The Food and Drug Administration (FDA) has recently approved depo-medroxyprogesterone acetate or Depo-Provera as an injectable long-acting birth control method. The drug has been used in this country for many years for other medical indications. It had already been approved in 90 countries as a contraceptive and has been used by millions of women worldwide. The drug is given every three months as an injection. A birth control pill (BCP) every day is a lot more to remember.

The hormone prevents ovulation; it also thickens cervical mucus, which blocks the sperm and it makes the lining of the uterus very thin, which prevents implantation of an egg even if it is somehow fertilized. This combination of these effects makes the failure rate of this method about the same as the BCP. There are other benefits to this form of contraception. The shot has no estrogen. This means that if the woman has a history of clots in her veins, is over thirty-five and smokes or is breastfeeding she can consider this method of birth control. Also, pelvic infections and tubal pregnancies are probably decreased and endometriosis may be greatly improved by Depo-Provera.

As far as safety goes, the World Health Organization did a ten year study and found a reduction in uterine cancer and no change in ovarian, cervical or liver cancer. There may be a slight increase in the risk of breast cancer. The side effects are few, but as with the BCP, they may preclude the use of this in some women. The most significant side effect is menstrual abnormalities. Spotting and irregular bleeding are very common during the first few month of use, 50% of women stop having periods completely.

Under the influence of this medication the absence of the menses is safe and can be quite beneficial. Some less desirable side effects than no periods that occur in some women include: weight gain, breast tenderness, decreased sex drive, depression, headache, nervousness and fatigue. Another aspect is the cost: the medicine with an injection fee is about $90 per shot; that's $360 a year. BCPs are now around $400 a year.

The first shot should be given during the menses, this decreases the risk of treating a pregnant woman and starts the contraception as early as possible in a cycle. This form of birth control is not for every one. I see it as a great contraception during a year of breastfeeding and for those that can't take estrogen or can't remember to take anything on a daily basis. The risks are small compared to the risks of driving on Central to one of those "big hospitals" down in Dallas and the benefits are almost as great as having the newly improved and expanded Trinity Medical Center within easy driving distance.