Hormonal Methods

Introduction

Hormonal methods work by mimicking the natural hormones of the woman's body: estrogen and progesterone or just progesterone. They prevent pregnancy as follows:

  • ovulation does not occur (without an egg, sperm cannot fertilize)
  • the lining of the uterus thins (in case a woman did ovulate (i.e., missed her pills towards the end of the pack), implantation would be difficult
  • the cervical mucous thickens (making it difficult for sperm to enter the uterus)

Effectiveness of hormonal methods can be found here.

 

Combined Hormonal Contraceptives

Combined Hormonal Contraceptives (CHC)

 

Please be advised: Our Fact Sheets are currently under review.  If you have any questions about a contraceptive method please contact our Sex Sense Line at 1-800-SEX-SENSE or book an appointment with an Opt clinic. 

 

 

(Birth Control Pills/Evra Patch/Vaginal Ring)

 

What are combined hormonal contraceptives?

Combined hormonal contraceptives (CHCs) use two hormones (estrogen and progestin) to prevent pregnancy from occurring. These hormones are similar to the ones you normally produce in your body.

    How do CHCs work?

    • They prevent pregnancy by stopping ovulation (release of an egg from the ovary) from occurring.

    • They make the mucous of the cervix thick so that it’s hard for sperm to get through into the uterus and they change the lining of the uterus.

    How effective are they?

    Combined hormonal contraceptives are excellent methods of birth control. For typical users, approximately 8 out of every 100 women will experience an accidental pregnancy in the first year. With perfect use, 1 in 100 will become pregnant.

      Advantages

      • Less menstrual cramping and bleeding

      • Predictable, lighter, regular periods

      • Less anaemia caused by iron deficiency

      • Less acne

      • Some protection against non-cancerous breast tumours and ovarian cysts

      • Decreased risk of ovarian and uterine cancer

      • Sexual enjoyment may be enhanced as pregnancy fears are diminished

      • May protect against osteoporosis and endometriosis.

      Disadvantages

      • You have to remember to take a pill every day, change a patch every week or remove and insert a new vaginal ring monthly.

      • Nausea, vomiting, breast tenderness, headaches or dizziness, and/or spotting are problems women may have the first one to three months

      • Serious complications: potential risks include blood clots, heart attack, stroke, rare liver tumours (these are less common)

      • Risks increase with age and when certain other risk factors are present such as smoking (especially more than 15 cigarettes a day)

      • Possibility of high blood pressure

      • Does not protect against sexually transmitted diseases

      • Certain types may be less effective in women with body weight > 90 kg (198 lb)

       

      How do I take CHCs?

      • Birth control pills need to be taken at the same time every day to be most effective.

      • The patch needs to be changed every week to be most effective.

      • The vaginal ring needs to be removed after 21 days and a new ring inserted after a 7 day hormone free interval to be most effective.

      • When prescribed, the start date is either the first day of your next period, the Sunday after you begin your period, or use the Quick Start method.

      See our fact sheets:

      Other Considerations

      Some medications interact with the CHCs. If your doctor prescribes any other medications for you, be sure to mention that you are using CHC. There are some antibiotics, seizure medications, and over-the-counter herbal supplements (such as St. John’s Wort), that decrease effectiveness and you may be advised to use a backup method while on these medications.

      There are some serious danger signs that all women using the pill should be aware of. These are:

      A abdominal pain, especially on the right side of your stomach, below your rib cage

      C chest or arm pain, shortness of breath, coughing up blood

      H headaches, severe and not relieved by aspirin or Tylenol

      E eye problems, blurred vision, flashing lights, double vision, blindness

      S swelling, redness, numbness, tingling or pain in the legs

      Seek medical attention immediately if you have any of the above symptoms.

       

       

       

       

       

       

       

       

       

       

       


       


       

      What if I have sex and don’t use Birth Control?

      Did you know that …for up to 120 hours (5 days)…after sex…you can take emergency pills to avoid becoming pregnant? (The sooner they are taken after an episode of unprotected intercourse the more effective they are)…AND for 7 days…after sex…you can have an IUD put in, so you won’t become pregnant. Not all doctors know about this. If you need to know more or would like the phone numbers of doctors or clinics near you that have emergency birth control, call the SEX SENSE line at 1-800-739-7367 or 604-731-7803 in the lower mainland.

