The Aftereffects of Coming Off the Depo-Provera Shot
|Expert Reviewed||Dr. Mark Trolice, Director of Fertility Care|
How Hormonal Birth Control Works
Depo-Provera (also spelled Depot Provera in some medical materials) is an injectable form of hormonal birth control that involves getting a shot in your arm or buttocks every three months. It works similarly to birth control pills.
It starts to work as contraception immediately if you get your first shot within five days of beginning your period.
Depo-Provera suppresses a woman’s own hormones, preventing the ovaries from releasing eggs into the fallopian tubes. The synthetic progesterone hormone will reduce sperm fertilization by increasing the thickening of the cervical mucus and reducing motility in the fallopian tubes, so the sperm has difficulty traveling in the female reproductive tract.
The cervical mucus thickens and the uterine lining changes so that it's harder for sperm to enter or survive in the uterus. All of these changes prevent fertilisation.
When a woman stops using Depo, her body tries to restore hormonal balance and regain reproductive function by restoring normal production of estrogen by the ovaries in preparation for ovulation.
What Are Common Side Effects After Going Off Depo Injections?
- Spotting and irregular periods.
- Loss of bone mineral density, which can make osteoporosis more likely. This risk is greater if you have used Depo-Provera for longer than two years.
- Difficulty conceiving. Some women become pregnant as soon as 3 to 4 months after receiving their last injection. But it takes some women up to a year or two to conceive after they stop using this type of birth control.
- Some women find that, after going off of Depo, symptoms that they had while using the injections get worse. These side effects include heavy bleeding, extreme breast tenderness, weight gain, headaches, nausea, mood swings, depression, and hair loss.
Is Infertility a Side-Effect of Going Off of Depo-Provera?
"Depo-Provera is a strong pituitary suppressant of hormone stimulation to the ovaries, meaning it will prevent ovulation," says Dr. Mark Trolice, Director of Fertility Care at the IVF Center in Winter Park, Florida. "The longer Depo-Provera is used, the longer it will take your body to restore normal menstrual cycles. I have seen up to 18 months of no periods after discontinuing Depo-Provera and before ovulation resumes, particularly in women who gained weight while on the medication."
That being said, Dr. Trolice notes, once regular periods resume, women should have no increased difficulty conceiving, particularly if periods were regular before using Depo-Provera.
My Experience Stopping Depo-Provera
I have to say that, in my opinion, and based on the stories shared on the Internet from other women in situations similar to mine, the side effects of this form of birth control can extend way past the point of its current use and time that it takes for the chemicals to leave the body.
Spotting and Irregular Periods After Depo-Provera
I was advised (all those years ago) that should I ever decide that I wanted to have a baby, it could take a while for it to happen after discontinuing the Depo injections. I was told that it could take up to two years for my period and fertility to return to normal.
I have to say it took about half a year longer than that! I have only just had my first period after a decade of getting the injections. It was not quite normal either. I had quite a few weeks of on-and-off spotting before having what could be called a true period of any description. I had had weeks of spotting on and off about 6 months after initially coming off the injection but it was typically more off then on.
I don't regret going on this form of birth control. The side effects for me proved very positive and to be honest I am a little scared of the complete return to my 'normal' periods. I am also worried that I may find it takes a long time still to become pregnant.
Difficulty Getting Pregnant After Depo-Provera
When the two-year mark had passed and the only change in my body was tender and painful nipples, I started reading what I could find of other people's experiences with coming off the injection. I found a few stories of women afraid that they had been made infertile. The stories ranged from two years of no period and no pregnancy (the maximum length of time medically advised for a return to fertility) to pregnancies ending in upsetting miscarriages.
I am going off of memory, but I do recall a story of someone who believed Depo-Provera to be responsible for their premature menopause after they came off of the drug. It does seem from my experience that this could well be possible, as my body is certainly producing results beyond what I was told could happen when I decided to start the injection.
I am not giving up hope that I may well find myself with a healthy, normal child now that I have had a heavier period (though not as bad as I used to be able to get). In 10 years, a lot can happen to a person and I have gone from thinking I should not have a kid (barely being able to take care of myself, let alone a baby) to being married and confident that I could provide a loving and happy home to a child.
If this medication has had such an effect on my body as to reduce my fertility permanently (making pregnancy very difficult) it would be upsetting as the medical advice did not alert me to this possibility.
On the other hand, when I started on Depo-Provera, I did not want to have a baby and probably would have made the same choice even if I had been told that it would reduce my chance of ever getting pregnant.
Life is full of choices and once made, our choices are our responsibility. Someone who wants to be more careful in making their birth control choice that I was should investigate their options further.
Does Depo-Provera Lead to a Loss of Bone Density?
