Depo Provera (DMPA) is a reversible prescription birth control method. Each Depo Provera shot slowly releases a synthetic form of progesterone medroxyprogesterone acetate that can protect against pregnancy for a period of 11 to 14 weeks. Many women stop using Depo Provera during the first year of use due to irregular bleeding (spotting) and/or continuous bleeding, both of which are especially bothersome during the first three months of use. The good news? After continuous Depo use for one year, the depo bleeding stops for almost 50% of women.
Frustrated with Unwanted Depo Bleeding?
The most common reason women choose to stop using hormonal contraception tends to be dissatisfaction with their bleeding patterns. Women seem to be most frustrated with unscheduled bleeding and spotting. It is estimated that discontinuation of contraception may account for almost 20% of the 3.5 million unintended pregnancies that occur each year.
Unfortunately, it seems that bleeding is the number one reason that women choose to stop using this birth control method. Depo bleeding side effects can occur as your body is adjusting to Depo Provera. Many women report experiencing irregular bleeding (spotting) and/or prolonged bleeding (like a continuous period) during this time. Unfortunately, there is no way to know ahead of time if you will experience this Depo Provera side effect. For some, the depo bleeding may continue until the injection wears off (12 to 14 weeks) whereas others may not have any bleeding/spotting at all.
Is There Hope For Me?
Even though this depo bleeding could occur right after your first Depo Provera injection, according to Pfizer (the manufacturer of Depo Provera), “in clinical trials, over a third of the women had stopped having periods (this is called "amenorrhea") by month 6. By month 12, over half of the women had stopped.” A good number of women may be willing to “wait it out” knowing that the frequency and duration of their depo bleeding will decrease over time. These women are willing to go through the initial bleeding in exchange for the chance of not having to have a period anymore.
OK, so good for those women… But what about the 70% of women who experience depo bleeding during the first year of use and are feeling, is there any hope for me? You may really want to continue with Depo Provera use. After all, it is highly effective (97% to 99.7%) and super convenient to only have to think about birth control 4 times a year. Plus, you would love for your Depo Provera to be the agent preventing pregnancy and not the fact that you are not having sex (= no chance for becoming pregnant) due to this annoying bleeding! It just requires patience.
Depo Bleeding Interventions
If knowing that the depo bleeding should decrease isn’t cutting it for you (or if your bleeding is not decreasing), there may be some treatments available. Keep in mind though, these interventions and medications may help stop the bleeding, but there is no evidence to support the routine use of these options. Seeking such interventions may help increase your likelihood of sticking with Depo Provera (and perhaps even being happy about your decision!).
Eager to see if I could uncover some hope for all of you complaining about depo bleeding, I researched an article on UpToDate -- a trusted electronic reference used by many doctors and patients. According this excerpt from UpToDate, some treatments include:
"Supplemental estrogen -- Oral or transdermal estrogen (1.25 mg conjugated estrogens, 2 mg of micronized estradiol, or 0.1 mg estradiol patch) administered for 7 to 14 days, if there are no contraindications to exogenous estrogen administration. An estradiol-releasing vaginal ring for the first three months after initiation of DMPA has also been tried. Estrogen supplementation is thought to promote tissue repair and coagulation. It does not affect the contraceptive efficacy of DMPA.
Tranexamic acid -- Tranexamic acid is an antifibrinolytic used primarily in patients with hemophilia during operative procedures. A randomized placebo-controlled trial of 100 DMPA users with unscheduled bleeding found that tranexamic acid 250 mg orally four times per day for five days was effective in halting bleeding. The tranexamic acid group had a significantly higher percentage of subjects in whom unscheduled bleeding stopped during the first week of treatment (88 versus 8.2 percent with placebo), and during the four-week follow-up period (68 versus 0 percent with placebo). The mean number of bleeding/spotting days was also significantly different between the groups (5.7 versus 17.5 days)."
OK, what does this mean to you, the poor woman who is bleeding on depo and is desperate for some relief?
Estrogen: one option that you can discuss with your doctor is the possibility of using hormone replacement therapy/estrogen supplementation to get some relief from your depo bleeding.
- Conjugated estrogens (Cenestin, Enjuvia, Premarin): these are a mixture of several different estrogens (estrogen salts) and are derived from synthetic sources.
- Micronized estradiol (Gynodiol, Estrace): these are bio-identical estrogens, made from plant sources that are micronized (broken down into little pieces) so it is easily absorbed and used by your body.
- Estradiol patch (Climara, Alora, Vivelle Dot, Estraderm): a transdermal skin patch that releases the estradiol and allows it to be slowly absorbed through your skin. These patches are NOT the same thing as the Ortho Evra contraceptive patch.
- Estradiol vaginal ring (Estring, Femring): a flexible ring that provides vaginal estrogen. This is NOT the same thing as the NuvaRing.
These estrogen treatments, taken for 7-14 days (the ring is used for the first three months) may provide some relief from the depo bleeding. However, research is limited and mixed about how well estrogen supplementation may work. The largest trial investigating estrogen-use indicates that ethinyl estradiol was more effective than a placebo in stopping depo bleeding, yet the bleeding started up again once the estrogen was stopped. Likewise, there has been one major study on the use of estradiol patch for depo bleeding. The results show that women using this intervention had a higher rate of continuing with Depo Provera use. At this time, due to lack of research, birth control pills are not indicated to help with depo bleeding.
The therapeutic use of estrogen may help stop depo bleeding because it encourages blood clotting and tissue repair as well as promotes fast growth of uterine lining and stabilizes blood vessels. Estrogen therapy may also be a good option because it does not compromise Depo Provera’s effectiveness at preventing pregnancy. That being said, you and your doctor must weigh the therapeutic advantages of estrogen supplementation against its potential problems. Not everybody is a candidate for estrogen, and it can be dangerous to use if you have certain risk factors or are estrogen-intolerant. Also, extended use of estradiol medications may increase your risk of breast cancer, ovarian cancer or uterine cancer.