Blog of the Society for Menstrual Cycle Research

Stopping Depo-Provera: Why and what to do about adverse experiences

April 11th, 2013 by Laura Wershler

Laura Wershler interviews Ask Jerilynn, clinician-scientist and endocrinologist

A screen shot of comments to Laura Wershler’s blog post of April 4, 2012: “Coming off Depo-Provera can be a woman’s worst nightmare.”

With 250 comments – and counting – to my year-old post Coming off Depo-Provera is a women’s worst nightmare (April 4, 2012) I thought it was time to revisit this topic.

That blog post has become a forum for women to share their negative experiences with stopping Depo-Provera (also called “the shot,” or Depo), the four-times-a-year contraceptive injection. (Commenters reporting positive experiences have been extremely rare.) Many women have experienced distressing effects either while taking Depo and/or after stopping it. They report that health-care professionals seem unable to explain their problems or to offer effective solutions. What is puzzling for many is why they are experiencing symptoms like sore breasts, heavy and ongoing bleeding (or not getting flow back at all), digestive problems, weight gain and mood issues when they stop Depo.

This post aims to briefly explain how Depo works to prevent pregnancy, its common side effects and, most importantly, why and what to do about adverse experiences when stopping it.

What follows is my interview with Dr. Jerilynn C. Prior, Society for Menstrual Cycle Research board member, professor of endocrinology at the University of British Columbia, and scientific director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) Section 1 explains how Depo-Provera works and what causes its side effects. Section 2  explains the symptoms women are experiencing after stopping the drug.

1) Taking Depo-Provera: How it works and established side effects

Laura Wershler (LW): Dr. Prior, what is Depo-Provera® and how does it prevent pregnancy?

Ask Jerilynn: The term, “depo” means a deposit or injection and Provera is a common brand name of the most frequently used synthetic progestin in North America, medroxyprogesterone acetate (MPA). Depo is a shot of MPA given every three months in the large dose of 150 mg. Depo prevents pregnancy by “drying up” the cervical mucus so sperm have trouble swimming, by thinning the endometrium (uterine lining) so a fertilized egg can’t implant and primarily by suppressing the hypothalamic and pituitary signals that coordinate the menstrual cycle. That means a woman’s own hormone levels become almost as low as in menopause, with very low progesterone and lowered estrogen levels.

LW: Could you explain the hormonal changes behind the several established side effects of Depo? Let’s start with bleeding issues including spotting, unpredictable or non-stop bleeding that can last for several months before, in most women, leading to amenorrhea (no menstrual period).

Ask Jerilynn: It is not entirely clear, but probably the initial unpredictable bleeding relates to how long it takes for this big hormone injection to suppress women’s own estrogen levels. The other reason is that where the endometrium has gotten thin it is more likely to break down and bleed. These unpredictable flow side-effects of Depo are something that women should expect and plan for since they occur in the early days of use for every woman. After the first year of Depo (depending on the age and weight of the woman) about a third of women will have no more bleeding.

LW: What about headaches and depression?

Ask Jerilynn: It is not clear why headaches increase on Depo—they tend not to be serious migraine headaches but are more stress type. Perhaps they are related to the higher stress hormones the body makes whenever estrogen levels drop. Unfortunately, headaches tend to increase over time, rather than getting better as the not-so-funny bleeding does.

The reasons for depression are mysterious to me but this is an important adverse effect. I believe that anyone who has previously had an episode of depression (whether diagnosed or not, but sufficient to interfere with life and work) should avoid Depo.

LW: Although there has been little discussion about bone health concerns on the previous blog post, I think we should address the fact that Depo causes bone loss. How does it do this?

Ask Jerilynn: As we discussed, Depo causes estrogen levels to drop. Dropping estrogen levels always cause bone loss. Several randomized, blinded studies for example, have shown that if women taking Depo wear an estrogen patch, compared with a placebo patch, they don’t lose bone. (That was a test of the cause of bone loss but isn’t a good strategy during Depo because it might prevent its contraceptive effectiveness).

The bone loss concern is now decreased because we know that women, on average, regain all of that lost bone as they stop taking Depo. MPA, like progesterone, stimulates new bone to form but this formation is not visible while bone loss is high (as in, while taking Depo). The increase in bone density on stopping Depo is because rising estrogen levels prevent bone loss and the increased bone formation then becomes visible.