      FS 401
      Revised March 2009

      Continous Extended Use of Combined Hormonal Contraceptives

      What is continuous or extended use of combined hormonal contraception?

      • Extended use refers to use of combined hormonal contraception with hormone-free intervals less often than once a month, such as taking 2 birth control pill packs back to back for two months with no hormone break to avoid having your period while you go on vacation.

      • Continuous use of combined hormonal contraception refers to uninterrupted use without hormone free intervals

      All low dose Combined hormonal Contraception including pills, patch and vaginal ring can be used in this manner

      How does continuous or extended hormonal contraception work?

      It works in the same way as standard use: prevents ovulation (the release of an egg by the ovaries each month) and thickens the mucous in the cervix to make it more difficult for the sperm to enter the uterus while allowing a woman to miss one or more periods.

      Advantages

      • Women use continuous or extended hormonal contraceptives (pill, patch or ring) so that they will have fewer bleeding days per year; some women will have no bleeding over time

      • This method can be used for contraception, medical or personal preference, women can choose continuous or extended use of their combined hormonal contraception method using either the pill, patch or ring

      • Increased convenience of not bleeding as much or as often, less pain medication, fewer missed work and school due to menstrual problems

      • May provide improvement of abnormal bleeding, fibroids, endometriosis, peri-menopause side effects and other reproductive health problems and should be discussed in consultation with a physician

      • Convenience-may be used by women working long hours, athletes, those wanting to delay a period for vacation, graduation, honeymoon, etc. and women who find menstruation inconvenient

      MYTH: Not having my period is "not safe", or "unnatural"

      FACT: Combined Hormonal contraceptive methods cause the lining of the uterus to become very thin, especially with extended or continuous use. As a result there is no significant amount of tissue to shed and no build-up of menstrual blood - therefore there is nothing to shed and no period is required.

      Is continuous/extended use as effective as standard use (such as the 21/7 regime)?

      • Yes, they have the same 92% effectiveness with typical use and 99.7% effectiveness with perfect use

      • May be more effective with daily use, easier to remember 

      What are the side effects/Disadvantages of Continuous/Extended use?

      • Unscheduled spotting or bleeding should be expected with the frequency decreasing over time, this is not harmful and the contraceptive will continue to work

      • Possible delay in recognition of a pregnancy if already pregnant or not using the method correctly

      • Side effects like headaches, bloating/swelling, pelvic pain, PMS and breast tenderness along with other menstrual related side effects may still exist but tend to be lower with continuous/extended use

      Combined hormonal contraception such as the pill, patch, or ring can be used
      3 ways:

      Standard Use - involves using the contraceptive method for 21 days and having 7 days where placebo or sugar pills/ or no pills are taken or the patch or ring are removed, during this time there will be a withdrawal bleed

      Extended Use - involves using the contraceptive method for several months in a row to prevent bleeding and then taking a 7-day pill, patch or ring free interval when there will be a withdrawal bleed. Spotting or bleeding may occur while using the contraceptive method and this should decrease with time

      Continuous Use - involves using the contraceptive method every day for as long as desired without taking a break (having a hormone free interval) or using the placebo or sugar pills, during this time there will likely be spotting or bleeding that will decrease over time.

      Your health care provider can help you decide the method that will work best for you and your lifestyle

       

      References:

      JOGC Canadian Consensus Guideline on Continuous and Extended Hormonal Contraception, 2007

      www.sexualityandu.ca/teens/contraception-6.aspx "Controlling your periods with contraception", 2008

      Contraceptive Technology Update, July 2007, "Continuous use oral contraceptive receives FDA regulatory approval"

      Managing Contraception

      Using the Contraceptive Patch


      Please be advised: Our Fact Sheets are currently under review.  If you have any questions about a contraceptive method please contact our Sex Sense Line at 1-800-SEX-SENSE or book an appointment with an Opt clinic. 


      General rules for using the patch

      • The patch works on a 4 week (28 day cycle)
      • Use the stickers in the package, a calendar, or your cell phone to help remind you of what day to change your patch.
      • Only wear one patch at a time
      • Place the patch on one of four areas: buttock, abdomen, upper body (NOT the breasts), or upper outer arm
      • When you change the patch, put it on a different area of skin to avoid irritation
      • Do not decorate or cut the patch in any way
      • Do not use tape or glue to keep the patch in place
      • You can exercise, swim, sweat and shower with the patch on
      • The patch does not protect against sexually transmitted infections

      How do I use the patch?

