Hormonal Methods continued...

This method consists of inserting 6 silicone rubber rods about the size of matchsticks under a woman’s skin in her upper arm. They can be seen under the skin and felt.
 
The implant releases medication throughout the period of use and begins to work within the first 24 hours. Protection may be provided for 5 years. The hormone stops ovulation. 

• How effective: Implants are as effective as surgical sterilization. Overall, pregnancy rates increase from 0.2% in the first year to 1.1% by the fifth year.  
  
  
• Advantages: Implants last a long time. A woman can become fertile again once the implants are removed (again, surgically).  
  
  
• Disadvantages: A minor surgical procedure is necessary to put them in and to remove them. Difficulty in removal is a disadvantage. Menstrual irregularities are common, along with other side effects, including weight gain, headaches, mood changes, growth of facial hair, flow of milk from nipples, and acne. This method does not protect against STDs. 
  
  
• Additional risks: Implants are often used for women who have just had a child and are breastfeeding, for those who have trouble remembering to take birth control pills or use other birth control methods, and for women who should not get pregnant because of a medical condition. Implants are not recommended for heavy smokers, women with a history of ectopic pregnancy, diabetes, high cholesterol, severe acne, high blood pressure, heart disease, migraine, and depression.

Although the Norplant system is no longer available, a new single rod system using a form of the progestin desogestrel and providing 3 years of contraception is currently available in Europe (Implanon) and may soon be available in the United States.

Injections
 
An injection of a synthetic hormone depomedroxyprogesterone acetate (DMPA, brand name: Depo-Provera) can be given every 3 months to stop ovulation. You receive it by injection in the doctor’s office. After injection, the medication is active within 24 hours and lasts for 3 months. It prevents your ovaries from releasing eggs.
 

• How effective: DMPA is an extremely effective contraceptive option. Most other medications or a woman’s weight do not change its effectiveness. Within the first year of use, the failure rate is 0.3%.  
  
  
• Advantages: DMPA does not produce the serious adverse effects of estrogen, such as blood clotting. It lowers risk for certain endometrial and ovarian cancers. Problem periods may become regular.    
  
  
• Disadvantages:  Some women may not have a period within the first year. Irregular bleeding can be treated by giving the next dose earlier or by adding a low-dose estrogen temporarily. Because DMPA lasts in the body for several months in women who have used it on a long-term basis, it can delay the return to fertility. About 70% of former users desiring pregnancy conceive within 12 months, and 90% of former users conceive within 24 months. Other adverse effects, such as weight gain, depression, and menstrual irregularities, may continue for as long as 1 year after the last injection. Recent studies suggest a possible link between DMPA and bone density loss. Results are conflicting and limited. This method does not protect against STDs.