I have tended to think the bone loss is not an important problem because the bone density returns to normal. However, women at osteoporosis risk do have more broken bones while on Depo. Therefore I recommend that all woman choosing Depo for contraception have at least three high calcium (dairy or calcium-fortified) foods per day (or take one 500 mg calcium pill with a meal and the other at bedtime) plus also 2000 IU of vitamin D3 daily.

It is probably wise for teens to avoid Depo if they have a personal history of amenorrhea (no flow for three or more months), or a close relative (mother, grandfather or sister) who had a broken bone without a major fall. (Note: For more life cycle specific information about preventing bone loss click here.)

LW: Weight gain has caused grief for many women taking Depo. What’s going on?

Ask Jerilynn: The suppression of women’s estrogen production likely causes the weight gain on Depo (that averages 2 kg or five pounds in the first year). A similar weight gain occurs in women or in animals when their ovaries are removed. It is probably the body’s way of trying to increase fat (that can convert male and stress hormones into estrogen) and thus to prevent the rapid bone loss that happens when estrogen levels drop.

LW: Another reported effect of Depo is digestive problems. I’ve read that abdominal distress including cramps, bloating and constipation are common because Depo loosens the tone of the muscles in the gastrointestinal tract. Can you comment on this?

Ask Jerilynn:  I don’t really understand this. What I do know is that abdominal problems are common in general for women and haven’t shown up as significantly different between women on Depo or placebo in trials of Depo. I suspect, again, that the drop in estrogen level triggers stress hormones that cause crampy gut pain and changes in bowel habits.

2) Stopping Depo-Provera: What is causing adverse effects and what to do about them

LW: Thanks for explaining the side effects women experience while taking Depo. What happens and why are women miserable when they stop it?

Ask Jerilynn: First let me say that I have looked in the recent medical literature and been unable to find any studies of women’s experiences on stopping Depo. One would surely hope that drug regulatory bodies have required research on the return to fertility in women taking Depo.

Here’s what I think is happening, and I’ve formed this understanding based on what women described in their posts: Women’s reproduction has been suppressed by Depo for months or years. This means that (figuratively speaking) the hypothalamus, pituitary and ovaries have ‘forgotten how’ to coordinate their usual complex and amazing feedback needed for normal ovulatory menstrual cycles.

However, our bodies are programmed to work hard to regain reproduction so there is a kind of rebound over-stimulation of estrogen levels (the easiest hormone to get the ovary to produce). The result is erratic but high estrogen levels causing nausea, sore breasts, fluid retention and abdominal bloating, mood swings and heavy or prolonged vaginal bleeding.

With high estrogen levels and weight gain, plus the “hypothalamic incoordination,” ovulation doesn’t occur and therefore no progesterone is produced. Progesterone – the hormone produced after ovulation in normal menstrual cycles – is needed to counterbalance the high estrogen levels. I believe that it is this estrogen-progesterone imbalance that is leading to all these miserable symptoms.

LW: Many women who have shared their experiences on my previous post also seem very concerned by the delayed return to normal menstrual cycles, with some experiencing no bleeding for months. Others seem to have flooding and continual flow. What’s up?

Ask Jerilynn: We’d have to study this to be sure, but I suspect that the women who have no flow for months on stopping Depo likely are younger, have gained the least weight and are under the most situational/emotional/physical stress. On the other hand, those who have heavy and/or prolonged vaginal bleeding are likely older (and often perimenopausal—when ovarian hypothalamic coordination has normally become dysfunctional) and have usually gained more weight.

Therefore I believe that the varying responses in vaginal bleeding depend on whether women were on the young-thin-stressed side when starting and stopping Depo versus normal to now overweight or obese. Another possibility is that women have become perimenopausal during their years on Depo. Thus when they stop Depo they are now in a symptomatic perimenopause that the Depo was preventing or treating.

LW: Some women have noted extreme weight gain upon stopping Depo. Can you explain why this might be happening?

