What’s the best contraceptive method for me?

Dear Dr Mitchell,

I need some advice on which is the best contraceptive choice for me. I am 20-years-old and I had my first child five months ago. I started the Depo Provera but it has been nothing but an awful experience. I got the first shot three months ago and I bled for the entire three months. Fortunately it was just light bleeding, but I don’t know if this is normal. Now I’m unprotected and I need a suitable contraceptive quickly but I don’t know what to use.

1. How effective is the monthly injection and will it have the same effect on me as the Depo Provera?

2. Which daily pill has the least side effects and what are the side effects?

3. Is it possible that throughout five months of bleeding (I’ve been bleeding since I had the baby) I could still get pregnant?

Depo Provera or Medroxy Progesterone Acetate is an injectable form of contraception that is given once every three months. The effective contraceptive level is maintained for four months. This preparation contains only progesterone and no oestrogen and differs from the monthly injection MESIGYNA which contains both oestrogen and progesterone. It is unlikely that any patient on the Depo Provera will ovulate and this method of contraception is equal to that of sterilisation (tubal ligation). One major problem with Depo Provera is irregular menstrual bleeding, with an incidence of about 30 per cent in the first year of use and 10 per cent after this. The majority of women have absolutely no period after several injections, and long term, this is beneficial since it reduces the chance of developing anaemia and there is the added convenience of the freedom from a period each month.

However, other side effects may include weight gain, breast tenderness and depression. The irregular bleeding that is experienced with Depo Provera may be treated by using oestrogen tablets orally for seven days.

The monthly injection Mesigyna is just as effective as Depo Provera. It may also be associated with breakthrough bleeding and this is a common reason for discontinuation of the method. The other difference between Mesigyna and Depo Provera is that during the seven day break from the Mesigyna, there should be a normal period. The preparation is similar to that of the oral contraceptive pill, so this basically replaces taking a pill every day for 21 days. The fact that the monthly injection has in oestrogen, makes it unsuitable for patients where oestrogen is contraindicated. This includes patients with heart disease, sickle cell anaemia, patients with a history of a clot in the legs or lungs and women over 30 years old who smoke. Depo Provera is ideal in all these patients. Depo Provera also increases the quantity of milk in nursing mothers and since you just had baby five months ago and is probably still breast feeding, this is a better choice for you, as the oral contraception may cause a slight reduction in the volume of breast milk.

The pill that has the least side effect is MIRELLE. This pill contains half of the dose of oestrogen that the standard low dose oral contraceptive pill contains. It is currently the lowest combined oral contraceptive pill available. However, breakthrough bleeding may also occur with the oral contraceptive pills especially the low dose preparations. The chance of this occurring is greatest in the first three months of usage and usually disappears by the third cycle in the majority of women. Weight gain, acne, breast tenderness and migrane headaches may also occur. There is also a risk of developing a clot in the leg, especially when the higher dose preparations are used. The side effects include depression and also a decrease in libido.

It is possible for you to become pregnant since you have missed taking the Depo Provera, so it is important for you to consult your doctor about suitable contraceptive options. If you desire a long-term form of contraception then the intrauterine contraceptive device (IUD) may be a good choice. The copper T lasts for 10 years from the time of insertion and the Mirena lasts for five years. These are effective immediately and side effects are minimal. However, the only method that protects against sexually transmitted infection is the barrier method (female or male condom) and so you should consider using this in addition to your primary method of contraception, whether it is the pill, injection or the intrauterine device. Pregnancy should be ruled out by doing a urine pregnancy test before insertion of the intrauterine device.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.