6.21.13 update: Our colleagues at the Center for Menstrual Cycle Research recently posted Stopping Depo-Provera: Why and What To Do About Adverse Experiences, an excellent interview with endocrinologist and OBOS contributor Dr. Jerilynn Prior, who shares her advice for managing symptoms after stopping Depo.
Our 2009 post on side effects of stopping the injectable birth control Depo-Provera (depot medroxyprogesterone acetate, or DMPA) continues to generate important discussion — more than 100 women have shared their stories of adverse effects after stopping the drug.
Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic. Frustratingly, there is really not much new on the topic in the 2 1/2 years since we first posted on this. There don’t appear to be ongoing or upcoming studies on the concerns we’ve heard, either. A few studies here and there report some effects, like how long it took for menstruation to return, how long periods lasted, and how long it took to become pregnant after stopping.
Most of the existing research on women who stop using Depo-Provera seems to focus on bone mineral density. The drug comes with a “black box” warning that it may cause significant bone density losses, although research suggests that it’s possible that these losses may be made up after women stop taking the drug. The Society for Adolescent Medicine has said that “The data from all of these studies [of bone density in adolescent users] are encouraging, although it is unknown whether girls ultimately achieved the same peak bone mass as they would have in the absence of DMPA.” They also suggest that the advantages of preventing pregnancy may outweigh the risk for bone loss, but that patients should be informed of the potential for bone loss. Because of this concern, though, research on what happens when women stop using this birth control method tends to focus on understanding changes in their bone density.
Studies of “discontinuation” of birth control methods also tend to focus on the side effects of taking a drug and the reasons women stop using them, rather than what happens – aside from pregnancies – after they make that decision. It is thought that about half of women who quit Depo in order to get pregnant are able to do so by 10 months later, but that some women have longer waits before they are fertile. According to the drug label, “it is expected that 68% of women who do become pregnant may conceive within 12 months, 83% may conceive within 15 months, and 93% may conceive within 18 months from the last injection.” It also notes, though, that almost 40% of who discontinued the drug to become pregnant could not be followed up on, so they are not represented in those percentages.
What would you like to know about stopping Depo-Provera? What should researchers be examining? If you would like to share your own story of stopping Depo, please add them to the previous post.