FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DR. WOLF'S PATIENTS AREN'T CRAZY OVER NEWER BIRTH CONTROL CHOICES

Question: I've read about Norplant and the birth control shot, but I'm not sure if they are a good choice for my contraceptive needs. Can you help me decide?

Answer: Knowledge is the only help I can provide. I'll try and explain the benefits as well as the problems of these newer birth control methods and compare them to the more traditional choices. Then, you and your doctor can make a choice of the birth control method that is best for you.

Pregnancy can be prevented by keeping sperm away from your fertile egg. Abstinence, condoms, contraceptive diaphragm, cervical cap, spermaticidal jellies, foams and suppositories, and sterilization work this way. And, like most things in life, each has some potential problems associated with its use. Pregnancy is probably the most severe of the complications, and none of these methods can prevent it 100 percent of the time.

Abstinence is the most effective at preventing pregnancy (word has it that it failed once about 2000 years ago). In practical terms, though, it always works but denies the couple the intimacy and pleasure of intercourse.

Contraceptive jellies, foams, suppositories, diaphragms and condoms have a relatively high pregnancy rate, although this is largely a result of misuse rather than a failure of the method itself. Also, allergic reactions are not uncommon but are usually limited to vaginal or penile irritation.

Sterilization is quite effective at preventing pregnancy, which is obviously important. Its biggest drawback is that it is, in practical terms, irreversible. Once it is done, it can't easily be undone.

Hormonal methods of birth control are the most popular. This includes birth control pills (BCPs) and the newer Norplant and DepoProvera that birth control shot you asked about. These work by keeping the ovaries from "ripening" an egg, a step that is necessary before pregnancy can occur.

All hormonal methods are quite effective at preventing pregnancy, including the newer medications, but they all have some potential for causing undesirable side effects. Menstrual irregularity or change in menstrual flow, headaches, nervousness and weight gain are possible problems, but the frequency of these types of complications is fairly low with the newer BCPs. This fact, coupled with their effectiveness, is responsible for the widespread success of "pills."

One problem with BCPs is they need to be taken every day. Missing one or two pills greatly increases the chance of pregnancy during that cycle of pills. The newer medications you asked about, Norplant and DepoProvera, avoid this problem. DepoProvera is given by shot once every three months and protects against pregnancy for this entire time. Norplant contains a hormone similar to DepoProvera, but because of a unique delivery system, it only needs to be replaced once every five years. So, both methods remove the problem of having to remember to take a BCP every day while still preventing pregnancy.

There was great excitement after these two newer methods of birth control were approved by the Food and Drug Administration about two years ago. And experience since that time has shown that these products are as effective at preventing pregnancy as was hoped. My own patients' experiences, however, have dimmed the glow of these new "rising stars" of birth control.

The side effects of these newer methods have been serious enough that many of my patients have switched back to BCPs or other methods of birth control. The most common complaints are due to the absence of or irregularity of menstrual periods. Some also have weight gain, headaches, dizziness and decreased sex drive. These side effects are experienced to some degree by everyone that uses these newer birth control methods. Some find the degree of problems they produce a satisfactory trade-off for the benefits they provide, while others don't. Talk with your doctor about Norplant and DepoProvera and the benefits they may have for you. Ask specifically about side effects, then decide if either of them is the right choice for you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.