Family Planning Associates Medical Group

The 3-month Depo-Provera Shot, also known as DMPA or Depo

Medroxyprogesterone Acetate is a hormone injection that lasts for 3 months to prevent pregnancy. It contains synthetic progesterone and no estrogen so it may be indicated for the woman who cannot use or has a medical condition that contraindicates estrogen-containing methods. It is a long-term, high efficacy, non-coitus dependent, private contraceptive method that cannot be seen on the body and requires no home supplies. Depo-Provera may work by stopping the ovaries from releasing eggs. Depo-Provera causes the cervical mucus to thicken and changes the uterine lining, making it harder for sperm to enter or survive in the uterus. The first injection can be given any time in a woman’s cycle if it is reasonably certain the woman is not pregnant.

A pelvic exam is not required to start Depo-Provera. Special conditions that may contraindicate use of DMPA include osteoporosis and abnormal vaginal bleeding. Women are advised to take extra calcium when using Depo-Provera. Common side effects once a woman gets Depo-Provera often include irregular bleeding and eventual cessation of her period.

Depo-Provera is 97-99.7% effective as birth control. It does not protect against reproductive tract infections, including HIV/AIDS.

Emergency Contraceptive Pill (ECP) commonly known as the 'Morning After Pill" for those patients who may have experienced a sexual encounter within the past 72 hours and are concerned that they may be pregnant, this simple oral medication can greatly reduce their chance of pregnancy.  This medication can also be prescribed in advance for those patients who wish to be prepared.

The Morning After Pill contains a hormone called progestin (learn more about these emergency contraceptive pills). This is the only type of pill available specifically for emergency contraception in the United States (sold under the brand names Plan B, Plan B One-Step, and Next Choice). Progestin-only pills can reduce your risk of getting pregnant by 89%.

When do I need ECP?

ECPs are meant to be used as emergency contraception. Some situations where this method would be appropriate include:

• If a condom breaks, slips, leaks, or falls off during intercourse
• If you diaphragm slips out of place during intercourse
• If you forgot to take your birth control pills
• If you had sex when you did not expect to and did not use any birth control during intercourse
• If you were forced to have sex

If you experience any of the above situations, your risk of becoming pregnant depends on which day in your menstrual cycle that you had sex. The days when you are most likely to get pregnant are right in the middle of your menstrual cycle--about 14 days after the start of your last period. If you have unprotected sex during these days, there is a high chance that you could get pregnant.

The "morning after pill" can cut down the risk of pregnancy to about 80% if taken within 72 hours of unprotected intercourse. The "morning after pill" can also be used for an additional 2 days, however the effectiveness rate declines with each passing day.

This time period is very important. If you have had unprotected sex more than once since your last period, and at least one of those times was more than 5 days ago, you may already be pregnant. If you are already pregnant, ECPs will not work. For instance, if you had unprotected sex on Saturday night, you could use ECPs until Thursday night. In general, however, the sooner you use them, the more effective they are.

What is Plan B®?

At Family Planning Associates Medical Group, we use Plan B® ("morning after pill") for emergency contraception. Plan B is the first progestin-only emergency contraception to be approved by the FDA.

Plan B (levonorgestrel) may prevent pregnancy by temporarily stopping the release of an egg from a woman's ovary, or it may prevent fertilization. It may also prevent a fertilized egg from attaching to the uterus. Plan B will not work if you are already pregnant.

Plan B does not protect against sexually transmitted diseases. It should not be used in place of regular contraception. Correct and consistent use of regular contraception is more effective.

How do I take Plan B®?

Plan B can be provided by FPA through a scheduled office visit. Upon arrival, you will complete a brief medical history and then be given a package of Plan B (two pills). You should swallow the first dose (one pill) from the package, up to 5 days after intercourse, but optimally within 72 hours. The second pill should be taken 12 hours after the first pill. You also have the option of taking both pills at the same time.

We recommend that you schedule an appointment for a complete gynecological exam, including a breast exam and a Pap Smear test, after your next period, if you have not done so in the past year.

Side Effects

It is very common to have side effects when using the "morning after pill". Some common side effects are nausea and vomitting, breast soreness, a headache, dizziness, break-through-bleeding, bloating, abdominal pain, tiredness and menstrual irregularities. These side effects are not long-term and are not to be considered serious. Your next period may start a few days earlier or a few days later than usual.

