Our Bodies, Ourselves (51 page)

Minipills are 98–99 percent effective with perfect use and 87–92 percent effective with typical use, slightly less than regular birth control pills. For women who are breastfeeding, they provide almost 100 percent protection from pregnancy and do not affect milk supply.

• Contains no estrogen. Since most of the side effects and medical risks of combined pills come from the estrogen, minipills avoid these effects.

• Unlike combined pills, minipills do not reduce the incidence of ovarian cysts; their advantages are otherwise the same as for combined oral
contraceptive pills
.

• Does not protect against sexually transmitted infections, including HIV.

• Must be taken every day at the same time; missing one pill can result in pregnancy.

• Increases the risk of functional ovarian cysts (not dangerous).

• May cause irregular bleeding or spotting.

• Requires a prescription, which must be filled by a pharmacy regularly.

Minipill packs have no inactive pills. Each pill contains hormones, so it is important to take a pill every day at the same time. Forgetting a minipill or taking it late increases the chance of pregnancy more than missing a combined pill does.

Using a backup method such as condoms or spermicide increases minipill effectiveness. To lower your risk of sexually transmitted infection, use condoms as well.

Take the first pill on the first day of your period. Take one pill daily, at the same time of day, even during your period.

As soon as you finish one pack, begin the next one. Start your next pack even if you are still bleeding or have not started your period. Continue taking one pill every day.

If you have problems with the minipill, call your health-care provider. If you stop taking minipills, you must use another birth control method to avoid pregnancy.

• If you are three or more hours late taking the pill, take it as soon as you remember. Use a backup method for forty-eight hours.

• If you miss one pill, take the missed pill as soon as you remember, and take the next one at the usual time. This may mean taking two pills in one day. If you miss only one pill and make it up, you probably will not get pregnant. Use a backup method for two weeks.

• If you miss pills for two days, take two pills each day for the next two days. Use a backup method for two weeks. You may have some spotting or bleeding, but if the bleeding is like a period, call your provider.

• If you miss pills for three or more days, use a backup method and call your provider for instructions.

If you missed one or more pills and you had unprotected intercourse, consider using emergency contraception. Progestin-only ECs (called Plan B or Next Choice) are higher doses of the minipill. (See the
section on EC
)

Women who want to become pregnant can stop using minipills at any time. Pregnancy may occur right away or after several months.

You should not use the minipill if you are already pregnant, have breast cancer or advanced liver disease, have had gastric bypass surgery, or take certain anticonvulsants or rifampin (a tuberculosis drug).

Women using progestin-only hormonal contraception have a decreased risk of pelvic inflammatory disease. You may have less menstrual cramping and pain, lighter periods, and less chance of anemia. This method can be used by women who cannot use estrogen.

The most common side effect for women using minipills is irregular bleeding or no bleeding at all. If you do not bleed for sixty days, take a
pregnancy test or call your provider, but continue taking your pills. The minipill may also cause mood changes, headaches, and decreased sex drive.

Minipills are affected by the same medications as the pill. See
“Drug Interactions”
for information on which medications can decrease effectiveness.

Depo-Provera is an injection of the hormone progestin. Depo prevents pregnancy for three months. It is usually given in the arm or buttock. The high level of progestin prevents fertilization by stopping the ovaries from releasing eggs, thickening the cervical fluid, and changing the uterine lining, making it harder for sperm to enter or survive in the uterus. You have to get a new shot every three months. Depo-Provera does not protect against sexually transmitted infections, including HIV.

The fact that Depo is a long-acting method is both its strength and its weakness. For women who like the shot, knowing that they are protected from pregnancy for at least three months is very important. But for those women who have unpleasant side effects such as ongoing bleeding, knowing that these effects may continue for another three or more months can be difficult. After the last shot of Depo-Provera, it can take more than six months for the drug to completely leave the body. If you are considering using Depo, talk to your provider about what your options would be if you experience side effects.

Depo-Provera is over 99 percent effective as birth control provided you get your next shot at the correct time every three months. Because not all women are able to get the next shot on time, its typical use effectiveness is 97 percent. After the first shot, make an appointment for the next shot.

• The most private method of birth control.

• Does not require monthly supplies or attention.

• Effective after twenty-four hours.

• Does not interrupt sexual spontaneity.

• Contains no estrogen. Because most of the side effects and medical risks of combined pills come from the estrogen, Depo avoids these effects and can be used by women who cannot use the combined pill.

• May stop bleeding after continued use.

• May decrease risk for ovarian and uterine cancers.

• Does not protect against STIs, including HIV.

• Requires regular injections every three months.

• Causes some loss of bone density, most of which is replaced when a woman stops using it, although its long-term effects on bone strength remain unclear.

• May delay ability to get pregnant after method is discontinued.

• Can cause weight gain.

• Possible irregular bleeding or no menstrual bleeding at all (seen as a benefit for some but not others).

• If side effects occur, the hormones cannot be removed. It may take months for periods to get back to normal.

You will probably be given your first shot of Depo-Provera during—or within five days after the start of—your period. If there is no chance
you are pregnant, it can first be given at any time during the cycle. After twenty-four hours, the shot provides effective birth control for the next thirteen weeks.