      A new patch is worn every week for the first 3 weeks and is changed on the same day each week. This day is called the Patch Change Day (e.g., if you apply your first patch on a Monday, all of your patches should be applied on a Monday)

      Week 1: Put patch on and leave on for 7 days (1 week).

      Week 2: Take off old patch, put on new patch. Leave new patch on for 7 days.

      Week 3: Take off old patch, put on new patch. Leave new patch on for 7 days.

      Week 4: Take off patch. Do not apply another patch for 7 days (1 week). Your period should start this week.

      Week 5: Start the next 4-week cycle at week 1 and continue.

      How soon after starting the patch will I be protected against pregnancy?

      • If you apply your first patch during the first 24 hours of your menstrual period, you will not need to use additional contraception.
      • If you put the patch on at any other time of the month, you must use back up such as condoms or not having sex for the first week (7 days)

      The patch does not protect against sexually transmitted infections.

      What about side effects?

      The possible side effects of the patch are the same as for combined birth control pills, and may include skin irritation where the patch is placed.

      How do I remove and dispose of the patch?

      When removing the used patch, simply lift one corner and peel off. Dispose in the garbage out of the reach of children and pets.

      See Problems with the Patch if you have missed a patch or the patch comes off.

      RS 403
      Revised March 2009

      Using the Pill (Combined Oral Contraceptives)


      Please be advised: Our Fact Sheets are currently under review.  If you have any questions about a contraceptive method please contact our Sex Sense Line at 1-800-SEX-SENSE or book an appointment with an Opt clinic. 


      Taking the Birth Control Pill

      1. Take ONE PILL EVERY DAY AT THE SAME TIME for as long as you don’t want to become pregnant.
      2. Take the pills from left to right.
      3. When you get to the placebo pills at the end of the package, continue to take them the same way.
      4. When you take the last pill in the package, start a new package the very next day.
      5. As long as you do this, you are protected from pregnancy for the entire month.

      How do I start my pills?

      There are three different ways to start taking birth control pills.

      1. First Day of Period Start: Start your pills on the first day of your period. Continue to take one pill every day at the same time. With this method, you do not need to use a backup method as the pills are effective in preventing pregnancy right away.
      2. Quick Start: Take your first pill today at a good time for you. Continue to take one pill every day at the same time. With this method, you need to use backup pregnancy protection (such as condoms or abstinence) for at least 7 days.
      3. Sunday Start: Take your first pill on the first Sunday following the start of your period. If your period starts on a Sunday, start your pill that day. Continue to take one pill every day at the same time. With this method, you need to use backup pregnancy protection (such as condoms or abstinence) for at least 7 days.

      What if I miss a period while using birth control pills?

      • It is not unusual to occasionally skip a period completely while using the pill. Remember, pills can make your flow lighter so even a very small amount of blood is considered a period.
      • If you do miss a period (and you have no signs of pregnancy), continue with your next pack of pills on schedule.
      • If you miss another period the next month, continue with your pills but go to a clinic or your doctor and have a pregnancy test done. Pills are not known to harm an early pregnancy.

      What if I miss taking a pill for one day, or take it late?

      • Consider using a backup method such as condoms or you could abstain (not have sex) for the first 7 days after you missed the pill.
      • Take one pill as soon as you remember and your regular pill at the usual time (you may be taking 2 pills on the same day: one at the time you remember and the other at your regular time).

      What if I miss taking more than one pill?

      If you miss more than one pill, what to do depends on how much estrogen (one of the hormones) is in your type of birth control pill.

      • Use a backup method such as condoms or abstinence and consider using emergency contraception
      • Call 1-888-NOT-2-LATE to find the nearest place to obtain ECP, or visit the Emergency IUD website for information on clinicians who do emergency copper IUD insertions. 
      • Call or email the SEX SENSE Line at 1-800-739-7367 or sexsense@optbc.org  to find out the most effective way to continue using your birth control pills.

      NB: Spotting can result from missing 2 or more pills in a row. Your menstrual period will probably be delayed until the hormonal pills are completed (end of the pack).

      What are some possible side effects from the pill?

      Some people experience minor effects such as nausea, breast tenderness, weight gain or loss, mild headaches, dizziness, or spotting (breakthrough bleeding) during the first three months on the pills.

