Birth Control Pills (Oral Contraceptive) vs. Depo-Provera (medroxyprogesterone injection)

• Birth control pills (oral contraceptives) and Depo-Provera (medroxyprogesterone) are methods of birth control used to prevent pregnancy.
• Birth control pills are taken orally and Depo-Provera is an injection administered every 3 months.
• Depo-Provera is also prescribed for missed menstrual periods (amenorrhea), abnormal uterine bleeding, endometrial cancer, and renal cancer.
• Side effects of birth control pills and that are similar include breakthrough bleeding, spotting, irregular bleeding, nausea, weight changes, and breast tenderness.
• Side effects of birth control pills that are different from include headache, scanty menstrual periods, and mood changes.
• Side effects of that are different from birth control pills include nipple discharge, skin reactions (hives, acne, hair growth and hair loss), fever, insomnia, and jaundice

Birth control pills (oral contraceptives) are hormonal preparations that may contain combinations of the hormones estrogen and progestin or progestin alone and are used to prevent pregnancy. Combinations of estrogen and progestin prevent pregnancy by inhibiting the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland in the brain. LH and FSH play key roles in egg development and preparation of the lining of the uterus for embryo implantation. Progestin also causes the uterine mucus that surrounds the egg to be more difficult for sperm to penetrate and, therefore, for fertilization to take place. In some women, progestin inhibits ovulation (release of the egg).

Depo-Provera (medroxyprogesterone) is an injection administered every 3 months used to prevent pregnancy. It is a derivative of the naturally occurring female progestin, progesterone, which is responsible for changes in the mucus and inner lining of the uterus (endometrium) during the second half (secretory phase) of the menstrual cycle. Progestins prepare the endometrium for implantation of the embryo. At high doses, progestins can prevent ovulation (release of the egg from the ovary) and thereby prevent pregnancy.

Oral Contraceptive

The most common side effects of the birth control pills include nausea, headache, breast tenderness, weight gain, irregular bleeding, and mood changes. These side effects often subside after a few months' use. Scanty menstrual periods or breakthrough bleeding may occur but are often temporary, and neither side effect is serious. Women with a history of migraines may notice an increase in migraine frequency. On the other hand, women whose migraines are triggered by fluctuations in their own hormone levels may notice improvement in migraines with oral contraceptive use because of the more uniform hormone levels during oral contraceptive use.

Uncommonly, oral contraceptives may contribute to increased blood pressure, blood clots, heart attack, and stroke. Women who smoke, especially those over 35, and women with certain medical conditions, such as a history of blood clots or breast or endometrial cancer, may be advised against taking oral contraceptives, as these conditions can increase the adverse risks of oral contraceptives.

Depo-Provera

Breast tenderness and leakage of liquid from the nipple occur rarely with medroxyprogesterone. Various skin reactions, including hives, acne, hair growth and hair loss, also have been reported occasionally. Break-through bleeding (menstrual-like bleeding in the middle of the menstrual cycle), vaginal spotting of blood, changes in menstrual flow, increased or decreased weight, nausea, fever, insomnia, and jaundice have all been reported.

Blood clots are an occasional serious side effect of progestin therapy, and cigarette smokers are at a higher risk for clots. Therefore, females requiring progestin therapy are strongly encouraged to quit smoking.

People with diabetes may experience difficulty controlling blood glucose when taking medroxyprogesterone for unclear reasons. Therefore, increased monitoring of blood sugar and adjustment of medications for diabetes is recommended.

The Women's Health Initiative (WHI) study found an increased risk of heart attacks, stroke, breast cancer, blood clots, and pulmonary emboli (blood clots that lodge in the lungs) in postmenopausal women (50 to 79 years of age) who took medroxyprogesterone in combination with estrogens for 5 years, as well as an increased risk of dementia in the women over age 65. Therefore, medroxyprogesterone should not be used for the prevention of heart disease or dementia. Although medroxyprogesterone alone has not been demonstrated to promote breast cancer, since breast cancer has progesterone receptors, physicians usually avoid using progestins in women who have had breast cancer.

Oral Contraceptive

Many of the birth control pills come in easy-to-use dispensers in which the day of the week or a consecutive number (1, 2, 3, etc.) is written on the dispenser with a corresponding tablet for each day or number.

