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Is 10 years too long to remain on Depo? #748/7

I have been on Depo-Provera for almost ten years and have never had a problem, however, I wonder if I’ve been on it for too long.  Is it recommended that women take a break for a cycle or two or can I remain on it if it is working?  I like Depo because it stopped my normally heavy and troublesome periods.


You have been on Depo for almost ten years and have never had a problem.  GREAT!


This is not too long.  It is not generally recommended that you take a break from Depo periodically.  You can continue receiving shots.

 

           


I am glad that you have found that Depo stopped your normally heavy and troublesome periods.


Bone Mineral Density and Depo-Provera

 





Women who used DMPA for more than 2 years have significantly reduced bone mineral density (BMD) of lumbar spine and femoral neck.  But effect is largely reversible, even after
> 4 years of DMPA use, comparable to the effect and reversal seen after lactation [Petitti-2000].  All women using DMPS including teens should to taking in sufficient calcium in diet or be encouraged to take calcium supplements.  Also encourage to exercise regularly and avoid smoking.  A double-blind randomized controlled study of estrogen supplementation in adolescent girls demonstrated at 24 months of DMPA use an increase of 4.7% in femoral neck bone density in teenagers receiving monthly injections of estradiol cypronate (5 mg) and a decrease of 5.1% in femoral neck bone density in teens provided DMPA and monthly placebo injections of 5 mi normal saline [Cromer-2005].  Bone mass may return after Depo-Provera has been discontinued.  Cromer et al indicate that they “cannot conclude that observed bone loss in irreversible until further study is conducted and the relevant data have been obtained.” [Cromer-2005]  Subcutaneous DMPA did NOT decrease bone density.

              

Below is the listing of advantages and disadvantages of Depo-Provera.  This information can be found on our website under CHOICES:

WHAT ARE THE ADVANTAGES?

  • Nothing must be taken daily or used at the time of sexual intercourse.
  •  Sex may be enjoyed more because of less fear of pregnancy.
  • Depo-Provera is extremely effective. If women receive their injections right on time (every 3 months or 13 weeks), only 3 women in 100 will become pregnant in the course of one year.
  • Women, including women with fibroids, lose less blood using Depo-Provera and have less menstrual cramping. Often after 5 injections women stop having periods. This is safe! Decreased risk of anemia.
  • Privacy is a major advantage. No one has to know you are using this method.
  • Nursing mothers can receive Depo-Provera injections. According to the World Health Organization, it's best to begin use after the baby is 6 weeks old, but most U.S. programs will provide Depo-Provera when a nursing mother leaves the hospital after delivery.
  • It’s OK to start a new contraceptive if fewer than 13 weeks have passed since the last shot.
  • Depo-Provera may improve PMS, depression and symptoms from endometriosis.
  • Can prevent ectopic pregnancies, sickle cell crises and grand mal seizures. 
  • Unlike combined pills, Depo-Provera is not less effective if you take medicines that affect the liver.
  • Decreased risk for cancer of the lining of the uterus (endometrial cancer).

WHAT ARE THE DISADVANTAGES?

  • Do NOT start this method of birth control unless you will find it acceptable to have your periods change.  They WILL change a lot.
  • Depo-Provera injections can lead to very irregular periods. If your bleeding pattern is bothersome to you, you can take medications which may give you a more acceptable pattern of bleeding.
  • Some women gain weight. To avoid weight gain, watch your calories and get lots of exercise.
  • Depo-Provera does not protect you from HIV or other infections. Use condoms if you are at risk.
  • You must return to the clinic every three months for your injection.
  • Depression and premenstrual symptoms may become worse.
  • It may be a number of months before your periods return to normal after your last shot. It takes an average of 10 months for fertility to return after the last shot, making it hard to plan pregnancy exactly.
  • Depo-Provera may lower your estrogen level and cause bone loss, although this is not certain. Get regular exercise and take extra calcium to protect your bones from osteoporosis.
  • A few women are allergic to Depo-Provera. Fortunately, allergic reactions are very rare, but they occur, and the effects of the shot cannot be stopped once it is given. Such a woman may need anti-allergy medicine for several days to months.
  • Depo-Provera is expensive in some healthcare settings.
  • Increase in LDL (bad cholesterol) and decrease in HDL (good cholesterol) in some studies  

Key Words:  Depo-Provera shots, problem, recommended, break, cycle, heavy, troublesome, periods, advantages, disadvantages


Posted 7-2007, Updated 2-25-2009 

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2009-02-25


Managing Contraception for Your Pocket 2013-2014
  


Managing Contraception for Your Pocket 2013-2014
  

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