Ask Jerilynn: If estrogen levels are high and progesterone levels are low, the natural result is inappropriate hunger and weight gain. Progesterone levels following ovulation make women burn about 300 more calories a day, which obviously helps prevent weight gain. I think this weight gain side-effect of stopping is also due “estrogen dominance.”

LW: Another common experience that disturbs women as they stop taking Depo-Provera is extremely sore breasts. What causes this?

Ask Jerilynn: This is directly caused by the “estrogen overdrive” as the body tries to recover from the suppression caused by Depo. Sore breasts tell us that our estrogen levels are higher than the highest normal mid-cycle estrogen peak. If it is sore when you press your palm onto your nipple, you don’t need a blood/urine/saliva test to know your own estrogen is higher than it ever should be in the normal cycle.

LW: Why are some women getting acne or pimples on their face and backs?

Ask Jerilynn: Whenever women are overweight and not making enough progesterone (because they are not ovulating) the body makes more male hormones that lead to oily skin and acne.

LW:  What about the hot flushes that some women are experiencing? These symptoms are typically associated with perimenopause, the transition to menopause.

Ask Jerilynn:  Yes. Some women who have become perimenopausal while on Depo will have had their hot flushes and night sweats effectively treated by the progestin. Therefore, when they stop, they experience the symptoms of perimenopause including night sweats and daytime hot flushes.

That brings me to another educated guess—many women stop Depo in their 30s and 40s because they want to have a family or because their doctors advise them to. They may already be starting into perimenopause but the signs, such as hot flushes, are masked while on Depo. However, off Depo the estrogen swings (that may be high both because of stopping Depo and because of changes related to perimenopause) cause hot flushes and night sweats. If you’d like more information about perimenopause here’s a recent open-access scientific review.

Heavy flow is one of the most common experiences of early perimenopause that at least a quarter of all women experience. When you add the estrogen excess production on stopping Depo to perimenopause (“Estrogen’s Storm Season”) you get really, REALLY heavy flow. No wonder women are so frustrated and doctors are so puzzled.

LW: Many women are told to just “wait it out.” This could mean months of not ovulating, ages without a menstrual period, or putting up with flooding menstruation. Do you think that’s a good idea? If not, what would you suggest?

Ask Jerilynn:  Based on what I’m guessing is going on hormonally, and also on a woman’s age, her desire or not for pregnancy, and on her current body mass index, here are some suggestions:

Heavy vaginal bleeding:  My first suggestion—something every woman should know— is ibuprofen. One tablet four times on every heavy-flow day, decreases flow by almost a half. See this article about how to manage flooding or heavy vaginal bleeding. You can take ibuprofen on your own and track your own cycles by downloading and completing the Daily Perimenopause Diary.

Having such a record will help your health care provider to understand what you are experiencing as well as allowing you to know for yourself what is going on. If ibuprofen does not sufficiently decrease heavy flow so you can cope, you will likely need to ask your physician’s help. You will need a prescription in order to take what I next recommend, cyclic or daily progesterone.  What works best is to print out this information sheet for on Cyclic Progesterone Therapy, one for yourself to stick somewhere obvious and one to take to your doctor.

However, if your flow has been so heavy and long that you already have iron loss anemia (commonly called a “low blood count”), have had continuous flow for over a month, or are bleeding enough to become dizzy when standing, you need a more powerful solution than cyclic progesterone. The answer is progesterone every day for three months (plus ibuprofen on every heavy flow day).  I’ve written this article on heavy flow to take to your family doctor.

No flow for three months after stopping Depo: I suggest starting to take natural, bio-identical progesterone (see Cyclic Progesterone Therapy) for two weeks and stop for two weeks. Don’t be discouraged if you don’t get a period when you stop it. Just keep doing that two weeks “on” and two weeks “off” progesterone until your flow returns. Even without flow, this treatment will increase bone density (based on a trial we did years ago).

If, in the course of taking cyclic progesterone you start getting irregular flow, follow the instructions (and picture) in that handout carefully. Most of all, think of this as restoring a normal balance of your own hormones and ovulatory menstrual cycles.

