Blog of the Society for Menstrual Cycle Research

Does Depo-Provera work like a charm or a curse?

February 6th, 2013 by Laura Wershler
Author’s Update, February 14, 2013: As clarified by Bedsider.org in the comments section below, the Works Like A Charm Contest mentioned in this post is not current but ended in 2011. The contest website pages are now inactive.

If Bedsider.org sponsored a contest called Why I Hate My LARC, there would be no shortage of contest entrants. But I expect it will be a long time before the nay-sayers get as much attention as the yeah-sayers.

Composite illustration by Laura Wershler

Bedsider has jumped on the LARC bandwagon. The online birth control support network for women 18-29 has launched the Works Like a Charm contest encouraging “the awesome women and couples” who use long-acting reversible contraception to share why they love their LARCs for the chance to win up to $2000. This is a variation of the Why I Love my LARC video campaign sponsored by the California Family Health Council last November, only with prizes!

To quote my blog post about the earlier campaign: “Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.”

One long-acting, not-so-reversible contraceptive in particular – Depo-Provera – is causing grief for many women. Yet “the shot” is front and center in the graphic on the contest website.

Considering the rah-rah tone of the Works-Like-a-Charm campaign messages, it seems that bedsider.org, a project of the National Campaign to Prevent Teen and Unplanned Pregnancy, is oblivious to the misery caused by this contraceptive. Often, Depo works like a curse.

I acknowledge that Bedsider is doing good work: The website provides youth-friendly, accessible information about the full range of birth control methods. But, in my opinion, any organization that promotes Depo-Provera as a contraceptive method should be totally transparent about the ill effects many women experience both while taking and after stopping the drug.

Depo-Provera, to put it bluntly, fucks with a woman’s endocrine system.

The long list of ill effects while on or after stopping this drug includes: continual bleeding (from spotting to heavy), mood disorders, severe anxiety, depression, digestive issues, loss of sex drive, extreme weight gain (often without change to exercise or eating habits), lingering post-shot amenorrhea, intensely sore breasts, nausea, and ongoing fear of pregnancy leading to repeated pregnancy tests. (Not to mention its documented negative effect on bone density.)

These effects are why the continuation rate of Depo-Provera is only 40-60% after one year of use, and why women are filling online comment pages with stories of their struggles coming off this drug.

At Our Bodies, Ourselves, the blog post Questions About Side Effects of Stopping Contraceptive Injections has been attracting comments since November 3, 2009, with no end in sight.

On my April 4, 2012 re:Cycling post – Coming off Depo-Provera can be a woman’s worst nightmare - there are over 130 comments. All but six were posted since mid-November when the post caught fire. Not more than a day or two goes by before another women shares her story of distress, confusion or frustration. I read each one and respond occasionally. Rarely, a positive experience appears; one criticized other commenters for complaining.

It’s one thing to read or hear about potential ill effects while trying to decide whether or not to use Depo-Provera. It’s quite another to experience some or many of them for months on end without acknowledgement or health-care support from those who promote or provide this drug.

The Works Like a Charm contest website says about LARCS:

Reversible = not permanent. If and when you’re ready to get pregnant, simply part ways with your LARC and off you go.

“Off you go?” Tell that to the thousands of women who are waiting, months post-Depo, to get their bodies and their menstrual cycles back to normal. Most of them still aren’t ready to get pregnant.

  

12 Responses to “Does Depo-Provera work like a charm or a curse?”

  1. Ericka says:

    Depo Provera is terrible. I only took one shot and never went back because of all the side effects. Its been almost 12 weeks since my 1st and only shot and Im still having digestive issues. My periods have returned but Im still depressed and the digestive issues and loss of appetitte caused me to loose weight towards the end. This shot effects all women differently and the sad part is its really unpredictable.

    • Laura Wershler says:

      Thanks for you comment. I had some long Twitter conversations about this post the other night. Someone said they knew lots of women who missed their shots and ended up pregnant. I Tweeted this:

      Why do they miss their shots? Bcz Depo sucks? What if we said:”If you hate it, please come back & we’ll find something else.”

      If the provider who gave you the shot had said this to you, might you have gone back to talk to them? Were you concerned that you wouldn’t be listened too if you went back? Or encouraged to keep taking it?

      I believe this is a drug and provider issue not a user issue. You’ve every right to stop a drug that makes you feel terrible. ONe of the problems is that providers for the most part do not or cannot explain to women what is happening to their bodies. They don’t understand the endocrinology of how the drug works while taking it and why symptoms can be so problematic after stopping the drug. Knowing what’s going on can make living through it more bearable.

      Your thoughts?

      • Ericka says:

        I agree 100% my doctor was lost and confused. She wasnt the one that gave me the depo shot I went to a birth control clinic. However my doctor seemed baffled at the lingering side effects and at 1st basically was saying it “should” be out of my system after just one shot. Almost 3 months later still having digestive issues

  2. Even though I do seem to hear less and less enthusiasm from health practitioners for the Depo shot (and more and more for the implant and Mirena), the Gates foundation has sunk a lot of money into making sure women in Africa will have access to Depo with an initiative that puts it at the forefront of contraceptive options. They’ve even developed Uniject with Pfizer – an injection that a woman can administer herself with no consultation. There are many reasons this is a bad idea – consider the impact of the side effects mentioned here when you’re malnourished and living in poorly sanitized conditions. Depo also increases the risk of HIV transmission according to many studies over the last ten years.

