Hormonal Methods continued...

Combination injection
 
One of the newest developments in contraception is a combined monthly injection (medroxyprogesterone acetate [progesterone] and estradiol cypionate [estrogen], brand name: Lunelle). It recently received FDA approval in the United States. The injections stop ovulation like birth control pills do. They thicken cervical mucus to prevent sperm from traveling up the fallopian tubes to fertilize an egg and thin the uterine lining to prevent an egg from implanting. 

Women who want to become pregnant may stop using Lunelle at any time. Some women have an immediate return to fertility. Others may have to wait 60-90 days to have normal menstrual cycles.

• How effective: When used correctly, Lunelle is 99.8% effective. One-year failure rates of less than 1% have been reported in clinical trials. In one US study of 782 women, there were no pregnancies after 1 year of use.  
  
  
• Advantages: A woman can regain fertility after 2-3 months after the last injection. There are fewer users with problem periods or no periods. Lunelle can protect the uterus from cancer and endometriosis and reduce ovarian cysts and tumors. 
  
  
• Disadvantages: Disadvantages include irregular spotting, weight gain, possible decrease in sexual desire, headache, and mild depression or mood changes. You are required to see your health care provider each month for the injections and may have to fill the prescription at the pharmacy and then take the medication with you to the provider for the injection. Injections are given every 28-30 days and no later than 33 days after the last injection. Timing is determined by the number of days, not your menstrual period. Some women may not have a period but should have the injection on schedule. In contrast to other hormonal contraceptive methods, due to its novelty, cancer risk is not known. More extensive worldwide use and additional studies may demonstrate the risk, if any, on cancer of the reproductive tract. Some women may experience changes in vision, especially for contact lens wearers. There is a higher risk of gallbladder disease. Any woman with a history of blood clots, stroke, heart disease, breast cancer, unexplained vaginal bleeding, and high blood pressure should avoid this option. Women older than 35 years who smoke should not have these injections. This method does not protect against STDs. 

Pharmacia, the drug's manufacturer, voluntarily recalled all prefilled syringes of Lunelle because of a production error that may have resulted in insufficient dosing on October 10, 2002. For more information on Lunelle, Pharmacia can be reached at (800) 323-4204.

Seek emergency medical care if you experience any of these symptoms:
 
A: Abdominal pain
C: Chest pain
H: Severe headaches
E: Eye changes (blurred vision)
S: Severe thigh or calf pain

Permanent Methods

Sterilization is considered a permanent method of birth control that a man or woman chooses. Although tubal sterilization, or a tubal ligation, for women and vasectomy for men can sometimes be reversed, surgery is much more complicated than the original procedure and may not be successful. Thus, when choosing a sterilization method you should not have thoughts of future reversal. 
 
Female sterilization, tubal ligation
 
About a million American women elect to have surgery to tie their fallopian tubes, known as tubal ligation. Some women have a hysterectomy (removal of the uterus and sometimes also the ovaries) each year, but usually not only for birth control.