When you start noticing stretchy mucus about the middle of the month, this means your estrogen levels are recovering. Now you can actively start working on becoming pregnant, if this is your desire. You will take the progesterone for two weeks or fourteen days but start checking for your urinary LH peak (with a fertility kit you can buy over the counter) in the evening when you notice stretchy vaginal mucus. Only begin the progesterone after you see the LH peak (a positive test) or after the stretchy mucus decreases. The reason is that if you take the progesterone too early it could suppress that necessary LH peak.

Sore breasts, bloating and/or nausea: These symptoms mean high estrogen levels, usually without any or enough progesterone. Increasing exercise, increasing vegetables and fruits, and decreasing junk/snacks and desserts (except fruit) will decrease estrogen levels in premenopausal women. Although I can’t promise that for women in perimenopause, it will certainly help you feel better. After you’ve started on these lifestyle changes, I’d suggest beginning cyclic progesterone 14 days after the start of a flow or any time if you are not getting flow regularly. Follow the suggestions about how to take progesterone on the Cyclic Progesterone Therapy. If sore breasts get better but still persist, you can also try (gradually) decreasing your caffeine and alcohol intakes.

Hot flushes and night sweats: To start, I think it is important to realize that the experience of hot flushes or night sweats means you are in perimenopause. So, although it is not much help, you can blame some of what you are experiencing on perimenopause instead of just on stopping Depo!

CeMCOR recently proved that progesterone is effective for treatment of menopausal hot flushes in a randomized, placebo-controlled trial. We are now testing its effectiveness for perimenopausal hot flushes in a similar controlled study. If you live anywhere in Canada, you could potentially participate.

If, as is typical in very early perimenopause, you are waking at night feeling hot (and often sweaty or irritable) on only a few nights a month, and usually around flow, then cyclic progesterone works. Take it for 14 days, but if you typically have night sweats on the first few nights of flow, continue it a few more days.

However, if hot flushes are coming day and night and are troublesome any old time, then take progesterone daily instead of cyclically.

LW: This information will certainly help the many women who are having these experiences. Is there anything else you want to add about Depo-Provera?

Ask Jerilynn: I would like to say, perhaps belatedly, that Depo is an effective contraceptive that I feel women should have the option to choose. (Here I may differ from Laura!) Those of you who know me (and CeMCOR) realize that my goal in life is to help every woman achieve normal, ovulatory menstrual cycles. However, not every woman is — because of living conditions, partner attitudes or general life chaos — to manage barrier birth control methods that support ovulatory cycles.  For women who should not take estrogen-based hormonal birth control (past blood clot, liver problems, heart problems, severe migraines, smoking, or over age 35) Depo may be an effective and valued contraceptive. Here’s a quote from one post, “I too was on the depo, for 11 years actually during this time I loved it…no periods, no PMS awesome. . . .”

LW: Point taken. I agree women should have access to Depo-Provera for the reasons you mention. But, what that commenter wrote next was: “My god what happened post depo I never ever thought I would go through…throbbing sore breasts to the point I couldn’t even touch them, night sweats (a year) anxiety, major bloating, nausea, withdrawal from social events, weight gain mid section and boobs…I hated life!!!!”  I think this is the “nightmare” scenario I was referring to in the title of last April’s post. Let’s hope your suggestions above are helpful for her and everyone who has commented, or will comment, on last year’s post.

What I find unacceptable is the lack of information women have about how this drug works and what its effects are both during and after use, as well as the lack of assistance available from healthcare providers in recovering from the drug. Thank you so much for explaining some of what is going on for the women who’ve been sharing their experiences here at re:Cycling, and for offering suggestions to help in their recovery from Depo-Provera.

Note to readers: Please feel free to share the PDF document of this interview with other women and health-care professionals who may find the content of value.

  

191 Responses to “Stopping Depo-Provera: Why and what to do about adverse experiences”

  1. Jenny says:

    I was on the depo shot for 3.5 years. It took a year to get my period back and 18 months to get pregnant. After my son was born I have been on and off it for the last 9 years. I have never had any of the other problems other women have. It just takes a while to get my cycle back. But I’m not complaining about that. I LOVE not bleeding every month. It’s the only birth control I can take because of very bad migraines. My cycle has always returned. How long it takes depends on how long I was on the shot. I know it effects everyone differently, and people are more likely to post a bad experience than a good one. I just washed to post my good experience so that people know that it does work for some people.

