After having been used for decades for birth control around the world, the black-box warning for Depo-Provera states that prolonged use of the drug may result in a significant loss of bone density, and that the loss is greater the longer the drug is taken. Also, this bone-density loss may not be completely reversible after stopping the drug. The warning also says that a woman should use Depo-Provera for birth control for no longer than two years, and only if other birth control methods have proved inadequate.

Black-box warnings are designed to highlight special problems, particularly those that are serious, and to give healthcare professionals a clear understanding of a potential medical complication associated with a drug.

The warning came about as a result of an analysis of data that finally established the drug’s long-term effects on bone density.

Pfizer, the drug’s manufacturer, is also issuing a letter to all healthcare practitioners in the US, warning them of the dangers of prolonged use of the drug.

One woman suffered for three months until it was removed. During that time, she was in pain almost all the time, and especially if she sat down suddenly. Another woman had such a bad time with the coil that it damaged her cervix and she had been unable to conceive.

One woman says that she was in such pain that she went into shock. It was eventually removed after it caused severe pelvic infection, which resulted in a stay in hospital.

One woman had her coil removed because of painful periods, and had it replaced with a coil that releases small amounts of progesterone. It worked! There was no pain, and she fell pregnant within a month of having it removed. Her doctor (a woman) said she herself had one fitted, as did every other female doctor, and every wife of every doctor!

One woman had more of an unhappy experience. She had painful periods, and intercourse was uncomfortable. Eventually, she had it removed. Another woman had a similar tale to tell, and understands it is worse for women who have not had a child as the womb is tilted further back.

Finally, a happy ending. One woman has had a coil fitted for four years, and has had few problems. She’s had some pains, but doesn’t know if it’s the fault of the coil or not. Well, happy endings of sorts.

One is from a woman who says she wrote in with her positive views, but we didn’t feature her comments last time. Was this deliberate and are we just biased, she wonders? While we love a conspiracy theory as much as the next E-news bulletin, the truth is that either your e-mail got lost, overlooked or mislaid. Sorry.

Another woman tells us she has kept her coil in because she couldn’t be bothered to have it removed – even though she is now 58.

But, more in the vein of last week’s correspondents, one woman said that she put on half a stone through water retention when she had a coil fitted. The symptoms disappeared when she had it removed.

Another reader tells us that her GP said he had seen coils removed from tumours, and her own experience with one was so bad that she had to have it removed. So there we are – views from both sides of the coil (sorry, coin).

* I have an irritable bowel, and I’ve tried all kinds of pills and diets without success. But today, for the second time, I’ve dragged myself into my weekly Pilates session after a bad night due to IBS and, lo and behold, the exercises have relaxed me sufficiently to ease the problem. I told the teachers what was wrong and they suggested which exercises to try first, avoiding those that pulled on my abdominal muscles for the first 15 minutes or so, then I was just on to the usual routine. Has anyone else had a similar experience? – F.H., via e-mail

* A friend of mine was diagnosed to take the birth-control pill a year ago after she was told her hormones were out of balance. She has not had a period for seven months. Now she wants to stop the Pill and find another hormone solution. Can anyone help? – J.M. via e-mail

* Male and female condoms, which are, respectively, 98 and 95 per cent-effective barrier methods

* Diaphragms and caps, which are 92-96 per cent effective and more eco-friendly barrier methods. They are used with natural or chemical spermicides. Natural spermicides include lactic acid, aloe and lemon juice, and honey (‘honey cap’; see http://www.naturalchild.co.uk)

* Natural family planning (NFP), which is as much as 98-per-cent effective if followed correctly. It involves taking your temperature, checking cervical secretions and the position of the cervix daily. It takes three to six months to learn, and requires commitment and discipline

* Lactational amenorrhoea method (LAM), which is 98-per-cent effective if you are regularly breastfeeding a baby of less than six months, and your periods have not returned.