      DO NOT STOP TAKING YOUR PILLS: These minor symptoms usually stop within the first three months of taking pills. If you have concerns about the side effects you are experiencing, call the Sex Sense Line (1-800-739-7367).  If these symptoms continue after three months, return to your clinic or doctor for follow-up. You may be switched to a different type of pill.

      Danger Signs

      There are some serious danger signs that all women using the pill should be aware of. These are:

      A abdominal pain, especially on the right side of your stomach, below your rib cage

      C chest or arm pain, shortness of breath, coughing up blood

      H headaches, severe and not relieved by aspirin or Tylenol

      E eye problems, blurred vision, flashing lights, double vision, blindness

      S swelling, redness, numbness, tingling or pain in the legs

      Seek medical attention immediately if you have any of the above symptoms.

      What if I have sex and don’t use Birth Control?

      Did you know that …for up to 120 hours (5 days)…after sex…you can take emergency pills to avoid becoming pregnant? (The sooner they are taken after an episode of unprotected intercourse the more effective they are)…AND for 7 days…after sex…you can have an IUD put in, so you won’t become pregnant. Not all doctors know about this. If you need to know more or would like the phone numbers of doctors or clinics near you that have emergency birth control, call the SEX SENSE line at 1-800-739-7367 or 604-731-7803 in the lower mainland.
       

       

      Using the NuvaRing


      Please be advised: Our Fact Sheets are currently under review.  If you have any questions about a contraceptive method please contact our Sex Sense Line at 1-800-SEX-SENSE or book an appointment with an Opt clinic. 


      What is the NuvaRing?

      The NuvaRing is a clear, flexible, and thin plastic polymer ring that is 54mm in diameter and 4 mm thick. It provides a continuous low dose of progestin (etonogestrel) and estrogen (ethinyl estradiol) to prevent pregnancy.

      How do I use the NuvaRing?

      The NuvaRing is inserted into your vagina, where it remains in place for three weeks. At the beginning of the fourth week, remove the ring from your vagina (use your index finger to hook the NuvaRing and pull it until it pops out). Your period should start in the week when the ring is not inside your vagina. Seven days after the removal of the NuvaRing, insert a new ring—even if you are still bleeding.

      When do I start the NuvaRing?

      Beginning to use the NuvaRing depends on whether or not you have been using a hormonal type of birth control (such as pills or the patch) during the previous month. It will also depend on the birth control method you were using, if any.

      For women who have not used hormonal birth control in the past month:

      Insert the NuvaRing into your vagina at any point during your cycle. Use backup contraception for next 7 days.

      For women who are switching from a combined oral contraceptive (birth control pills that have estrogen and progestin):

      After taking your last active hormone pill in the package, insert the NuvaRing within the next 7 days. It is effective in preventing pregnancy right away.

      For women who are switching from the Patch:

      After removing your last patch at the end of your cycle, insert the NuvaRing within the next 7 days. It is effective in preventing pregnancy right away.

      For women who are switching from a progestin-only contraceptive (The NuvaRing is effective at preventing pregnancy right away if you follow the directions below:

      • If you are using a progestin only pill (such as Micronor) insert the NuvaRing on the same day you take your last pill. Use backup for 7 days.

      • If you are using a progestin-containing IUD (intrauterine device), insert the NuvaRing on the same day that the implant or IUD is removed.

      • If you are using an injectable contraceptive (such as Depo-Provera), insert the NuvaRing on the day that your next injection would be due. Use backup for the next 7 days.

      Use the stickers that come in the NuvaRing booklet to remember when you put the ring in and when you need to take it out.

      How do I insert the NuvaRing?

      • Wash and dry your hands. Remove the ring from the foil pouch.

      • Find a comfortable position (lying down, squatting, sitting on the toilet or standing with one foot resting on a higher surface, such as a stool, bed, chair, or bathtub).

      • Hold the NuvaRing between your thumb and index finger, pinching the ring so that it becomes long and narrow.

      • Gently insert the narrowed ring into your vagina. Release it when it is inside the vagina. If you can feel the ring, use your finger to re-position it until it is comfortable. The NuvaRing will not go in too deep or get lost inside your vagina. After the ring is in place, it stays in the vagina for three weeks and then it is removed for seven days.

      How do I remove the NuvaRing?