  2. Valerie says:

    The bigger issue is the long term effects of depo. Canada had banned the drug due to the bone density issues of long term use. Many women have faced major joint issues such as arthritis, osteoarthritis, osteoporosis. Using the drug long term drops estrogen levels which leads to these and other issues. Whether or not it’s nice to have a period or not have a period, or how long it takes you to get your period back, is not the primary medical issue. We have to look at the long term effect of this drug on our bodies and make smart decisions. not decisions based on how convenient it is for us to have periods are not have periods! this drug is a bad drug due to the long term side effects not the day today conveniences are inconveniences.

    • Laura Wershler says:

      Valerie, Point of fact, Canada has not banned Depo Provera. It is still prescribed, though much less often than a decade ago.

  3. Jenny says:

    I never once said I made the decision to use Depo because it’s a convince to not have a period. All I said was that it was a bonus. And I made the comment about how long it took me to get my periods back because based on the comments I read on this article that seemed like a huge concern to a lot of women. I take Depo because it works for me. I have been on it for about 10 out of the last 14 years. I have had two bone scans done because of the fear of bone loss.. They were both completely normal. I need the drop in estrogen. If I’m not on depo I have 2 to 3 migraines a month that take me out for 2 to 4 days. When I’m on depo I have a migraine once every 3 to 4 months. The two times I tried to take the pill I didn’t last two weeks without having horrific migraines. So for me it’s worth it. It’s not a bad drug for me. I have had several conversations with my Dr. about depo versus IUDs. The only stories I have heard about IUDs are bad stories, but I guess the same could be said for Deop. That’s part of the reason why I wanted to post my good story. I know not everyone will agree with me and that’s fine. Like I said I just wanted to get my positive experience with Deop out there.

    • Laura Wershler says:

      Thank you for sharing your positive experience with Depo-Provera. You are right that women are more likely to share negative experiences than positive ones, but as the author of this post it is disconcerting to keep reading week after week-on this post and the previous one I wrote about coming off Depo- how many women do have problems using and quitting this contraceptive. It is also frustrating to see how little doctors and sexual health care providers understand as to why and what women so often experience when they stop taking Depo. All the best.

    • Jen says:

      hi there,

      i stopped taking the depo, my last shot was oct i think.Do you have to wait any certain time to go back on the shot after being off of it?

      thanks much!

  4. Danielle says:

    If this article is accurate why is my doctor prescribing me the birth control pill (as he explained primarily estrogen) to combat this issue? He said I needed estrogen, not progesterone, the exact opposite. I am scared to take it because of how horrible coming off depo has been. I have had all of these issues coming off depo and more. I finally found a doctor that explained what the issue was at least (surprisingly the doctor that prescribed me depo told me there was no way my symptoms were caused by stopping it), but I don’t want to make things worse by taking even more estrogen.

    • Laura Wershler says:

      Danielle, your comment illustrates how little most doctors understand about the endocrinology of the menstrual cycle and the effects of unopposed estrogen, which is what you are experiencing. Dr. Prior, an endocrinologist, has studied ovulation and the menstrual cycle for over 40 years. You decide who knows more about what women are experiencing when they stop Depo and why.

      You may want to consider your age, your future plans for having children, your birth control requirements, and your health priorities before making a decision about how to proceed. One thing is certain, taking the pill is not about recovery from Depo, but rather the exchange of one synthetic hormonal profile for another. All the best.

      • Danielle says:

        Thank you Laura for your response. My question is what I should be doing about the symptoms I’m having. My doctor is concerned about severe anemia at this point because of the amount of blood I’m losing ( I’ve been bleeding heavily for 2.5 months) and that is, according to him, why he recommended birth control. He said there are other options if I’m not comfortable with that but I don’t know what I’m supposed to request. My health priority is I want to get better. My husband and I want to have children now. I’m 29 years old and I’ve been life disruptingly sick for over 8 months now, and stopped taking the shot 10 months ago, while we want to have children we couldn’t even consider it until I’m better because I’d be unable to care for a child right now, I can barely get through my day. I have no birth control requirements – I want to get pregnant and I use NFP anyways. I am looking for how to get past this, because I can’t imagine another 2 years like this as I’ve read some people have had. As I’ve been bleeding it’s gotten progressively heavier and I get cramps now every other day and they have gotten to be extremely painful.