Melatonin levels normally go up when it turns dark, and they are low during daylight hours. This
hormone is also an antioxidant/free-radical scavenger that appears to slow the aging process. The
production of melatonin is high in youth and declines steadily with age. Many signs of aging are
associated with this loss of melatonin production, but cause and effect have not been proven. Large
doses of melatonin have been administered to animals and humans without any known side effects.

Supplements of melatonin, taken at night, often help with insomnia and in overcoming symptoms of
jet lag (for jet lag, it is taken near the bedtime in the new time zone for two or three days before
departure and after arrival). Unlike most medications for insomnia, melatonin is not addictive. When
it is used for insomnia, it does not leave you with any hangover or withdrawal symptoms. Some
animal and human studies have shown benefits in reducing cancer and enhancing immune function. In
animal studies, there is a clear increase in longevity (unfortunately, it is difficult to do longevity
studies in humans). In humans, it has helped in treating depression and also in lowering the eye
pressures in patients with glaucoma.

How to Take Melatonin
Melatonin is commonly available in 3-mg capsules or tablets, and the usual dose is 3-6 mg at
bedtime. Sometimes higher doses are helpful for insomnia and depression. Some people seem to
benefit from taking 10-15 mg of melatonin, without developing any apparent side effects. Larger
doses are being studied for birth control because of melatonin’s effect on sexual hormone balance.

Supplements of melatonin are almost all synthetically produced, but the synthetic molecules are
identical to the natural human melatonin. There may be some brands on the market that contain
actual animal pineal gland, but I do not recommend these. They are not as well standardized and
they may contain impurities. Synthetic melatonin supplements are pure white, while the gland
sources usually have some coloration.

Physical signs and symptoms associates with menopause are:

• Hot flashes – sudden waves of heat that can start in the waist or chest and work their way to the neck and face and sometimes the rest of the body. They are more common in the evening and during hot weather. They can hit as often as every 90 minutes. Each one can last from 15 seconds to 30 minutes – five minutes is average. Seventy-five to eighty percent of women going through menopause experience hot flashes, some more bothered by them than others. Sometimes heart palpitations accompany hot flashes.
  
• Irregular periods – this varies and can include:
  
  
  
  • Periods that get shorter and lighter for two or more years.
    
  • Periods that stop for a few months and then start up again and are more widely spaced.
    
  • Periods that bring heavy bleeding and/or the passage of many or large blood clots. This can lead to anemia.
    
  
  
• Vaginal dryness – this results from hormone changes. The vaginal wall also becomes thinner. These problems can make sexual intercourse painful or uncomfortable and can lead to irritation and increased risk for infection.
  
• Loss of bladder tone which can result in stress incontinence (leaking urine when you cough, sneeze, laugh or exercise).
  
• Headaches, dizziness.
  
• Skin and hair changes. Skin is more likely to wrinkle. Growth of facial hair, but thinning of hair in the temple region.
  
• Muscles lose some strength and tone.
  
• Bones become more brittle, increasing the risk for osteoporosis.
  
• Risk for a heart attack increases when estrogen levels drop.
  

• Irritability.
  
• Mood changes.
  
• Lack of concentration, difficulty with memory.
  
• Tension, anxiety, depression.
  
• Insomnia which may result from hot flashes that interrupt sleep.
  

Medication to treat depression and/or anxiety may be warranted in some women. Also, certain sedative medicines can help with hot flashes.

To reduce the discomfort of hot flashes, try these tactics:

• Wear lightweight clothes made of natural fibers.
  
• Limit or avoid beverages that contain caffeine or alcohol.
  
• Avoid rich and spicy foods and heavy meals.
  
• Have cool drinks, especially water, when you feel a hot flash coming on and before and after exercising. Avoid hot drinks.
  
• Keep cool. Open a window. Lower the thermostat when the heat is on. Use air conditioning and/or fans. Carry a small fan with you (hand or battery operated).
  
• Try to relax when you get a hot flash. Getting stressed out over one only makes it worse.
  