      • After three weeks, remove your NuvaRing.

      • Insert your finger into your vagina and hook your finger under the rim or grasp it between the index and middle finger. Then pull it out gently.

      • Place the used ring in the original foil pouch (if you kept it) and throw out in the trash. Do not flush it down the toilet.

      • Your period will usually start during the week the NuvaRing is not in your vagina. To continue to prevent pregnancy a new ring must be inserted one week from the time the last one was removed, on the same day of the week, even if you are still bleeding.

      What if the NuvaRing was not inserted properly?

      • If the ring has not been inserted properly, it can slip out of the vagina. Sometimes this happens when exerting force, like during a bowel movement. If it does slip out, and it has been out of your vagina less than three hours, you are still protected from pregnancy. Rinse the ring with cool to lukewarm water and reinsert it as soon as possible within three hours. If your NuvaRing is lost, a new one should be inserted for a new 21-day cycle. It is not recommended to remove the ring for sexual intercourse.

      • If the NuvaRing has been out of your vagina for more than three hours, you will need to use back up contraception such as condoms for the next 7 days and follow the instructions below:

        • During the first or second week of your cycle, if the ring is out of the vagina for >3 hours, it may be reinserted.

        • During the third week of cycle, if the ring is out of the vagina for >3 hours, discard the ring and choose one of the following two options in combination with a 7-day back up method:

          1. Insert a new ring immediately to begin a new three week cycle

          2. Have a withdrawal bleed and insert a new ring no later than 7 days from the time when the last ring was removed/expelled. This is an option only if the ring was used continuously for the preceding 7 days

      • Do not remove the NuvaRing during intercourse.

      Get immediate medical attention if you have:

      A - abdominal pain, upper right side

      C - chest or arm pain, shortness of breath, coughing up blood

      H - headaches, severe and not relieved by aspirin or Tylenol

      E - eye problems, blurred vision, flashing lights, double vision, blindness

      S - swelling, redness, numbness, tingling or pain in the legs

       

      FS471
      Revised March 2009

      Yasmin

      What is Yasmin?

      YasminTM is a low dose birth control pill that was approved for use in Canada in 2005. Yasmin works in the same way as other combined birth control pills and is very effective at preventing pregnancy, when taken as directed.

      How does Yasmin work?

      Yasmin works like many combined oral contraceptives in preventing pregnancy by:

      • stopping ovulation (release of an egg from the ovary) from occurring
      • making the mucous of the cervix thick so that it's harder for sperm to get through into the uterus
      • changing the lining of the uterus

      What is unique about Yasmin?

      This pill contains a type of progestin called drospirenone. This progestin may reduce water retention or bloating (which may reduce premenstrual weight gain). It may also help with some types of acne.

      How effective is Yasmin?

      Yasmin is considered to be 92% (typical use) to 99.7% effective.

      What are the side effects?

      Similar to other birth control pills, possible side effects of Yasmin include:

      • Menstrual changes
      • Breast tenderness
      • Nausea
      • Vaginal discharge
      • Mood changes
      • Appetite changes

      Yasmin could also have serious side effects similar to other combined hormonal contraceptives, which require immediate medical attention:

      A - abdominal pain, upper right side

      C - chest or arm pain, shortness of breath, coughing up blood

      H - headaches, severe and not relieved by aspirin or TylenolTM

      E - eye problems, blurred vision, flashing lights, double vision, blindness

      S - swelling, redness, pain in the legs

      Who should not take Yasmin?

      • Yasmin is not recommended for women who have kidney, liver, or adrenal disease since drospirenone may increase potassium levels in their body.
      • It is not recommended for women who take long-term medications that increase the potassium levels in the body.
      • If you have other health risk factors, Yasmin may not be for you. Please discuss any health concerns with your health care professional.

      When do I start Yasmin and how do I use Yasmin?

      Yasmin needs to be taken at the same time every day to be most effective. When prescribed, the start date is either the first day of your next period, the Sunday after you begin your period, or use the Quick Start method.

      See "Using Combined Oral Contraceptives" for more details.

      For more information about Yasmin and other birth control options check out:

      Call the SEX SENSE Line at 1-800-SEX-SENSE (739-7367) or 604-731-7803 (in the Lower Mainland) to speak with a trained volunteer or registered nurse.

