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DESCRIPTION
DEPO-PROVERA CONTRACEPTION INJECTIONS
The goal of contraception (or birth control) is to prevent an unplanned pregnancy. The majority of methods of contraception enable sexually active couples to temporarily avoid pregnancy. Permanent birth control is accomplished through sterilization. Be sure you know and understand the different types of birth control available to you, the risks and benefits of each, and any side effects, so that you can make an informed choice.
MoonDragon's Contraception Information: Contraception Methods Compared
The most widely used injectable form of birth control is the hormone medroxyprogesterone (Depo-Provera [DMPA] AKA "The Shot"). Depo-Provera (Depot-medroxyprogesterone acetate) is a synthetic progesterone hormone similar to the one that a women's body produces. It is an injectable form of a progestin that is used about 4 times per year (every 90 days). It was approved by FDA in 1992 for contraceptive use. Previously, it was approved for treating endometrial and renal cancers.
DMPA prevents pregnancy in the same way as other methods which rely on progestin. It suppresses ovulation to some extent, it makes the mucus of the cervix thicker and unable to be penetrated by viable sperm and renders the lining of the uterus thinner and unreceptive to a fertilized egg. Depo-Provera is the only birth control shot that is approved for use in the United States as of 1995. There are other types of injections that are being researched.
Depo-Provera has a failure rate of approximately 1 percent or less. The woman who chooses this method of birth control has a 0.03% chance of getting pregnant. This means if a 1000 women use this method, only 3 may become pregnant within the first year. To make this method as effective as possible, it is important to return to your health care provider every 12 weeks (90 days) for a renewed injection if she doesn't want to become pregnant. It is injected every three months into a muscle in the buttocks or arm by a trained health care provider. If given during the first 5 days of menstrual bleeding, no additional protection is needed.
Depo-Provera is one of the most effective methods of contraception, but it does not protect against the transmission of sexually transmitted infections/diseases (STI/STDs). Also, For protections from sexually transmitted infections, condoms (male or female) must be used. some women have experienced severe reactions to the hormonal shot. If you have a monogamous partner who has tested negative for STIs, you might want to try Depo-Provera. If you experience unpleasant side effects, see your health care provider who may be able to prescribe additional medications to help alleviate the symptoms.
LUNELLE CONTRACEPTION INJECTIONS
Lunelle (Cyclofem/CycloProvera) is another injectable contraceptive that is administered monthly (every 28 to 30 days) and is a monthly combination birth control injection. Lunelle was approved by the Food and Drug Administration (FDA) in October 2000. The hormone in Norplant and Depo-Provera is progestin, a synthetic hormone similar to one found naturally in a woman's body; Lunelle contains the hormones progestin and estrogen.
The purpose of these hormones is to prevent pregnancy; they are about 99% effective in achieving this goal. No hormonal contraceptive methods provide protection from AIDS or other sexually transmitted diseases.
The hormones in Lunelle works similarly Depo-Provera. The shot has 2 hormones: an estrogen and a progestin (5.0 mg estradiol cypionate and 25 mg medroxyprogesterone acetate). The the egg (ovum) is prevented from maturing and being released. The mucus in the cervix (opening into the uterus or womb) becomes thicker, making it difficult for the sperm to enter. It also causes the lining of the uterus to become thinner, making implantation of a fertilized egg unlikely.
As with an injection of Depo-Provera or Lunelle must be given within the first five days of a normal period. Depo-Provera provides protection against pregnancy for three months, while Lunelle provides similar protection for one month. Ovulation (release of a mature egg) typically occurs within 60 days of the last injection of Lunelle, about twice as fast after use of Depo-Provera. Also, because Lunelle is a combined hormone contraceptive as opposed to progestin-only Depo-Provera and Norplant, it is less likely to cause irregular or absent menstruation.
The woman being considered for Depo-Provera or Lunelle will have a pelvic and breast examination, a Pap test (a microscopic examination of cell samples taken from the cervix), blood pressure check, weight check, and a review of her medical history. Women who have diabetes mellitus, major depression, blood clotting problems, liver disease, or weight problems should use these methods only under strict medical supervision. Depo-Provera or Lunelle should not be used if the woman is pregnant, has unexplained vaginal bleeding, suffers from severe liver disease, has breast cancer, or has a history of blood clots or stroke. One benefit of Lunelle, however, is that its effects wear off more quickly than Depo-Provera, an important factor in the event that a woman has serious side effects or wants to become pregnant.
Depo-Provera contains only one hormone, a progestin. Also, you only get this shot once every three months rather than monthly, and the advantages and disadvantages of using it differ from those of Lunelle. The particular disadvantages of Lunelle are:
- The need for a monthly visit to a doctor's office to receive the shot.
- Weight gain.
- Headache.
- Nausea.
- Breast pain.
Lunelle was approved for use in the U.S. in 2000. However, in October 2002 it was voluntarily recalled from the market, due to plant manufacturing problems. The maker doesn't plan to reintroduce it in the U.S. Since Lunelle was the only combination shot available in the U.S., once again American women are left without an alternative. For women in the rest of the world, the alternatives to Lunelle are: Mesigyna, Perlutal, Yectames, and Chinese Injectable No.1.
ADVANTAGES
Quickly and easily administered by a health care provider.
The hormone used, progestin, provides a birth control option for women who cannot take estrogen hormones that are used in oral contraceptives.
The injections require no daily routine. It is a very private method of contraception.
Freedom from concern and enjoyment of spontaneous sexual intercourse. Doesn't interrupt sex.