        The doctor showed me that I have a cyst in my ovary (he said that could actually be good news, he said the edges are starting to collapse and it could be a sign of returning ovulation), and that the ultrasound can’t even pick up a depth to the width of my uterine lining, which is why he thinks I’m bleeding so much now – he said I’m basically down to the muscle wall and that is constantly seeping blood, he said that estrogen builds up the uterine wall and that is why he wants me to take it (in the form of bc, but he said I could do the natural form if I was more comfortable with that).

        So while I’d like to be flippant about this doctor being wrong, I don’t live in a place where there is an endless supply of doctors, and I’ve already been to five over the past 6 months and he is the first one that at least gave me an accurate read on the cause. He also said he wanted me to use bc because he didn’t suggest getting pregnant before the depo is out of my system as that can cause problems with fetus development. He explained that the depo shot is oil based and that’s why it hangs out for so long in your system.

        Anyways, unless you know a doctor in Western Montana that can help me, I’d imagine that this doctor is my best bet in that he is the first one to not tell me that this is some weird form of depression, or anxiety, and to take my symptoms seriously, be able to explain why I feel this way and what is happening to my body, show compassion for it and try to help. I have constant daily bleeding, every other day cramps bad enough that Advil/Midol taken at twice the recommended level just gets me to a point that I can walk around, severe exhaustion but poor sleep (I have a device that measures my sleep and I get very little deep sleep a night and it is constantly interrupted by light sleep), severe memory fog (I will ask my husband a question and then ask him again a few seconds later – when this first started we would get in fights when I’d ask a bunch about a sensitive topic because he thought I was just trying to be a jerk,) hair that thinned so quickly my hairdresser thought I started dying my hair or something, dermatographia, constipation that continues regardless of diet, excercise, water, and medication, and severe weight gain (I was 135 pounds 8 months ago, now I’m 163, even when I sprained my ankle and couldn’t exercise for months the most I’ve ever weighed was 150 pounds, and I have an active lifestyle that hasn’t changed and eat primarily food I cook myself from whole ingredients, no junk, though the cravings for sugar I’ve been getting with the constant period are tough).

        So I’m asking for what I should be doing and asking him in order to recover from this, what options there are for making the bleeding stop and helping me get my life back, because I’m at a point where it’s day to day, actually hour to hour, whether I’ll even be able to function. I am scared to take anything, and I’m scared to keep going like this. I just want to be healthy and able to start a family with my husband. Thank you for your help.

        • Laura Wershler says:

          Hi Danielle, I’m sorry for the extreme adverse effects you are experiencing. Your age and future plans to have children do make a difference in deciding how to proceed. I’ve asked Dr. Prior to respond to your inquiry with the additional information you have provided.

          If you haven’t already, I recommend you click through to the articles on managing heavy flow: http://www.cemcor.ubc.ca/help_yourself/articles/managing_menorrhagia
          and the use of Cyclic Progesterone Therapy:
          http://www.cemcor.ubc.ca/help_yourself/articles/cyclic_progesterone_therapy

          Your body is trying to get back to normal cyclic function. Beyond the treatment ideas found in this post, you may want to consult with a Holistic Reproductive Health Practitioner on nutritional and other ways to help you restore menstrual cycle health. Lisa Leger is an HRHP who has responded to many other comments on this post. You may want to look through the comments for her suggestions.

          Hope this is helpful. Hang in there. It will get better.

  5. Valerie says:

    Please read timeline re: when depo passed & where

    http://www.bigclassaction.com/lawsuit/depo_provera_contraceptive_osteoporosis_class_action.php

    most women’s health organizations called for depo to not be approved @ that time & most still call for its ban.

    The bone loss issues lead to 700 million dollar lawsuits in canada. Problems with bone density, osteoporosis were the reason for “black box
    warning” on long term usage. Current lawsuits in US around bone density issues are being filed currently.

  6. This is a response to Danielle who has been having heavy flow for 2.5 months, cramps, weight gain and difficulty sleeping after stopping Depo-Provera 10 months ago.