       

      References:

      Hatcher,R.A., Trussell, J., Stewart, F., Nelson, A.L., Cates, W., Guest, F. et al. (2004). Contraceptive Technology, 18th Ed.. New York: Contraceptive Technology Communications Inc.

      Hatcher, R.A., Zieman, M., Cwiak, C., Darney, P.D., Creinin, M., and Stosur, H.R. (2004). A Pocket Guide to Managing Contraception (2004-2005 edition). Tiger, Georgia: Bridging the Gap Foundation.

      Depo-Provera

      Depo-Provera


      Please be advised: Our Fact Sheets are currently under review.  If you have any questions about a contraceptive method please contact our Sex Sense Line at 1-800-SEX-SENSE or book an appointment with an Opt clinic. 


      What is Depo-Provera?

      Depo-Provera is a long-acting form of birth control using only the progestin hormone. It is given by injection and repeated every 12 weeks. You need a prescription to get Depo-Provera.

      How does it prevent pregnancy?

      Depo-Provera prevents pregnancy by:

      • stopping ovulation (release of an egg from the ovary)
      • making the mucous of the cervix thick, which makes it harder for sperm to get through into the uterus
      • thinning the lining of the uterus, which makes it difficult for a fertilized egg to implant

      How effective is it?

      • For typical users, approximately 3 out of every 100 women using Depo-Provera will experience an accidental pregnancy in the first year. With perfect use, 1 out of every 100 women will become pregnant.
      • Depo-Provera starts working within 24 hours of the first shot if injected within 5 days of beginning a period.

      How is Depo-Provera used?

      • Depo-Provera is prescribed by a doctor and given as an injection once every 12 weeks.
      • You should get your first shot within five days of beginning a period, unless you are presently using the Pill or an IUD.
      • If you get your first Depo-Provera shot later than five days after your period, you will need to use condoms for the first seven days following the shot.
      • If you want to continue to use Depo-Provera for birth control, you must return for another shot in 11 to 12 weeks, but no later than 13 weeks.

      Who Can Use Depo-Provera?

      • Depo-Provera is best for women who want a highly effective, private, long-acting method of birth control, without needing to take a pill every day or using a method right before sex.
      • Depo-Provera may be a very good contraceptive choice for women who have completed childbearing, but don't want tubal ligation.
      • Depo-Provera may also may be a good choice for women who can't use other birth control methods because of:
        • medical reasons
        • side effects they experienced using other contraceptive methods.
      • If other methods a woman has tried are not working.
      • Depo-Provera is safe to use while breastfeeding, especially if started after breastfeeding has been well-established (approximately 6 weeks post partum). Its risk of decreasing milk supply is less than with birth control pills.

      Who Shouldn't Use Depo-Provera?

      Don't use Depo-Provera if:

      • You are pregnant, or want to become pregnant shortly (within a year).
      • You have abnormal vaginal bleeding that hasn't yet been discussed with a doctor.
      • You have breast cancer.
      • You take medication to treat Cushing's syndrome.

      It's believed that DMPA doesn't cause the complications associated with estrogen and the pill, and therefore may be safe for women smokers over 35.

      Advantages

      • It is highly effective and private.
      • Menstrual bleeding usually decreases after one year of use. Some women stop having periods completely; this is a natural effect of the hormone. Your periods return to normal when you stop using Depo-Provera.
      • It may decrease menstrual pain and premenstrual symptoms.
      • You don't need to remember to take a pill, insert a device, or apply a product. There is no need to keep birth control supplies at home.
      • It can be used by breastfeeding mothers and women who can't take estrogen (as in combined oral contraceptive pills).
      • It will reduce rick of uterine cancer and ovarian cancer.
      • It may reduce and treat endometriosis.

      Disadvantages

      • Irregular bleeding during the first year of use can happen.
      • You need to return for regular 12-week injections.
      • Minor side effects may occur such as headaches, breast tenderness, mood changes, and weight gain.
      • Effects of Depo-Provera, including return to fertility, are not immediately reversible (may take 6-12 months).
      • Depo-Provera does not protect against sexually transmitted infections.
      • There may be possible effects on bone growth or density in young women. After two years of use you should speak to your doctor to have a complete assessment.
      • If you have concerns or history of depression or mood disorders, you should speak to your doctor prior to initiating use.

