Long-acting contraceptive options.

Long acting contraceptives are good options for women who want convenient and very effective contraception that does not require frequent compliance. Women who cannot use estrogens are also good candidates for long acting contraceptives which include levonorgestrel implants the contraceptive injectable Depo-Provera and the copper releasing IUD (e.g. Copper T380A IUD). All these long acting contraceptives have annual pregnancy rates less than 1%. Norplant comprises six soft plastic implants filled with 36 mg of crystalline levonorgestrel. It is effective for 5 years. Its leading side effects are irregular and persistent menstrual bleeding and spotting which often lead to discontinuation. Insertion of the implants is technically easier and time-sparing than removal. Anticonvulsants and antibiotics that stimulate hepatic enzymes (e.g. phenobarbital) may reduce the contraceptive efficacy of implants. Anticonvulsants apparently do not affect the efficacy of Depo-Provera however. The levonorgestrel implants and Depo-Provera suppress ovulation. Providers inject Depo-Provera or depot-medroxyprogesterone acetate (DMPA) (an aqueous suspension of microcrystals) into the muscle. 150 mg of DMPA is injected every 3 months to adequately protect from pregnancy. The most common side effects among DMPA users are irregular bleeding spotting and amenorrhea. The time between DMPA discontinuation and return to fertility may range from 1-2 years so DMPA may not be the best method for women who want to conceive relatively soon after discontinuation. The Copper T380A IUD is effective for up to 10 years. IUDs are contraceptives not early abortifacients. Long term IUD use does not increase the risk of pelvic inflammatory disease. Major common side effects of copper releasing IUDs include heavier menstrual flow and cramps. They prevent fertilization by causing endometrial inflammation which prevents viable sperm from reaching the fallopian tube.