Norplant is a long-acting hormone that is inserted under the skin and prevents conception for up to five years. Depo-Provera is also a hormone, but it isinjected into a muscle and provides protection against pregnancy for three months. The hormone in Norplant and Depro-Provera is progestin, a synthetic hormone similar to one found naturally in a woman's body.

Both hormones are about 99% effective in preventing pregnancy. Neither of these methods provide protection from AIDS or other sexually transmitted diseases.

Given as a shot, Depo-Provera works in several ways to prevent conception. First, it prevents the egg (ovum) from maturing and being released, and it causes the mucous in the cervix (opening into the uterus or womb) to thicken, making it difficult for the sperm to enter. Depo-Provera also causes the liningof the uterus to become thinner, making implantation of a fertilized egg unlikely. The injection must be given within the first five days of a normal period and provides protection against pregnancy for three months. It is recommended that a second contraceptive device be used for two weeks after the firstinjection.

Norplant capsules contain a synthetic hormone that is slowly released over aperiod of up to five years. It functions like Depo-Provera in that it prevents the ovaries from producing ova (eggs) and also results in thicker mucous inthe cervix, which prevents the sperm from passing through the cervix. Norplant can be inserted at any time.

The woman being considered for Depo-Provera will have a pelvic and breast examination, a Pap test, blood pressure check, weight check, and a review of hermedical history. Women who have diabetes mellitus, major depression,blood-clotting problems, liver disease, or weight problems should usethis approach only under strict medical supervision. It should not be used ifthe woman is pregnant, has unexplained vaginal bleeding, suffers from severeliver disease, has breast cancer, or desires to become pregnant within 18-24months. Advantages of this approach may include a decreased risk of cancer of the lining of the uterus (endometrial cancer) and stopping menstrual periods.

Individuals who select Norplant will receive the same basic physical examination as for Depo-Provera. If approved for this method, an implantation site will be selected (usually the inside of the upper arm), and the area prepared for minor surgery. The physician will use a local anesthetic to numb the area,a small incision will be made, the six Norplant capsules will be inserted, and the incision sewn up. Protection against pregnancy normally begins within24 hours. If necessary, the implants can be removed in 15-20 minutes. Norplant should not be used by women who are pregnant, have blood clotting problems,or have unexplained vaginal bleeding. Advantages include light periods withless cramping and decreased anemia. This form of birth control may also protect against endometrial cancer.

Because Depo-Provera and Norplant use only the hormone progestin, they may provide an alternative for women who cannot use estrogen-containing birth control pills.

The most common side effects associated with Depo-Provera are yellowing of the skin, headache, nervousness, dizziness, abdominal pain, hair loss, rash, increase in number of migraine headaches, increased or decreased interest in sexual intercourse, the development of dark spots on the skin, depression, and weakness. Danger signs that need to reported immediately include weight gain, heavy vaginal bleeding, frequent urination, blurred vision, fainting,severe abdominal pain, and coughing up blood. Because the effects of Depo-Provera may last up to 12 weeks, it may take a longer time for women trying tobecome pregnant after discontinuing the injections.

The main reactions to Norplant include headache, weight gain, irregular periods or no period at all, breast tenderness, acne, gain or loss of facial hair,color changes of the skin over the area of insertion, and ovarian cysts. Thedoctor should be notified immediately of lumps in the breast, heavy vaginalbleeding, yellowing of the skin or eyes, or infection of the incision. Womenwho use Norplant are discouraged from smoking.

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