       

      FS411
      Revised March 2009

       

      Using Depo-Provera

      Before starting on Depo-Provera the doctor will need to know if:
      • There is the possibility you might be pregnant
      • You have liver or heart problems, seizures, diabetes, asthma
      • You suffer from migraine headaches or depression
      • You are using any medication (including birth control pills, the patch, or have an IUD)
      • You have allergies
      • You experience or have experienced abnormal vaginal bleeding
      • You have lumps, swelling or tenderness in your breasts
      • You have any medical conditions/illnesses

      When do I start Depo-Provera?

      You should get your first injection within the first five days of starting your period in order for it to be immediately effective for birth control, unless:

      • You are currently using birth control pills. You can start with the first Depo-Provera injection anytime in the cycle. Continue with your pills until your current pack is finished.
      • You are currently using an IUD. You can start with the first Depo-Provera injection anytime in the cycle. Do not have the IUD removed for at least 2 weeks.

      If the injection is not given at the beginning of your period then a pregnancy test should be done and a back-up method of contraception used for 7 days following the shot.

      How do I continue on Depo-Provera?

      • You need to return for another shot every 11 to 12 weeks and no later than 13 weeks.
      • The shot slowly wears off over time, so you can't count on being protected against pregnancy longer than 12 weeks after the last shot.

      How do I manage common side effects associated with Depo-Provera?

      Menstrual changes

      Most women notice changes in their periods. During the first year of use, periods are usually irregular, and spotty bleeding may occur between periods. Some women also notice heavier or longer bleeding during their periods, but this rarely causes serious medical problems. After 6 to 12 months of use, most women have periods less often, and many stop having periods altogether. This change is not permanent. Your periods will return after you stop using Depo-Provera.

      Pregnancy symptoms

      Side effects similar to the symptoms of an early pregnancy occur in many women after the first few injections, but then usually go away. Some women notice acne, sore breasts, nausea, fatigue, and abdominal discomfort. Occasionally, some women experience a spotty darkening of the skin, usually on the face.

      Weight changes

      One of the effects of the hormone may be an increase in appetite. As a result, about two-thirds of the women who use it gain weight. However, 20% lose weight, and 10% have no change. The average weight gain is 5½ lbs. (2½ kg) by the end of the first year and 8 lbs. (3½ kg) by the end of the second year. Eating a low-fat diet and exercising regularly helps.

      Mental depression

      This side effect can be worse in women who've had depression before, although the cause isn't clear. Depression related to Depo-Provera usually goes away after the medication has worn off.

      Other reactions

      Other side effects that may or may not be caused by Depo-Provera have been reported: headaches, dizziness, nervousness, some loss of scalp hair, some increase in body hair, and either an increase or decrease in sex drive.

      Be sure to report any new or unusual problems to your doctor or nurse right away. Be especially on the lookout for prolonged, heavy vaginal bleeding; unusual swelling or pain in your legs; severe chest pain; shortness of breath; coughing up of blood; bad headaches; blurred vision; a lump in your breast, or prolonged pain at the injection site. If any of these happen, see a doctor immediately.

      What are other considerations with use of Depo-Provera?

      Depo-Provera and pregnancy

      Once you stop using Depo-Provera, it can take you an average of 9 to 10 months after the last shot to get pregnant. After 2 years, pregnancy rates are the same in women who used Depo-Provera as is in women who used the Pill or an IUD. Women who want children in the near future should keep this in mind when deciding to use Depo-Provera.

      Depo-Provera and breast milk

      Can be used by nursing mothers as soon as their milk flow is well established because it doesn't affect the amount or quality of the milk.

      Depo-Provera and cancer

      Research has shown recently that Depo-Provera helps prevent cancer of the lining of the uterus (endometrium) and ovaries. The risk of breast cancer is very small.

      Possible thinning of bones

      Studies have shown that women who used Depo-Provera for a long time had a slight decrease in the calcium in their bones, which can contribute to the development of a condition called osteoporosis. For all women, the best way to prevent osteoporosis is to exercise, get enough calcium (1000 mg/day), and not smoke. For information, visit HealthLink BC or call 8-1-1 for free and ask for a dietician.

      Lack of protection against sexually transmitted infections

      While Depo-Provera is a highly effective, convenient method of birth control, it doesn't protect against STIs such as gonorrhoea, Chlamydia, or HIV (the virus that causes AIDS). Use a latex condom every time you have sex in order to protect yourself against these infections.

