Several options are available to women who want long-term, but not permanent, protection against pregnancy. These options rely on estrogen-progestin or progestin alone to prevent ovulation. They include:
With this method you get injections, or shots, of the hormone progestin (Depo-Provera (DMPA), or the low-dose form, Depo-Subq-Provera) in the buttocks or arm every three months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.
Depo-Provera should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.
You may experience some changes in menstrual bleeding. Early on, you may have spotting. Later, you may stop having your period altogether.
Progestin shots have been shown to reduce the risk of uterine (endometrial) cancer and prevent anemia, ectopic pregnancy and pelvic inflammatory disease.
Possible side effects
Bloating/weight gain, headaches, depression, loss of interest in sex and hair loss are the most common side effects, and it usually takes 12 weeks before the effects of the shot disappear. Recent studies show a link between Depo-Provera and a loss of bone density, which can lead to an increased risk of osteoporosis. The bone density loss may not return completely after discontinuing Depo-Provera.
Intrauterine Device (IUD)
The IUD is a plastic, T-shaped device that is inserted by a health care professional into the uterus. It is considered to be 99 percent effective. There are two types of IUDs:
- Copper IUD - The "copper-T" IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. This type of IUD can remain in your uterus for 5 to 10 years.
Who shouldn't use it: Women with any risk factors for pelvic inflammatory disease (PID) or who have a recent history of pelvic inflammatory disease or experience heavy menstrual bleeding because a copper-IUD can increase heavy bleeding.
- Hormonal IUD - The hormonal or IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It slowly releases a low dose of the same progestin, levonorgestrel, found in many birth control pills into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. Separately, it can help reduce cramping and bleeding. This IUD can stay in your uterus for up to 5 years.
Who shouldn't use it: Women with a history of pelvic inflammatory disease (PID).
Many doctors hesitate to offer patients the intrauterine device (IUD) and some women are reluctant to use it because of past experiences with the Dalkon Shield, an IUD withdrawn from the market decades ago after being linked to pelvic inflammatory disease (PID). The newer IUDs, which are constructed differently, pose a slightly increased PID risk only in the first three weeks after insertion, University of North Carolina research shows. They are considered safe and effective for women with low risk of sexually transmitted diseases.
IUDs are highly effective in preventing pregnancy; they also provide some protection against ectopic pregnancies. Once the IUD is inserted, it requires no care other than checking the strings attached to the device to ensure that it remains in place.
Possible side effects
The most common side effects associated with ParaGard IUD use are cramping and heavy bleeding in the beginning. Women using the Mirena IUD may initially have irregular periods/bleeding. After a few months, you may experience lighter periods or no periods at all.
Use of all IUDs has been associated with an increased incidence of pelvic inflammatory disease (PID), so women who have a recent history of PID or who are at high risk for contracting STDs should not use the IUD.
Vaginal Contraceptive Ring
One of the newest contraceptives on the market, NuvaRing, available by prescription only, consists of a soft, flexible, transparent, ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.
It is inserted into the vagina like a tampon, where the hormones are slowly released on a continual basis. To insert: squeeze the ring between your thumb and index finger and insert it into your vagina, where it should remain for three weeks. Then you remove the ring for one week, during which time you have your period. You need to insert a new ring each month for continuous contraception.
Since NuvaRing only needs to be inserted once a month, it's a convenient form of birth control. And, like oral contraceptives, NuvaRing is highly effective (98 to 99 percent) when used according to the labeling. Also, unlike a diaphragm, the ring's exact position within the vagina doesn't matter.
Possible side effects
Side effects of the NuvaRing may include vaginal discharge, vaginitis and irritation. Like oral contraceptives, NuvaRing may increase the risk of blood clots, heart attack and stroke. Women who use NuvaRing are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
The contraceptive Ortho Evra is a transdermal (skin) patch approved by the FDA in 2001 that is worn on the lower abdomen, buttocks, outer arm, or upper body (excluding the breast). Like the vaginal ring, it works by releasing the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period.
The Ortho Evra patch is 99 percent effective in preventing pregnancy when used correctly. It also removes the problem of having to remember to take a pill every day, or insert a device before intercourse.
Possible side effects and warnings
In clinical trials, the patch was less effective in women weighing more than 198 pounds. Also, some women experienced breast symptoms, headache, a reaction at the application site, nausea, upper respiratory infection, menstrual cramps and abdominal pain. Other risks are similar to those associated with birth control pills, including an increased risk of blood clots, heart attack and stroke. Women who use Ortho Evra are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
In 2005, the FDA updated the labels on Ortho Evra, stating that the birth control patch delivers a higher dose of estrogen than the birth control pill and therefore may increase the risk of blood clots. Women taking or considering the birth control patch should talk to their health care professional about these risks.