No method of birth control is without its drawbacks. After you've struggled with various birth control methods for a while, and after you've had all the children you want, you may want to consider permanent birth control, or sterilization. Female sterilization is a procedure that works by blocking the Fallopian tubes, thus preventing the eggs released by the ovaries from reaching the uterus and being fertilized by sperm.

How does it work? Family Planning Associates Medical Group (FPAMG) provides permanent female sterilization in one of two methods, depending upon patient choice and request.

• ESSURE: The newest and least invasive procedure is called ESSURE (www.essure.com). With this method, the physician uses a small camera to insert two micro-inserts in to the fallopian tube, where they then cause occlusion of the fallopian tubes and no longer allow a uterine pregnancy to form. In addition to the routine 2 week follow-up appointment with FPAMG, patients also are required to have a follow-up x-ray to confirm proper placement and occlusion of the fallopian tubes at 90 days. With the ESSURE method, there is no need for an incision through the abdominal wall and the healing time is greatly reduced. The procedure is covered by most insurance plans, including Medi-Cal, Family PACT (SOFP), and many independent health plans in Southern California. In many ways, the ESSURE procedure has revolutionized the way in which permanent female sterilization is accomplished.


• TUBAL CAUTERIZATION: This is the "traditional" tubal sterilization procedure where two small incisions are made in the abdominal wall of the patient and the fallopian tubes are scarred by cauterization (aka. burning) to cause occlusion. Unlike the newer ESSURE (www.essure.com) procedure, this method does involve two surgical incisions.

Both methods are equally effective and will produce the desired permanent female sterilization that is required.

Effectiveness: Tubal sterilization by either method is considered 99% effective in preventing pregnancy. The incidence of pregnancy after tubal cauterization is less than 3-4 in 1000.

Permanence: Tubal sterilization is considered permanent. It is theoretically possible to reconnect the tubes, but the operation is expensive and complex, requiring a major incision and hospital stay, and is not always successful. You should choose this form of birth control only if you are certain that you don't want any more children.

Counseling: If you are interested in one of our tubal sterilization procedures, you can make an appointment with one of FPA's skilled treatment coordinators who will answer your questions and help you make sure this procedure is right for you.

How long does it take? Tubal sterilization by either method takes only about 30 minutes. However, with the preparation and post-operative observation, your stay in the clinic is about five hours.

Recovery: You will be discharged from the clinic a few hours after your surgery. We advise you to rest for a day. Your throat may be a little sore from the administration of the anesthesia, and you may have a small amount of vaginal spotting. Every woman is different, so the time needed to recover from surgery will vary, but we recommend that you avoid heavy lifting and wait until after your two weeks post-operative check-up to have intercourse.

Complications: No surgery is risk-free. Complications are rare; however, they do exist. Your treatment coordinator will explain them to you.

After Effects: After the Fallopian tubes have been blocked, the ovaries continue to function normally. Sterilization has no effect on the production of hormones, nor does it interfere with menstruation or menopause. It causes no physical changes.

The only after-effect is a beneficial one; without the fear of an unwanted pregnancy, you will probably feel a new sense of freedom and an increase in sexual response.

Cost: In keeping with FPA's commitment to provide quality care at moderate cost, the fee for sterilization includes counseling, the procedure, and follow-up care. During your first appointment, we will review the charges with you and help you decide what form of payment is best suited to your financial position. We accept private insurance, Medi-Cal, Family PACT (SOFP), and work closely with several other health plans to provide services to their patients. Please contact us at 1-877-88-FPAMG for more information.

The intrauterine device (IUD) is a long-term birth control method. Unlike IUDs that were used in the 1970s, present-day IUDs are small, safe, and highly effective.

Mirena is a soft, flexible IUD that releases small amounts of hormone locally into your uterus. It gives you birth control you can count on-that lasts as long as you want, for up to 5 years.

• Mirena is more than 99% effective at preventing pregnancy
• You can try to become pregnant as soon as Mirena is removed. Within a year of having Mirena removed, about 8 out of 10 women succeed at becoming pregnant
• If you have a pelvic infection, get infections easily or have certain cancers, Mirena is not right for you
• Mirena is also proven to reduce heavy periods in women who choose intrauterine contraception

 For more information, please visit http://www.mirena-us.com/