      Reviewed by Danielle Chard, RN, BSc Nursing, Director of Clinical Services

      POPs

      Progestin-only Pills (POPs)


      Please be advised: Our Fact Sheets are currently under review.  If you have any questions about a contraceptive method please contact our Sex Sense Line at 1-800-SEX-SENSE or book an appointment with an Opt clinic. 


      What are POPs?

      The progestin-only pill differs from combined oral contraceptives in that it contains only one hormone, called progesterone. (The combined pill contains both estrogen and progestin.)

      How do POPs work?

      There are many ways in which progestin-only pills work: they thicken cervical mucus; decrease ovulation (the release of an egg) or fertilization; and change the lining of the fallopian tubes and uterus. To be most effective, these pills must be taken every day at the same time. There are no ‘reminder’ pills to take, and there are no days you don’t take pills. As with other progestin-only methods, irregular bleeding is common.

      How effective is it?

      About 3 women in 100 using the progestin-only pill perfectly for one year will get pregnant. In actual use, 8 women in 100 using POPs will get pregnant in one year.

      Could I have problems taking it?

      You could have irregular bleeding, and you risk pregnancy if you take your pill three hours late or more and have sex during the next 48 hours.

      Advantages

      • No estrogen

      • Lighter to absent bleeding, less cramping and PMS

      • Decreased risk of uterine and ovarian cancer.

      • May decrease symptoms and possibly treat endometriosis.

      Disadvantages

      • Have to remember to take a pill everyday at exactly the same time

      • Does not protect against sexually transmitted infections

      • Irregular bleeding

      How do I use it?

      • Each pill package contains 28 pills. Every pill contains hormones; there are no ‘reminder’ pills. POPs must be taken daily without interruption to be effective, because the small amount of progestin in them is used rapidly in the body. Little or none of it remains in the body after 24 hours.

      • It’s essential to take your pill at the same time every day.

      • You can start POPs at any time during your cycle. If you start on the first day of your period, you don’t need a back-up contraceptive method. If you start later, use a back-up method for 48 hours afterward.

      • When you first start POPs, as your body gets used to them, you could have minor side effects like ‘breakthrough’ bleeding and headaches. They’re not dangerous and usually go away in the first two months. If you have symptoms that persist longer, or seem severe, call or return to the clinic for a re-evaluation. About half the women who take POPs have irregular bleeding—irregular bleeding doesn’t mean your pills aren’t working

      What do I do if I miss a pill?

      1. If you miss a pill by 3 hours or more, take it as soon as you remember, and for the next 48 hours use a back-up method like condoms, or don’t have intercourse. Continue taking your pills at the regular time, even if that means taking 2 pills in one day.

      2. Use a back-up method for 48 hours after any episode of heavy vomiting or diarrhoea, because illness may cause you to absorb too little of your pill to be effective.

      3. If you have unprotected sex after missing a pill by 3 or more hours, you can get emergency contraception, provided you do so within 120 (5 days) hours for best results. Continue taking your pills, but talk to your clinician as soon as possible. Consider having a pregnancy test two to four weeks after taking ECP just to be certain you aren’t pregnant.

      4. If you accidentally become pregnant while using POPs, your fetus won’t be harmed by the small amount of progestin in the pills. However, as with any other medication, discontinue use as soon as you know you’re pregnant.

      What do I do if I miss a period?

      If you don’t get a period within 45 days of your last one, call the clinic for a pregnancy test. Continue your pills until your appointment. Many women on POPs have irregular spotting or bleeding and some do not have a period at all.

      What happens if I stop taking POPs?

      Your first period may be irregular or it may be late. It’s possible to get pregnant soon after discontinuing POPs. If you don’t want to be, use another birth control method.

      What else should I know?

      • Always tell your doctor if you’re using the progestin-only pill.

      • Some medications, like those for seizures, tuberculosis, and diarrhoea and vomiting, can lower the effectiveness of the pill so that you could become pregnant even if you don't miss any pills. While on these medications or when you’re sick, use another method of birth control like foam and condoms along with your pills, or you may need to discontinue them temporarily for another method.

      • If you have an emergency when the clinic is not open, call your family doctor or go to the local hospital emergency room.

      • If you have any questions or problems, call your clinic or the SEX SENSE line at 1 800 SEX SENSE .

       

      FS419
      Revised March 2009