher body weights. The length of time it took to become pregnant was not related to the duration of Depo-Provera use.

This long-lasting effect does not apply to all women, however. If you give up this method but do not wish to become pregnant, to be safe you must start using another contraceptive method within three months after your final Depo-Provera injection.

IN A NUTSHELL

DEPO-PROVERA

Depo-Provera is a progestin that is given as an injection every 3 months to prevent pregnancy. It is very effective and easy to use because you do not have to remember to take a pill every day or get a prescription refilled.

Depo-Provera does not protect you against STDs. For protection against diseases, you or your partner need to use a condom as well.

To have regular Depo-Provera shots, you need to go to a clinic like Planned Parenthood or to a doctor.

The most common side effect is a change in your periods. Eventually some women have no periods at all. If you stop having the injections, your periods will start again.

menstruation. If Depo-Provera ally return to normal.

HEALTH EFFECTS

Irregular Bleeding. Like other progestin-only contraceptives, Depo-Provera changes your menstrual cycle. It produces irregular periods, long periods of light bleeding or spotting, or no periods at all (amen-orrhea). Some women have more days of heavy bleeding, although the total amount of blood they lose is not increased. Irregular bleeding patterns can be annoying, but they decrease with time and eventually, for most women, menstruation stops. If you can wait, you eventually will have no periods at all, which many women find is a comfortable state of affairs. Depo-Provera suppresses the hormones that usually activate the ovaries. Over a period of time, this causes the ovaries to rest and not produce eggs. The regular monthly enrichment of the endometrium does not take place, so there is little or no is stopped, menstrual periods gradu-

Weight Gain and Bloating. It is not unusual to gain a few pounds while using Depo-Provera, and some women gain so much weight they change to another method of birth control. Fluid retention also may occur. If you have epilepsy, asthma, or migraine headaches, and you experience bloating, bring this reaction to the attention of your physician.

Headaches. Some women will experience an increase in the number or intensity of headaches. If this reaction does not disappear after a few months, it may be necessary to discontinue the injections.

Breast Tenderness. This happens in a few women and sometimes can be very painful. Although pregnancy is unlikely, if breast tenderness appears after you have been on Depo-Provera for some time, you should talk to your health care provider about having a pregnancy test.

Depression. If depression and anxiety occur, especially if you have a history of these problems, use another method.

HDL Changes. Levels of high density lipoprotein (HDL) drop in women using Depo-Provera. If your cholesterol levels are high, your physician should monitor you more frequently while you use this contraceptive method.

Drug Interactions. So far there are no reports of Depo-Provera effectiveness being reduced by the use of antiseizure drugs or the TB antibiotic rifampin. However, Depo-Provera does affect the outcome of some laboratory tests. You should always let your health care providers know you are using hormonal birth control.

Cancers. The progestin in Depo-Provera reduces the risk of endome-trial cancer and is expected to reduce the risk of ovarian cancer by suppressing ovulation. It has no effect on breast cancer.

Other Side Effects. Reactions that are less common include dizziness, fatigue, nausea, abdominal pain, backache, hot flashes, leg cramps, and a decreased interest in sex. These may disappear or become much less noticeable after a few months of using the method.

IS DEPO-PROVERA RIGHT FOR YOU?

Good Candidates

All women. Depo-Provera is suitable for almost all women in good health. Because it is a progestin-only contraceptive, it is a particularly good choice for women who cannot or should not take estrogen. This method also is popular because it is an injection given at a clinic, and there is no way to tell that you are using birth control. And it does not interrupt lovemaking.

Breastfeeding women. As with all hormonal methods, Depo-Provera is not the birth control method of first choice for breastfeeding women. If you are breastfeeding and wish to use a hormonal method, however, you should use one that contains only a progestin and no estrogen, such as Depo-Provera. Studies have shown that progestins do not reduce the supply of breast milk. Small amounts of the hormone will be in the breast milk, however, although this has not been shown to have a negative effect on infant growth and development. (For more information on contraception while breastfeeding, see Chapter 17.)

Diabetics. Depo-Provera also is a good method for women with diabetes who do not wish to become pregnant.

Young women and teenagers. Although women of all ages appreciate the advantages of Depo-Provera, it is popular particularly among younger women, because there is little hassle associated with it, no rigid schedule to follow, no prescription that must be refilled and no pills to be remembered. If an appointment is slightly delayed, there is no immediate worry about pregnancy because this method has a 1-to 2-week grace period. Furthermore, the thick cervical mucus that progestin causes seems to offer some protection against pelvic inflammatory disease.

Women with sickle cell anemia or seizures. Both these conditions may be improved by DMPA.

Women who have severe menstrual cramps and other menstrual cycle problems. Progestin-only contraceptives, including Depo-Provera, tend to reduce the intensity of menstrual pain, premenstrual symptoms, heavy bleeding, and midmonth ovulatory pain.

Women Who Are Not Good Candidates

Women with unexplained vaginal bleeding. The unpredictable and irregular bleeding that usually accompanies the first year or so of Depo-Provera may conceal unusual bleeding that can be a symptom of cancer of the reproductive tract. If a woman already has unusual bleeding, Depo-Provera should not be used until the explanation for that bleeding is found.

Women who cannot tolerate irregular bleeding. If having regular periods is important, Depo-Provera and the other progestin-only methods are not good choices.

USING DEPO-PROVERA

After a single 150 mg dose of Depo-Provera is injected, the concentration of the DMPA slowly increases until it reaches a peak level in the bloodstream 3 weeks later. It then very gradually decreases. The DMPA level remains protective against pregnancy for about 13 to 14 weeks. If the time interval between injections is longer than 13 weeks, however, you may need to be tested to make certain you are not pregnant.

Most women's health centers, HMOs, and birth control clinics such as Planned Parenthood offer Depo-Provera as part of their selection of contraceptive methods.

If you are concerned about privacy issues, you may find it helpful to ask the clinic or doctor some of the questions listed on page 234 of Chapter 18.

To begin using this method, you will be asked to call the clinic when your next menstrual period begins. The first Depo-Provera injection is given while you are bleeding to make certain you are not pregnant. If you have just given birth and do not plan to breastfeed, the first injection should be within 5 days of the birth. If you are breastfeeding, the first injection is usually scheduled for the sixth week after the birth. (See Chapter 17 for more information on breastfeeding and contraception.)

Subsequent injections are every 3 months. Clinics use various ways to remind their clients about the next shot. Some simply give you a calendar on which you mark the dates; others will mail you a reminder. If you use a diary or desk calendar, marking it with the day of the next injection is one of the easiest ways to remember.

COST

The costs of the physical examination plus the injection of Depo-Provera vary substantially from area to area. The $120 that Planned Parenthood affiliates and some women's health centers charge for the exam and injection are in the middle of the price range. Subsequent injections commonly are $60 each. The annual expense for four injections is often $240, which compares favorably to the expense of using the Pill. Many HMOs offer Depo-Provera injections and the physical exam for their usual co-payment of $5 to $20. Other health insurance plans and Medicaid often pay for some of the cost of Depo-Provera.

Part TMRee

The Intrauterine Method

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