For example, some Ortho-Novum dispensers are labeled "Sunday" next to the first tablet. Thus, the first tablet is to be taken on the first Sunday after menstruation begins (the first Sunday following the first day of a woman's period). If her period begins on Sunday, the first tablet should be taken on that day.

For birth control pills that use consecutive numbers, the first tablet (#1) is taken on the first day of the menstrual period (the first day of bleeding). Tablet #2 is taken on the second day and so on.

Still other packages instruct women to begin on day five of the cycle. For such products, women count from day one of their menstrual cycle (day one is the first day of bleeding). On the fifth day, the first tablet is taken. Tablets then are taken daily.

Most birth control pills are packaged as 21-day or 28-day units. For 21-day packages, tablets are taken daily for 21 days. This is followed by a seven-day period during which no birth control pills are taken. Then the cycle repeats.

For the 28-day units, tablets containing medication are taken for 21 consecutive days, followed by a seven-day period during which placebo tablets (containing no medication) are taken.

Newer formulations with 24 days of hormone pills and only four days of placebo pills are now available, as are continuous or extended-cycle oral contraceptive regimens, in which only active hormone pills are taken. Extended-cycle preparations include seven-day intervals of placebo pills to be taken approximately every three months.

Women just starting to take birth control pills should use additional contraception for the first seven days of use because pregnancy may occur during this period.

If women forget to take tablets, pregnancy may result. If a single tablet is forgotten, it should be taken as soon as it is realized that it is forgotten. If more than one tablet is forgotten, the instructions that come with the packaging should be consulted, or a physician or pharmacist should be called.

Depo-Provera

The usual dose of medroxyprogesterone tablets is 5 or 10 mg daily.

• Secondary amenorrhea is treated for 5 to 10 days.
• Uterine bleeding is treated for 5 to 10 days beginning on day 16 or 21 of the menstrual cycle.
• Endometrial hyperplasia is treated for 12 to 14 consecutive days beginning on day 1 or 16 of the menstrual cycle.
• The dose for contraception is 150 mg every 3 months injected intramuscularly or 104 mg injected subcutaneously every 3 months.
• The dose for endometrial or renal cancer is 400-1000 mg weekly initially followed by monthly maintenance doses.

Oral Contraceptive

Estrogens can inhibit the metabolism (elimination) of cyclosporine, resulting in increased cyclosporine blood levels. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels do not become elevated.

Estrogens appear to increase the risk of liver disease in patients receiving dantrolene (Dantrium) through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk.

Estrogens increase the liver's ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of anticoagulant (blood thinning) effect if an estrogen is begun.

A number of medications, including some antibiotics and antiseizure medications, can decrease the blood levels of oral contraceptive hormones, but an actual decrease in the effectiveness of the oral contraceptive has not been convincingly proven. Nonetheless, because of this theoretical possibility, some physicians recommend backup contraceptive methods during antibiotic use. Examples of medications that increase the elimination of estrogens include

• carbamazepine (Tegretol),
• phenobarbital,
• phenytoin (Dilantin),
• primidone (Mysoline),
• rifampin (Rifadin),
• rifabutin (Mycobutin), and
• ritonavir (Norvir).

Birth control pills with higher concentrations of estrogen or alternative forms of contraception may be necessary in women using those medications.

Depo-Provera

Aminoglutethimide (Cytadren) may increase the elimination of medroxyprogesterone by the liver leading to a decrease in the concentration of medroxyprogesterone in blood and possibly a reduction in the effectiveness of the medroxyprogesterone.

Oral Contraceptive

Use of birth control pills during lactation has been associated with decreased milk production, decreased infant weight gain, and decreased nitrogen and protein content of milk. The amount of estrogen consumed by an infant whose mother takes a standard dose of birth control pills is considered to be the same as from a lactating woman who is not taking birth control pills, and side effects have not been reported. Using a progestin-only product is most often recommended during lactation if birth control pills are to be used during this period. The American College of Obstetrics and Gynecology (ACOG) recommends delaying taking combined estrogen-progestin contraceptives until at least six weeks postpartum, while the World Health Organization (WHO) recommends delaying the initiation of combined contraceptives until six months.

Depo-Provera

Medroxyprogesterone inhibits fertility at high doses. It should not be given during pregnancy. Medroxyprogesterone is secreted in breast milk. The effect on the infant has not been determined.