• Use relaxation techniques such as meditation, biofeedback or yoga.
  
• Take 400 international units of vitamin E daily, but consult your doctor first.
  

• Wear loose fitting cotton nightwear. Have changes of nightwear ready.
  
• Sleep with only a top sheet, not blankets.
  
• Keep the room cool.
  

• Don’t use deodorant soaps or scented products in the vaginal area.
  
• Use a water soluble lubricant such as K-Y Jelly, Replens, etc. to facilitate penetration during intercourse. Avoid oils or petroleum-based products. They encourage infection.
  
• Ask your doctor about intravaginal estrogen cream.
  
• Remain sexually active. Having sex often may lessen the chance of having the vagina constrict, help keep natural lubrication and maintain pelvic muscle tone. This includes reaching orgasm with a partner or alone.
  
• Avoid using antihistamines unless truly necessary. They dry mucus membranes in the body.
  

• Exercise regularly. This will help maintain your body’s hormonal balance and preserve bone strength.
  
• Talk to other women who have gone through or are going through menopause. You can help each other cope with emotional symptoms.
  
• Avoid stressful situations as much as possible.
  
• Use relaxation techniques. Examples include: meditation, yoga, listening to soft music and massages.
  
• Eat a healthy diet. Check with your doctor about taking vitamin/mineral supplements.
  

Questions to Ask

Do you have any of these? Extreme pain during intercourse Pain or burning when urinating Thick, white or colored vaginal discharge Fever and/or chills
Do you have heavy bleeding with your periods or pass many small clots or large ones which can leave you pale and very tired?
Have you begun menstrual periods again after going without one for six months?
Are hot flashes severe, frequent or persistent enough that they interfere with normal activities?
Do you have risk factors for osteoporosis? Family history of osteoporosis Small bone frame Thin Fair skin (Caucasian or Asian race) Had surgery to remove ovaries before normal menopause or menopause before 48 years of age Lack of calcium in diet Lack of weight-bearing exercise Alcohol abuse Hyperthyroidism Use of steroid medicine
If taking hormone replacement therapy (HRT), are you having any of the following? Side effects Return of menopausal symptoms

Acne is the teenagers’ curse. Teenagers have to worry about pimples just when they want to look their best. Acne can pop up on the shoulders, back, neck, and face. Many people still have acne or acne scars when they are adults.

These things do not cause acne:

• Greasy foods
  
• Chocolate
  
• No sex

Teenagers get acne because they have a lot of androgen. Androgen is a hormone. The glands under your skin make more oil when you have a lot of androgen. The oil ducts get clogged and infected. Then bumps pop up on the skin. Newborn babies can get a little acne from their mother’s hormones. This can happen when the baby is 2 to 4 weeks old.

These things help cause acne:

• A girl’s hormones before her period or when she is pregnant
  
• Heavy lotions or greasy makeup
  
• Stress
  
• Foods with iodine–like kelp, beef liver, broccoli, asparagus, and white onions
  
• Vitamin pills that have iodine
  
• Cooking oils, tar, or creosote in the air
  
• Sleeping on one side of your face or resting your head in your hands
  
• Birth control pills, steroids, anticonvulsive medicines, and lithium

Your child’s doctor can give your child special creams, antibiotics, or Retin A cream or gel if your child’s acne is bad. Ask the doctor for advice. Don’t do anything special for a baby’s acne. Just wash the skin gently.

Are there signs of infection with the acne such as fever and swelling?
Is the acne very bad?
Are the pimples big and painful?
Have you tried self-care, and it doesn’t help?
Does self-care make the skin worse?

Time is the only cure for acne, but these tips can help:

• Keep the skin clean. Wash often with plain soap and water. Use a washcloth. Work the soap into the skin gently for a minute or two. Rinse well.
  
• Have your child use a clean washcloth every day. Bacteria grow on a wet washcloth, and they can give your child more pimples.
  
• Have your child try an astrin-gent lotion, degreasing pads, or a face scrub.
  
