Hormonal Methods of Birth Control (cont.)
Injected contraceptive: depot medroxyprogesterone acetate
Depot medroxyprogesterone acetate (DMPA) is a synthetic long-acting form of
the hormone progesterone. DMPA is similar to the birth-control minipill in that
it does not contain estrogen. Like other progesterone-based contraceptives, DMPA
acts by preventing the release of the egg from the ovary (ovulation) and by
promoting thick cervical mucus that impedes the sperm's progress. Its
effectiveness in preventing pregnancy is close to 100%.
DMPA must be injected by a health-care professional every three months (12
weeks). Preparations are available both as intramuscular or subcutaneous
(beneath the skin) injections. The injection must be administered within the
first five days of a woman's menstrual period. She is then protected from
pregnancy within 24 hours of receiving the injection.
A woman may stop having periods altogether after using DMPA for one year.
After two years of use, 70% of women will have no menstrual bleeding. Menstrual
periods stop because the DMPA causes the ovaries to go into a "resting" state.
When the ovaries do not release an egg every month, the regular growth of the
lining of the uterus does not occur and no uterine lining is shed during the
subsequent menstrual cycle.
A woman's menstrual periods should begin again within six to 18 months after
she stops taking the injections. A woman can also become pregnant, usually
within 12 to 18 months, once she stops using DMPA. If a new mother does not
breastfeed her baby, she can resume the injections right after childbirth.
Mothers who are breastfeeding can safely begin the injections six weeks after
childbirth. The injections do not reduce the flow of her breast milk, and no
harmful effects on the baby have been noted.
The most common side effects of DMPA injections are irregular menstrual
cycles, cessation of menstrual periods, and weight gain. Other side effects may
include nervousness, dizziness, stomach discomfort, headaches, fatigue, or
breast tenderness. It is important that a woman realize that once she has been
injected with DMPA, any side effects she may experience cannot be neutralized or
eliminated. She has to tolerate these side effects until the medication wears
off, typically three months later.
DMPA has also been shown to have a negative effect on bone mineral density,
especially with longer-term use; however, studies have shown that her previous
bone density is usually restored when the drug is discontinued.
Women may be able to use DMPA when avoidance of estrogen is prudent for
medical reasons (see oral contraceptives). A qualified health-care provider
should be able to help make the proper distinction. DMPA should not be used by
women who have a history of breast cancer, blood clots, liver disease,
unexplained vaginal bleeding, or stroke. A woman on DMPA should contact her
health-care professional if she experiences a heavy menstrual flow, severe
abdominal pain, headaches, or depression.
DMPA injections are over 99% effective if the injections are received
according to the correct schedule. A woman using injection contraceptives has
the advantage of being capable of becoming pregnant at a later time, if desired,
simply by discontinuing use. DMPA does not increase a woman's risk of cancer,
including breast cancer, and greatly reduces her risk of developing uterine
cancer.
Injectable hormonal contraceptives do not protect against sexually
transmitted infections.
Next: Contraceptive patch: Ortho-Evra »
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