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LONG-ACTING METHODS 

Three types of highly effective long-acting methods of contraception are currently available in United States injections, implants, and IUDs.

            *    Each injection provide birth control for  3 months.
            *    Implants offer 5 years of contraception.
            *    IUD offers 1 year of contraception; the copper
                 T380AIUD provide 10 years of birth control.  

All of these methods may be appropriate for women who seek extended contraception, cannot tolerate estrogen.

None of them protects against STIs.  injections and implants may cause irregular bleeding in users.  The copper T 380A  IUD increases menstrual flow and cramping; the progesterone-releasing IUD appears to decrease menstrual flow and dysmenorrhea.

The most prominent health risk associated with use of IUD is pelvic infection.

Injections

Injections of hormones are other option.  Each injection provides birth control for 3 months, so you only need four injections a year.

Appropriate candidates for DMPA injections.
            *    Women seeking long-term, reversible contraception
            *    Women in whom estrogen is not well-tolerated or is
                  contraindicated
            *    Women who do not wish to conceive within the
                  next 1 to 2 years
            *    Women with menstrual disorders
            *    Women seeking an ultra-private method of
                  contraception
            *    Women with medical conditions, such as seizures,
                  cerebrovascular disease, complicated    migraine
                  headache, cardiovascular disease, diabetes, lipid
                  disorders, liver disease and smokers < 35years of
                  age.

Implants

Implants are another form of hormonal birth control. Six soft plastic tubes the size of match stick are placed just under the skin of your upper arm.  After the tubes are inserted you don't need do any thing else to prevent pregnancy.  Implants provide birth control for 5 years.

Appropriate candidates
            *    Women seeking long-term, reversible contraception
            *    Women in whom estrogen is not well tolerated or is
                  contraindicated
            *    Women who have contraceptive compliance
                  problems
            *    Women with mental or physical handicaps or
                  psychiatric disease
            *    Women >age 35 who smoke
            *    Women who are postpartum or breast-feeding
            *    Women who are using antiepileptic agents
            *    Women with cerebrovascular disease, complicated
                  migraine headache, cardiovascular disease,
                  diabetes, lipid disorders, liver disease.

The  intrauterine device is a small plastic device containing copper or hormones.  It is inserted in and left inside of the uterus.  The presence of the IUD prevents the egg from beeing fertilized.  Although IUDs provide convenient, effective, safe long-term contraception, most American women are reluctant to use them.

Appropriate candidates:
            *    Women in a mutually monogamous relationship with
                  no risk of STIs
            *    Women who have had at least 1 child
            *    Women who desire long-term contraception
            *    Women who can not tolerate estrogen
            *    Women >age 35 a smoker
            *    Breast cancer survivors
            *    Women with active liver disease
            *    Women with vascular disease associated with
                  diabetes or lupus
            *    Women with coronary artery disease
            *    Women cerebrovascular disease
            *    Women with complicated migraine headaches
            *    Women with increased risk of thromboembolism
                  and
            *    Women with lipid disorders.

There are numerous conditions that contraindicate the use of an IUD.  A history of ectopic pregnancy prohibits use of the progesterone-releasing IUD, but not the copper IUD.  The copper T 380A IUD increases menstrual bleeding and dysmenorrhea.

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