• Ask your child’s doctor for the name of a good acne soap.
  
• Leave your child’s skin alone! Tell your child not to squeeze, scratch, or poke at pimples. They can get infected and leave scars.
  
• Buy a lotion or cream that has benzoyl peroxide. (Some people are allergic to benzoyl peroxide. Try a little on your child’s arm first to make sure it doesn’t hurt the skin.)
  
• Have your child wash after they exercise, and any time they sweat.
  
• Have your child wash their hair at least twice a week.
  
• Have your child keep their hair off their face.
  
• Don’t let your child spend too much time in the sun.
  
• Don’t let your child use a sun lamp.
  
• Have your child use only water-based makeup. Don’t let them use greasy or oily creams, lotions, or makeups.

No longer is birth control simply a matter of planning or preventing a pregnancy. Protection from AIDS and sexually transmitted diseases (STD’s) should also be considered. Using more than one method may be needed to prevent both pregnancy and diseases that are transmitted sexually.

Ideal Use – is the percentage of pregnancies that occur among couples who use the method correctly for every time they have sexual intercourse.

Average Use – combines figures for ideal use with pregnancies that occur among couples who do not use the birth control method(s) correctly or every time when they have sexual intercourse.

Disadvantages

Method	Failure Rate……%*	Information	Advantages	Disadvantages
Cervical Cap Covers the cervix; prevents sperm from reaching egg.	Ideal use……6% Average use……18%	Works by creating a barrier that prevents sperm from reaching the cervix. Needs a prescription and proper fitting by a doctor.	Can be kept in place up to 3 days. No dangerous side effects.	Limited number of sizes available. Potential problems with insertion. Slight risk of infection when left in place for several weeks. May cause an abnormal Pap smear. Not to be used by those with a history of abnormal Pap smears. Should not be used during menstrual period.
Condom (Female)	Ideal Use……5% Average Use……25%	Shaped like a male condom, but larger. Is placed inside the vagina like a lining. Made of polyurethane which is thinner and stronger than latex. Has 2 rings; One around the outer rim which covers the labia and the base of the penis and one inside that fits over the cervix like a diaphragm.	Effective protection against STD’s and AIDS (especially when used with a male condom.) Available over-the-counter.	Can take time and patience to use correctly. Can twist if not inserted properly. Costs more than male condoms. May reduce sexual spontaneity and sensation.
Condom (Male)	Ideal Use……2% Average Use……16%	Thin pliable sheath worn over erect penis; prevents sperm from entering vagina. Latex ones are more durable than ones made of animal membranes.	Easy to get. Easy to use. Latex brands are most effective. They protect against gonorrhea, syphilis and AIDS (especially when used with a spermicide containing Nonoxynol 9)	May reduce sexual spontaneity and sensation. Slight risk of breakage. Easily damaged with improper storage. Deteriorate when exposed to ultraviolet light, heat or moisture. Not good choice if allergic to latex or spermicides.
Depo-Provera	Ideal use……0.3% Average use……0.04%	A female prescription contraceptive given by injection every 3 months. A synthetic version of the female hormone progesterone. Blocks ovulation.	Highly effective in preventing pregnancy. May reduce risk of endometrial cancer.	Provides no protection for STD’s or AIDS. May cause side effects, irregular periods, weight gain, fatigue and headaches. Once stop-ped, it can take 4-18 months for a woman to become fertile again.
Diaphragm	Ideal Use……6% Average Use……18%	Thin, soft, rubber cap that covers the cervix; prevents sperm from reaching and fertilizing egg. (Up to 6 hours after insertion) Needs doctor’s prescription.	Not disposable. Can be used over and over again. No dangerous side effects. Helps protect against some STD’s when used with spermicides.	Requires proper fitting. Should be checked for leaks and size may need to be changed with weight increase or decrease. May dislodge during intercourse. May reduce sexual spontaneity. May increase chance of getting bladder infections. Should not be used during menstrual period.