    • Laura Wershler says:

      One would think that with the implant, Mirena, and now the new Skyla progestin IUD, that health-care practitioners would be moving away from promoting Depo-Provera. So why is Planned Parenthood Arizona tweeting about it as option TODAY: “Do you like hormonal birth control, but want something more convenient than a daily pill? Check out Depo-Provera: http://ow.ly/htnOs

      Convenience it seems is more important than a young woman’s health and well-being. And the information provided about ill effects is guarded and misleading. Two examples:

      “Depo-Provera may cause a loss of calcium from your bones that could lead to osteoporosis.”

      FACT: The black box warning on this drug, issued on November 17, 2004, says: Long-term use (defined as two years or more) of Depo-Provera is associated with significant bone mineral density loss that may not be reversible. The irony? Girls and women on the shot are told to take calcium every day, yet the shot is promoted to women who can’t remember to take the BC pill every day.

      “After stopping the shots, menstrual bleeding returns. Also, after stopping the shots, it may take nine to 10 months to get pregnant.”

      FACT: After stopping the drug many women will find that regular menstrual cycles do not return for months and months, and sometimes not for over a year. They might not bleed at all, or they might bleed for weeks and months on end, but they are not having regular, ovulatory cycles. And it takes longer than 9 or 10 months for many women to become pregnant post-Depo.

      This is blatant false advertising.

      • Debbie says:

        Took depo for a few years…I almost died because of my gallbladder rupturing…look it up, how many women have gall bladder issues after just a few shots of depo…something like 8 out of 10. I was a monster while on the shot…at times I like a crazed person almost homicidal. Now, I am older and I am starting to feel the same way, my husband says it is pms on steroids…well, I need a Doc. to confirm but I think it is PMDD and I really don’t want to “take” and more RX’s, I think that’s where the problems began…If I knew what I know now, STAY AWAY for depo

        • Laura Wershler says:

          Thanks for sharing your story. If you are experiencing problems with perimenopause, you may find some helpful information on how to manage these at http://www.cemcor.ubc.ca This is the Centre for Menstrual Cycle and Ovulation Research. Search for articles under the subject “perimenopause.”

          All the best.

  3. Thanks for your perspective on this. First of all, a point of clarification: the “Like a Charm” contest ended over a year ago. Unfortunately, we overlooked the task of taking the site down after we chose winners and awarded prizes back in fall of 2011. We’ll address that right away.

    Second, we totally agree that women should be informed about all their options and be empowered to choose what’s best for them. As you said, health care providers need to be an important part of that, but we’re also aware that provider time is limited and that providers don’t always get a chance to educate patients about all their contraceptive options. We’ve found that many women only know about high-maintenance methods like the pill and condoms and we feel it’s important to get the word out that there are other options.

    We realize that people have negative experiences with all the different methods of birth control and we see a lot of those stories being told. We also think it’s important to share stories of positive experiences–sharing those stories was the motivation behind the “Like a Charm” contest. Too many women give up on birth control without knowing all their options–ultimately our goal is to help women find a method that works for their body and their lifestyle.

    • Laura Wershler says:

      Thanks for the clarification on the time frame for the Works Like A Charm Contest. I’ve noted this in an addendum at the top of the post.

      I take exception to the Love your LARC campaigns because they treat contraception like a product to be marketed and sold, when in fact many LARCs, especially Depo-Provera, are powerful endocrine-disrupting drugs. Drugs, I might add not intended to treat illness or disease, but rather to impair fertility to prevent pregnancy, which is also not a disease.

      To promote one class of contraceptives as “better” than another is not the same as merely stating that they may be more “effective.” And they are only more effective if women keep using/taking them. By failing to acknowledge with full transparency how nasty the effects of Depo-Provera are for MANY women, you set them up for unintended pregnancies. How? If a woman hates the effects of the shot, and fails to show up for her next shot, she is at risk for pregnancy. Provider enthusiasm/recommendation for these methods can make it hard for a women to come back and say, “I hate this.”

      When the black box warning came out for Depo-Provera in 2004, it seemed apparent that this was a last-choice contraceptive that should be taken, at best, for no more than two years. Yet it continues to be promoted as a LARC you can love. There it is, top left on the bedside.org methods page. And being Tweeted about last week by PP Arizona.

      At the very least, sexual and reproductive health organizations and care-providers must be more open about the problems caused by Depo-Provera before providing it, and they must develop treatment protocols that help women restore menstrual cycle and general health after stopping the drug. In my opinion, if they are providing Depo, then they are obligated to find the time, limited as it may be, to fix the problems this drug creates. It’s obvious from the comments on my previous post about coming off Depo-Provera that this is not happening.

  4. Chris says:

    Nearly 15 years ago when I went to my very first OBGYN appointment and discussed prevention methods prior to getting married, I requested Depo Provera. It seemed like such an easy way to take care of birth control and I knew that I would struggle with a daily pill. To this day I am thankful for an honest, experienced, OBGYN who looked me straight in the eye and said that he would not prescribe that for me, he would never prescribe that for anyone, and that he had seen too many young women terribly messed up by the Depo Provera shot. I was shocked! I thought that I had done my research and had never heard anything terribly alarming about Depo. Later I had a coworker who was hospitalized as she came off of Depo due to the terrible mental health side effects. Over the years I have heard story after story of the problems people had on Depo or after stopping it.
    Honestly, I have never heard a good experience story about Depo and I wonder why it is still even on the market. I guess in this day and age only a class action lawsuit can accomplish that.

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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.