May prevent some health problems, like ovarian cancer, uterine cancer and PID. Reduces menstrual flow and cramps. Reduces risk for endometrial and ovarian cancer, reduces symptoms of endometriosis, and reduces risk of pelvic inflammatory disease (PID).
Reduces risk of ectopic pregnancy.
Reduces frequency of seizures in women who have a seizure disorder.
Reduces number of sickle cell crises in women who have sickle cell disease.
Can be used after a miscarriage or an abortion.
Reduces cramps and pain at ovulation.
Future fertility does not appear to be affected, but it may take several months to 1 year for ovulation to occur once the injections are discontinued.
DISADVANTAGES
Presence of other medical problems may affect the use of these injections. There are a few medical conditions that health care providers will consider before recommending Depo-Provera. They will check to make sure the woman isn't pregnant. If a woman has abnormal vaginal bleeding, the cause needs to be known before starting this method. These include:
- Allergies.
- Liver disorders.
- Cancer or a history of cancer.
- Diabetes mellitus.
- Epilepsy.
- Unexplained vaginal bleeding.
- Other bleeding problems. Blood clots.
- Stroke.
Requires seeing a health care provider every 12 weeks for an injection.
Doesn't protect against STDs. A woman using hormone injections as a contraceptive is encouraged to use condoms (male or female) for STD protection.
COMMON SIDE EFFECTS
Common side effects of hormone injections are:
- Irregular bleeding and spotting during the first months followed by episodes of amenorrhea (no menstrual period). Menstrual periods may be heavier than usual or lighter than usual. About 50 percent of the women who use Depo-Provera for one year or longer report their periods stop completely (amenorrhea).
- Weight gain.
- Headaches.
- Nervousness.
- Depression. May make symptoms of depression and PMS worse.
- Nausea.
- Dizziness.
- Abdominal pain.
- Breast tenderness.
- Hair loss.
- Skin rashes.
- Increased or decreased sexual desire.
- Development of dark spots on the skin.
- Tiredness, fatigue or weakness.
Serious side effects should be reported to your health care provider immediately if you have any of the following:
- Marked weight gain.
- Heavy or longer menstrual (vaginal) bleeding. Heavy bleeding could also be a sign of PID, cancer or other health problems.
- Frequent urination, fluid retention (edema).
- Blurred vision.
- Fainting.
- Severe abdominal pain, possible ectopic pregnancy (considered rare).
- Severe depression and mood changes.
- Migraine headaches.
- Lump in either breast.
- Heavy or continuous bleeding.
- Yellowing of the eyes or skin.
- Sudden shortness of breath.
- Sharp chest pains.
- Coughing up blood.
- Bleeding disorders. Blood clots, tumor, stroke or heart attack are listed as possible problems on the product inserts.
- May decrease levels of HDL ("good") cholesterol.
- Skin reactions to injections. Some women are allergic to hormone injections. Infection at the injection site.
- May lower your estrogen level and cause bone loss. Bone mineral density may be reduced. Osteoporosis, or thinning of the bones. Using Depo-Provera for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medication. Bone thinning can lead to osteoporosis in later life. This concern may be greatest during the teen years, when young women should be building bone mass. Talk to your health professional about whether the benefits of long-term use outweigh your risks and how you can protect your bones with daily calcium and regular weight-bearing exercise, such as walking or running. This was noted in one study of women using Depo-Provera. It is still being studied.
- May increase the risk of chlamydia or gonorrhea infection among women who are sexually exposed to these bacteria. (Depo-Provera users who have any risk of exposure to STDs are advised to use condoms.)
Many of the side effects go away or decrease after the first 6 months of use. However, if a woman stops this method because of certain side effects she has, it may take a few months for them to go away. It may take awhile before she can become pregnant after stopping the injections. Fertility may not return for 6 to 8 months after stopping the medication.
Normally not recommended for breastfeeding women.
Does require injections every 3 months in a health care provider's office.
Cannot be reversed as easily as discontinuing a daily pill.
Long-term effects are still being studied.
GENERAL MEASURES
INSTRUCTIONS FOR USE
The injections will be prescribed for you after the health care provider has studied your medical history and the results of a physical examination.
The first injection is often given during the 5 days of the menstrual period so that pregnancy has been ruled out. If you get the shot at any other time of your menstrual cycle, use a back-up method for two weeks. Depo-Provera starts to work in less than 24 hours after it is injected.
The injections are injected into a muscle once every 3 months (usually a large muscle such as the buttocks muscle may be used) or your arm. The contraceptive levels of hormone persist for up to 4 months (following a 2 to 4 week margin of safety). But for pregnancy safety reasons, have the injection redone every 12 weeks. Make your appointment 2 to 3 weeks before you next injection is due.
It is normal to have little or no menstrual bleeding while on Depo-Provera. Many women stop having any menstrual bleeding after a year of use. If you have little or no menstrual bleeding, this does not necessarily mean you are pregnant. It is very rare to get pregnant while using Depo-Provera. If you are concerned, you can be tested.
Follow-up medical examinations are recommended at least once a year; may be done more frequently. See your health care provider is you have any of the Depo-Provera warning Signs.
MEDICATION
There may be some interactions with other medications. Advise any health care provider treating you or prescribing for you that you have these hormone injections.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You are interested in hormone injections as a method of temporary contraception.
After the injections:
- You suspect you are pregnant.
- Unexpected vaginal bleeding occurs or other changes in your menstrual cycle develop.
- You develop pain or swelling in the calf or any unusual leg pain.
- There are changes in your blood pressure.
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