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Birth control options for women - Injected Contraception

Description

An in-depth report on the birth control options available to women.

Alternative Names

Contraception

Injected Contraception:

Injected contraceptives are given once every 3 months. Most injectables are progestin-only. In the United States, depo-medroxyprogesterone acetate (Depo-Provera) is the only approved injected contraceptive. Depo-Provera (also called Depo, or DMPA) uses a progestin called medroxyprogesterone. Like other progestin contraceptives, Depo-Provera prevents pregnancy by halting ovulation, thickening the cervical mucus, and stopping the implantation of fertilized eggs in the uterine lining.

Depo-Provera is very effective in preventing pregnancies. About 3 in 100 women who use it become pregnant. However, Depo also carries the risk for many mild and serious side effects. The most serious side effect is loss of bone density (see "Disadvantages"). Because of this complication, Depo-Provera should not be used for more than 2 years.

Administering Injections:

A physical examination is necessary before beginning the injections.
Depo is injected into a muscle in the patient's arm or buttock. During months between injections, the hormone slowly diffuses out of the muscle into the bloodstream.
Depo requires an injection by the doctor once every 3 months.
If more than 2 weeks pass beyond the regular injection schedules, the woman should have a pregnancy test before receiving the next injection.

Candidacy

Because Depo-Provera does not contain estrogen, it is safe for many women who are not candidates for combination oral contraceptives, such as women smokers over age 35.

Depo-Provera should not be given to women who have a history of:

Current or past breast cancer
Stroke or blood clots
Liver disease
Epilepsy, migraine, asthma, heart failure, or kidney disease (due to the fact that the drug causes fluid retention)
Unexplained vaginal bleeding
Risk for osteoporosis

Because of the long lag time between ending treatments and restoration of fertility, Depo-Provera is not recommended for women who are thinking of becoming pregnant within 2 years.

Advantages of Depo-Provera

Provides highly effective reversible protection against pregnancy without placing heavy demands on the user's time or memory.
Does not increase risk for breast, ovarian, or cervical cancer. May protect against endometrial cancer.
May be useful for women with painful periods, heavy bleeding (including heavy bleeding caused by fibroids), premenstrual syndrome, and endometriosis.

Disadvantages and Complications of Depo-Provera

Weight gain. Most women gain an average of 5 - 8 pounds.
Other common side effects include menstrual irregularities (bleeding or cessation of periods), abdominal pain and discomfort, dizziness, headache, fatigue, nervousness.
Most users of Depo-Provera stop menstruating altogether after a year. Depo can cause persistent infertility for up to 22 months after the last injection, although the average is 10 months.
Long-term (more than 2 years) use of Depo-Provera can cause loss of bone density. Depo-Provera� ' s label warns that the decline in bone density increases with duration of use and may not be completely reversible even after the drug is discontinued. The FDA recommends that Depo-Provera should not be used for longer than 2 years unless other birth control methods are inadequate. Some studies indicate that this bone loss may be reversible once Depo-Provera use is discontinued.
The injections do not provide protection against sexually transmitted diseases.

Resources

www.nichd.nih.gov -- National Institute of Child Health and Human Development
www.plannedparenthood.org -- Planned Parenthood
http://ec.princeton.edu -- Emergency Contraception Website
www.acog.org -- American College of Obstetricians and Gynecologists
www.guttmacher.org -- The Alan Guttmacher Institute
www.arhp.org -- Association of Reproductive Health Professionals

References

Blythe MJ and Diaz A. Contraception and adolescents. Pediatrics. 2007; 120(5): 1135-48.

Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E and Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008;(2): CD001324.

Cole JA, Norman H, Doherty M, Walker AM. Venous thromboembolism, myocardial infarction, and stroke among transdermal contraceptive system users. Obstet Gynecol. 2007 Feb;109(2 Pt 1): 339-46.

Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, DollR, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008 Jan 26;371(9609): 303-14.

Creinin MD, Meyn LA, Borgatta L, Barnhart K, Jensen J, Burke AE, et al. Multicenter comparison of the contraceptive ring and patch: a randomized controlled trial. Obstet Gynecol.2008;111(2 Pt 1): 267-77.

Erkkola R. Recent advances in hormonal contraception. Curr Opin Obstet Gynecol. 2007;19(6): 547-53.

Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ. 2007;335(7621): 651.

Hov GG, Skjeldestad FE and Hilstad T. Use of IUD and subsequent fertility--follow-up after participation in a randomized clinical trial. Contraception. 2007;75(2): 88-92.

Inki P. Long-term use of the levonorgestrel-releasing intrauterine system. Contraception. 2007;75(6 Suppl): S161-6.

Jick S, Kaye JA, Li L, Jick H. Further results on the risk of nonfatal venous thromboembolism in users of the contraceptive transdermal patch compared to users of oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception. 2007 Jul;76(1): 4-7.

Kaunitz AM. Clinical practice. Hormonal contraception in women of older reproductive age. N Engl J Med. 2008;358(12): 1262-70.

Kaunitz AM, Arias R and McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception. 2008;77(2): 67-76.

Kulier R, O'Brien PA, Helmerhorst FM, Usher-Patel M and D'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev. 2007;(4): CD005347.

Lopez LM, Grimes DA, Gallo MF and Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2008;(1): CD003552.

Margolis KL, Adami HO, Luo J, Ye W, Weiderpass E. A prospective study of oral contraceptive use and risk of myocardial infarction among Swedish women. Fertil Steril. 2007 Aug;88(2):310-6.

Meirik O. Intrauterine devices - upper and lower genital tract infections. Contraception. 2007;75(6 Suppl): S41-7.

Nelson AL. Contraindications to IUD and IUS use. Contraception. 2007;75(6 Suppl): S76-81.

O'Brien PA, Kulier R, Helmerhorst FM, Usher-Patel M and d'Arcangues C. Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception. 2008;77(5): 318-27.

Peterson HB. Sterilization. Obstet Gynecol, 2008;111(1): 189-203.

Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC and Grimes DA. Advance provision of emergency contraception for pregnancy prevention (full review). Cochrane Database Syst Rev. 2007;(2): CD005497.

Power J, French R and Cowan F. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database Syst Rev. 2007;(3): CD001326.

Prager S and Darney PD. The levonorgestrel intrauterine system in nulliparous women. Contraception. 2007;75(6 Suppl): S12-5.

Roumen FJ. The contraceptive vaginal ring compared with the combined oral contraceptive pill: a comprehensive review of randomized controlled trials. Contraception. 2007;75(6): 420-9.

Rosenberg L, Zhang Y, Constant D, Cooper D, Kalla AA, Micklesfield L, et al. Bone status after cessation of use of injectable progestin contraceptives. Contraception. 2007;76(6): 425-31.

Tolaymat LL and Kaunitz AM. Long-acting contraceptives in adolescents. Curr Opin Obstet Gynecol. 2007;19(5): 453-60.

Reviewed last on: 11/11/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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