Norplant
Average Failure Rate: 1 - 5%
Norplant is a progestin implant, consisting of six small plastic rods. These are surgically placed under the skin of the upper arm for up to five years, during which time the rods slowly release progestin into the body.
Effectiveness varies due to numerous factors; teens, heavier women, those who have had the implant for several years, and women using hard capsules as opposed to soft ones will experience more failures than typically expected. The mechanism for action is the same as that of progestin pills. Roughly half of all women taking Norplant continue to ovulate, making fertilization more likely than with combined OCs. If conception does occur, changes in the uterus will cause the expulsion of the embryo.
Norplant can be expensive, costing $500-700 for insertion. Common side effects include menstrual disturbances, headaches, acne, weight gain, nausea, anxiety, hair loss, and ovarian cysts. Because of these problems, half of all Norplant users have the implants surgically removed before the third year, despite the fact that Norpant is intended as a five-year contraceptive. Insurance companies, which are increasingly covering insertion, do not always pay for removal. Removal takes more time, costs more, and can cause severe scarring.
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Documented Side Effects of Norplant
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| Side Effect |
Approximate Users Affected |
| Menstrual Cycle Disturbances |
4 in 5 |
| Headaches |
1 in 6 |
| Ovarian Enlargement |
1 in 12 |
| Dizziness |
1 in 14 |
| Breast Tenderness |
1 in 15 |
| Nervousness |
1 in 15 |
| Nausea |
1 in 15 |
| Acne |
1 in 17 |
| Dermatitis/Skin Inflammation |
1 in 17 |
| Breast Discharge |
1 in 24 |
| Weight Gain |
1 in 18 |
| Unwanted Hair Growth or Loss |
1 in 50 |
Depo-Provera
Depo-Provera, also known as DMPA or "the shot," is a highly-effective progestin injection given by a doctor every three months, though infertility may last up to a year. Although the progestin is slightly different, these injections work as birth control in the same way as the mini-pill and Norplant.
During the first year of use about a quarter of women fail to menstruate altogether, and amenorrhea increases with continued DMPA use. Thirty percent have regular cycles, which indicates continued ovulation. Common side-effects include headache, weight gain (roughly five pounds per year of use), nervousness, and menstrual irregularities. Other possible adverse effects include dizziness, allergy, depression, and ovarian cysts. Adolescent users especially as well as adults have been found to experience a significant loss of bone density, so those concerned about osteoporosis should avoid DMPA. Some studies indicate that Depo-Provera increases the chances cervical cancer and breast cancer, and can also cause hemorrhaging. Similar progestins are known to cause fetal defect. Conclusive long-term studies remain to be done.
INTRAUTERINE DEVICE
The intrauterine device, or IUD, is a small plastic or metal device that is placed inside the uterus by a doctor for an extended length of time. The IUD causes inflammation of the uterus, preventing implantation of an embryo and making it more difficult for sperm to enter. Copper in some types of IUD exerts a spermicidal effect, and recent studies cite the interceptive action as a major factor. To make the IUD more effective some contain progestin, which also interferes with implantation. (See box above.) It has also been postulated that the IUD may mechanically dislodge an embryo after implantation. In women who do begin healthy pregnancies despite IUD use, the device causes a miscarriage half of the time. IUDs may also be used as a method of Emergency Contraceptive treatment after unprotected intercourse.
The IUD carries with it a number of serious health risks, which have caused many manufacturers to stop distribution. These risks include pelvic-inflammatory disease, permanent infertility, ectopic pregnancy, and even death. The IUD should never be used by women with multiple sex partners, due to the increased chance of contracting pelvic-inflammatory disease (PID). Because of the risks to fertility, doctors do not usually recommend the IUD to women who have not had children.
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