Spermicides (Foams, Jellies, Creams, Suppositories)	Ideal Use……3% Average Use……30%	Spermicides inserted into the vagina; kill sperm before entering the uterus.	Available over-the-counter. More reliable when used with barrier methods (condoms, diaphragms). Protects against some STD’s. No dangerous side effects.	May cause irritation. Must be applied no longer than 10 minutes before intercourse. May reduce sexual spontaneity and sensation.
Intrauterine Device (IUD)	Ideal Use……0.8% Average Use……4%	Small copper device inserted into uterus; prevents pregnancy by interfering with sperm transport and fertilization. Needs a doctor’s prescription. Inserted by a doctor. There are at present only two IUDs available in the U.S.: Copper T-380A and Progestasert.	be used up to 10 years. Progestasert can be used for up to one year. Remains in place at all times.	Does not prevent STD’s or AIDS. May cause heavy menstrual flow. May become dislodged. Risk of infection and perforation of the uterus. Not recommended for those who have a history of pelvic inflammatory disease.
Natural Family Planning (Fertility Awareness, Periodic abstinence)	Ideal Use……1-9% Average Use……19-35%	Requires monitoring of body temperature and observation of cervical mucus to determine when ovulation occurs. A woman is most fertile 2 days before and through the 2 days after ovulation. Safe days start the day after the three days of elevated temperature and last until menstruation begins.	Does not require use of hormones, or other things that are placed inside the body. Is completely reversible. Method to use when planning a pregnancy because it helps a woman know when she ovulates.	Sexual intercourse must be limited to “safe days”. Consult your health care provider for an explanation of “safe days”. This method takes training, time, and a need to keep records of measurements, to be effective. Does not protect against STD’s.
Norplant	Ideal Use……0.04% Average Use……0.05%	Six thin capsules (the size of match sticks) are placed under the skin of a woman’s upper arm. Releases a hormone that keeps a woman from making hormones needed for ovulation. Needs a doctor’s prescription, insertion and removal. Make sure doctor is well trained in inserting and removing implants.	One time insertion effective for up to six years. Can be removed at any time. Fertility returns soon after removal of implants.	Does not prevent STD’s or AIDS. May cause irregular menstrual bleeding during the first 6 months after implants are put in. More expensive than birth control pills. Some women may need more than one simple surgery (with only local anethesia) to remove implants.
Pill (Oral Contraceptives)	Ideal Use……0.1% Average Use……6%	Hormones, in pill form; prevent the release of eggs. (Ovulation) Needs a doctor’s prescription.	May reduce a woman’s chance for: uterine and ovarian cancers, pelvic inflammatory disease (PID). Promotes regular periods, lighter menstrual flow.	Does not prevent STD’s or AIDS. Must be taken as prescribed. Not recommended for women who smoke or have heart disease. May increase the risk of blood clots and stroke.
Sterilization (Female): Tubal Ligation, (Having “tubes tied”)	Failure Rate……0.003%	Surgery to burn, cut or tie off the fallopian tubes. This prevents eggs from being fertilized. Failures are usually due to pregnancy prior to surgery, surgical error or regrowth of the fallopian tubes.	Permanent form of birth control.	Should be used only when no more children are desired. Usually requires general anesthesia. Does not prevent STD’s or AIDS. Costs more than a vasectomy.
Sterilization (Male): Vasectomy	Ideal Use……0.1% Average Use……0.2%	The tubes through which the sperm travels from the testes (vas diferans) are cut. Can be done with a surgical cut or a puncture tool. (Newer method)	Done as out-patient with local anesthesia. Less costly than tubal ligation.	Does not take effect right away. Sperm can still be present for 20 ejaculations. Vasectomies can be reversed with surgery, but this is not always successful. Does not prevent STD’s or AIDS.

[Note: In addition, another way to prevent pregnancy is total abstinence from sexual encounters. Using no method of birth control has about 90% chance of pregnancy in one year.]