"While the FDA has issued a warning on the increased risk of fracture while on Depo-Provera," says Dr. Mark Trolice, "several societies, including the American College of Obstetrics and Gynecology believe the contraceptive benefits outweigh the theoretical risk of bone loss."
Studies also show that the decline in bone density significantly reverses after stopping Depo-Provera.
The most serious side effect is a loss of bone density that can occur over a prolonged period of use. I spent many years using the Depo birth control injections and have not experienced a loss of bone density so it seems that, though it is a serious concern, it is not a certainty. I may well have been consuming a large enough amount of calcium and I was not still growing when I started it (I was in my mid-20s).
The unusually high estrogen levels that come after stopping Depo-Provera can cause mild to severe breast soreness, not unlike the way breasts can feel before a menstrual period or during pregnancy.
What Are Signs That Depo-Provera Is Wearing Off?
"Patients usually stop menstrual bleeding while on Depo-Provera," says Dr. Mark Trolice. "If you experience a return of bleeding while on Depo-Provera, this may suggest breakthrough ovulation or an anatomic issue with your uterus, so seek advice from your gynecologist."
In order to be sure that the birth control is fully effective, women have to get Depo-Provera injections every 12 weeks. Once 12 weeks have passed with no injection, the hormones slowly wear off over time.
Some women who want to get pregnant after stopping injections conceive in just 3 or 4 months, while others wait as long as two years.
Pros and Cons of Birth Control Pills vs. Injections
Birth control pills and injections work in a similar way. The main difference is how the hormones are delivered.
Birth control pills:
- may be more expensive than Depo injections
- may cause milder side effects because the hormones are delivered gradually on a daily basis
- can be risky because you have to remember to take them.
Birth control injections:
- are convenient because one shot lasts three months
- can lead to extreme side effects because the hormones enter the body all at once.
What Are the Side Effects While Using Depo-Provera?
1. Decrease and Eventual Stopping of Menstrual Period
There are quite a few possible side effects of using Depo-Provera, though the only one that I experienced was my period stopping.
This is a common side effect (it seems). I found this effect to be wonderful as my periods had been intensely painful and triggered severe depression that could leave me suicidal.
2. Weight Gain While Using Depo-Provera
The next side effect that most women need to think about is weight gain. I did not notice any appreciable weight gain but it does seem like it is the most common side effect.
3. Nervousness, Mood Swings, and Depression
Some women report feeling anxious and depressed while using Depo-Provera. Unfortunately, this can continue after stopping the injections. Women who experienced anxiety before beginning the injections are more likely to see this condition get worse while using Depo.
Women with a history of mood disorders should talk to their doctors before starting Depo-Provera to discuss the risks.
Other Side Effects of Depo-Provera
Things other women have experienced include:
- Hot flashes
- Decreased interest in sex
- Hair loss
I Haven't Started Using Depo Yet. What Can I Do to Avoid Bad Side Effects?
"Physicians can educate women on what to expect, so they're not surprised," says Dr. Nicole Swiner, a family physician at Durham Family Medicine in Durham, North Caroline, "or start them immediately on a different treatment to help continue (menstrual) regularity."
As stated earlier, women with a history of mood disorders should take care before starting Depo-Provera as these women are more likely to experience heightened anxiety while on the medication.
Is Depo-Provera the Same as Medroxyprogesterone?
Yes. Medroxyprogesterone is a synthetic type of female hormone, similar to the progesterone that women produce naturally. It is available by prescription in tablet and injection form under the brand names Depo-Provera, Depo-SubQ Provera 104, MPA, Provera, and Depot medroxyprogesterone acetate.
Will Weight-Bearing Exercises Help Prevent Osteoporosis?
Bones are living tissue, just like muscles, and they become stronger when we exercise. We all lose bone mass as we age, but women, in particular, can reduce their chances of getting osteoporosis by exercising regularly.
If you are concerned about your bone mineral density after coming off of Depo-Provera, consider heading to the gym. More and more women are lifting weights these days, so you'll have plenty of company! Ask a gym staff member for tips on developing a routine, or use one developed specifically for female lifters.
Will Using Depo-Provera Increase My Breast Cancer Risk?
Research is contradictory on the question of whether hormonal birth control increases the risk of cancer.
Some studies show an increased risk of breast cancer but a decrease in risk of endometrial and ovarian cancers among women who use birth control pills. This link might be caused by high doses of estrogen, but women in studies who took Depo-Provera, which only contains progesterone, have also been found to have higher rates of breast cancer.
I Am Miserable After Stopping Depo! Is Their Online Support?
Yes. Women who experience extreme discomfort after stopping Depo-Provera are not alone. This extensive collection of women's experiences coming off Depo may help. It includes an interview with an endocrinologist who has studied how hormonal birth control affects women's health.
I hope that you've learned something new from my experience and that this has been helpful for you!
Dr. Mark Trolice
- The article has been modified since this review was written.
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