The Shot is a secret weapon against birth-control bother

November 14, 1994|By Fawn Vrazo | Fawn Vrazo,Knight-Ridder News Service

Women call it The Shot.

Like its predecessor, The Pill, it promises freedom from pregnancy. But there is a big difference -- one that has women by the thousands flocking to ob-gyn offices, public clinics and student health centers across the country.

Women have to remember to take The Pill daily. They have to get The Shot just once every three months.

That difference seems to account for the growing and unexpected popularity of injectable Depo-Provera, approved as a contraceptive two years ago by the Food and Drug Administration. In that time, The Shot has caught on so widely that public-health programs have been financially pressed to keep up with the demand. Upjohn Co., the drug's manufacturer, predicts that its consumer hot line will ring 750,000 times with Depo-Provera information requests this year.

Few anticipated the method's "enormous explosion in interest," said Jerry Bennett, deputy director of the federal Public Health Service's office of population affairs. There was great fanfare over the FDA's earlier approval of the contraceptive Norplant, while Depo's approval happened "kind of quietly," he noted.

While it may never pose a huge commercial threat to The Pill -- currently used by 11 million American women, Depo seems to be blowing Norplant out of the water. At clinic after clinic, doctors say demand for the implantable Norplant is shrinking just as requests for Depo climb.

Doctors and women cite several reasons for The Shot's success.

High on the list is the secrecy factor. Like the hair-color ad that once promised "only her hairdresser knows for sure," an injection of Depo-Provera may be known "only to a woman and her clinician," said Steven Sondheimer, professor of obstetrics and gynecology at the University of Pennsylvania Medical Center.

With Depo, women who do not want anyone else to know they are using an artificial method of birth control do not have to worry about hiding pills, diaphragms, condoms or spermicidal foam.

A synthetic form of the hormone progesterone, Depo-Provera works by preventing eggs from ripening. That results in another benefit that many women say they love: an end to menstruation. About 55 percent of Depo-Provera users have no periods after one year of use, a figure that increases to nearly 70 percent at the two-year mark. The drug is almost 100 percent effective in preventing pregnancy -- in fact, Depo frequently keeps a woman infertile for many months after the shots end.

The cost also is appealing: Doctors charge about $45 for the three-month shot, comparable to a three-month supply of oral contraceptives.

But it is the new method's convenience that seems to account for its growing popularity. Users say they are thrilled to be able to forget about day-in, day-out Pill use. Keeping up with the quarterly injections is not a big inconvenience, say women, who are expected to see their gynecologists regularly anyway.

"I like the fact it's less responsibility on my part," said Cynthia Sparks, 26, of Philadelphia, who began using Depo-Provera a year ago.

Ms. Sparks was not a model oral-contraceptive user, she admits. On frequent trips to Baltimore, she often forgot to take the pills along.

Ms. Sparks says she has experienced no side effects from The Shot, but she may not be typical.

Other Depo users frequently report weight gain -- an average of four pounds a year for each year of use. Some experience mood swings, headaches, water retention and other symptoms associated with a hormonal birth-control method.

Long-term users may also be at risk for bone loss and osteoporosis. Upjohn, under orders from the FDA, is conducting a controlled five-year study on the drug's bone effects.

And the final word is not yet in on Depo-Provera's possible link to breast cancer.

In the late 1960s and early '70s, when Upjohn first came to the FDA seeking Depo's approval, studies showed that beagles developed breast cancer when given high doses of the drug. Although Depo was already widely used in other countries around the world, those studies kept the drug off the U.S. market as an approved contraceptive until this decade, when the FDA dropped its requirement that beagles be used in contraception testing.

The World Health Organization has concluded that Depo-Provera, now taken by 15 million women worldwide, is a safe method of birth control. Some groups, including the National Women's Health Network and the National Black Women's Health Project, are not yet convinced. But the issue of cancer has all but disappeared from the public discussion about Depo.

Upjohn itself reports on the Depo-Provera package insert: "Women under 35 years of age whose first exposure to Depo-Provera was within the previous four years may have a slightly increased risk of developing breast cancer similar to that seen with oral contraceptives."

Finally, Depo has raised social concerns -- notably, that poor women may be more often pressured by medical personnel and contraception providers to get The Shot, sometimes without their full knowledge and consent.

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