Depo can also be started immediately after a birth or during the first seven days after an abortion, including immediately after an abortion.

If you are more than a week late for your shot, use a backup method of birth control for the next two weeks. If your period is over two weeks late and you have had unprotected intercourse during that time, consider taking a pregnancy test before receiving the next dose. Remember that it can take six to nine months for your menstrual cycle to return to normal after you stop Depo-Provera.

If you have heavy or continuous bleeding after your first injection, you can have a second injection as early as four weeks after your first injection; this second injection should stop your bleeding.

If you decide to switch from Depo-Provera to the birth control pill, the vaginal ring, or the contraceptive patch, it is recommended that you start your new method on the date the next injection is due. It is not harmful to start earlier; it just means that you will be double covered to prevent pregnancy. If you decide to switch to an IUD, it can be inserted anytime during the three months following the last injection.

If you want to become pregnant, you can stop using Depo-Provera at any time. Depo's contraceptive effect can last an average of four to six months after your last injection, and for some women, it can last up to eighteen months. (However, some women become pregnant immediately after stopping, so don't count on the long-term effect if you do not want to be pregnant.) If you think you might want to become pregnant in the next year, Depo is probably not a good choice for you.

If you suspect or know you are pregnant, or you have breast cancer, you should not use Depo-Provera.

Depo-Provera is not recommended if you are planning to get pregnant soon. It probably should not be used by women who have multiple risk factors for cardiovascular disease, severe hypertension, history of heart attack or stroke, diabetes, or advanced liver disease.

Depo-Provera causes some loss of bone density, though its long-term effects on bone strength remain unclear. Recent research indicates that bone density loss is worse for adolescent women or with longer use of Depo-Provera and may not be completely reversible, especially when a woman's diet does not provide enough calcium. For this reason, it's important for women using Depo to exercise regularly and eat calcium-rich foods. If this is difficult for you, you may want to consider switching to a different method of contraception after two years.
13
Some evidence shows that you can help protect your bones by adding a small amount of estrogen if using Depo for more than two years.

If you become pregnant while using Depo-Provera and continue your pregnancy, you may have a slightly increased risk of premature birth.

Women using Depo-Provera have a decreased risk of endometrial cancer and pelvic inflammatory disease. You may have less menstrual cramping and pain, fewer periods, and less chance of anemia.

All women who use Depo experience changes in menstrual bleeding. This is not dangerous. Spotting, heavy bleeding, and no bleeding are common
side effects. After a year of use, over half of all Depo users stop having periods (amenorrhea); two-thirds stop by the end of the second year. It is not possible to predict who will experience amenorrhea. Many women like not having periods, while others find it unsettling. Irregular bleeding is the most common reason for discontinuing the use of Depo.

Many women who use Depo-Provera gain some weight over time, usually about 1.5 pounds in the first year. One in four Depo-Provera users experiences rapid weight gain, and may gain up to eighteen pounds in the first year.
14
(For more information, see “Will Birth Control Make Me Gain Weight?” page 229.)

Symptoms some women experience during use of Depo-Provera include headaches, nervousness, mood changes, bloating, hot flashes, decreased interest in sex, breast tenderness, acne, hair loss, and backache. After the last shot of Depo-Provera, it can take more than six months for the drug to leave the body. Side effects may linger until the drug is completely gone.

No medications have been shown to lower the effectiveness of Depo-Provera.

Long-acting birth control includes the contraceptive implant and intrauterine devices (IUDs). These methods are highly effective, and because you don't have to take any action for them to work, there is no difference between their perfect and typical use effectiveness. Fewer than one in one hundred women using these methods will become pregnant in a year. Some women find these methods convenient because they require fewer clinic or pharmacy trips. Although they may be expensive up front, depending on your health-care coverage, they can be the most affordable methods over time. They provide highly effective protection against pregnancy but do not protect against STIs, including HIV.

Getting an implant or IUD requires a visit to a doctor or clinic, where a skilled clinician places the contraceptive in a quick, nonsurgical procedure. These birth control methods can last for years but do not have to be used that long. They can be removed at any time, and your fertility returns immediately. Removal, which is also done by a skilled clinician, takes just a few moments.

Implanon is a single soft, progestin-filled capsule that is inserted under the skin in a woman's upper arm. It works in the same way as other progestin methods, preventing ovulation and thickening the cervical fluid, thereby preventing sperm from entering the uterus. Implanon offers a safe, long-term, reversible contraceptive option.

Implanon is over 99 percent effective—as effective as tubal sterilization, but reversible. It lasts up to three years.

• One of the most effective reversible birth control methods.

• Can be used privately.

• Does not interrupt spontaneity.

• You don't have to think about contraception for up to three years.

• Can be used by women who are breastfeeding.

• Contains no estrogen. Because most of the side effects and medical risks of combined pills, the patch, and the ring come from the estrogen component, Implanon avoids these effects and can be used by women who cannot use combined pills, the patch, or the ring.

• Provides steady, very low does of progestin.

• Fertility returns quickly once implant is removed.

• Does not protect against STIs, including HIV.

• Most women experience irregular bleeding and changes to periods.

• Requires a trained medical provider to insert and remove.

• Side effects can last until removal.