    See if I can explain–when you were on the Depo, it suppressed your own estrogen levels. When you stopped it, your body was trying hard to get back to normal. It is easy for a woman to make estrogen, but it takes excellent coordination of many systems before it is possible to ovulate and thus make progesterone.

    If you want to try combined hormonal contraceptives for a cycle to work with the new doctor that you trust, I certainly can understand. However, I wouldn’t give it more than one month’s try.
    In the meanwhile:
    1) on every heavy flow day, take a 200 mg ibuprofen tablet with each meal. That will decrease the amount of bleeding by half; for cramps, take 2 pills initially and take a further one as soon as the cramps start to come back.
    2) Keep the Menstrual Cycle Diary http://www.cemcor.ubc.ca/files/uploads/Menstrual_Cycle_Diary_with_treatments.pdf so you’ll know for yourself what’s going on. If your breasts are at all sore, it mean you have a high estrogen level. If you have stretchy cervical mucus it means not only high estrogen but low progesterone levels. Here’s a link to the first of four YouTube videos describing how to complete the Diary and what your experiences mean: http://www.cemcor.ubc.ca/help_yourself/handouts/daily_diaries.
    3) Since you were told you have anemia, and are bleeding a lot, it is most likely because you don’t have enough iron to match what you’ve lost with flow. I would take one ferrous gluconate tablet a day (these are over the counter in Canada although you have to ask the pharmacist) for one whole year (to build up depleted bone marrow iron stores.
    4) You could start cyclic progesterone therapy any time you are ready (and have a prescription for it). Take 300 mg at bedtime every day for at least one full month. Then follow the instructions in the link to Cyclic Progesterone therapy that Laura gave you.
    Most important of all–believe that your body has the power to restore balance (with a little help) and that when you are ready, you’ll be able to ovulate, get pregnant and carry a healthy baby. Keep up your good habits so that day will come sooner.
    All the best,
    Jerilynn http://www.cemcor.ubc.ca

  7. Brianna says:

    I got off the shot about two months ago and just started my period for the first time yesterday. My question is, is it going to be normal now, about a week of bleeding every month? Or will I bleed for a long time? I see everyone has different side affects just wondering if this is something that is different for everyone as well or if i should expect blood for a while?

  8. Jenny says:

    Brianna, from my experience on and off the depo shot over the years it just depends. I would say if you start having normal week pong periods two months out you’re very lucky. It usually takes a year for me to start having normal periods. I’ve never bled for more than 10 days but I know other women have. I have also had shorter periods that last only 3-4 days. It really just depends on how long it takes your body to get the hormone levels back to normal. It really is different for everyone. We can all tell you our experiences but yours could be completely different. I hope this helps you.

  9. Miranda says:

    I spoke to my doctor and explained to him, my concerns on depo as I had it before (1 shot) and immediately got off of it as I bled for 6 months straight and I had a serious loss of libido. This time around he said, he would prescribe me estrogen pills, to help with the irregular bleeding. Is this common? I also, wanted to know what I could do if I do lose my libido again, I heard Maca root pills would possibly help, anything else you would suggest?

    • Lisa Leger says:

      ughh – a Dr using a drug to treat the side effects of the 1st drug…. How about Not taking any synthetic hormones at all? how about Not disrupting your endocrine system? how about letting your cycles unfold naturally? I know, it sounds radical, even revolutionary, but its actually sensible and adaptive to avoid things that make you sick.

  10. Lizzie says:

    I am pleased to report that slowly, my body seems to be getting back to normal… Even though my ‘normal’ consists of heavy, painful periods, intense PMS, painful ovulation etc etc, it is preferable to the sever anxiety and depression caused by depo and then perpetuated by the mirena coil…

    Currently for birth control my long term partner and I are relying on latex free condoms (I’m allergic to latex). My doctor has recommended I avoid all hormonal contraceptive methods in the future if at all possible. I would like to know, therefore, if anyone had any experiences of being on the copper coil? It is really the only option left to me… Any shared experiences much appreciated!

    • Lisa Leger says:

      Hi Lizzie – I recommend Fertility Awareness along with your condoms. No need for contraceptive hormones or gadgets at all when you learn to identify your fertile times. You can learn to chart your cycles at http://www.justisse-chartng-app.com or perhaps there is a local teacher in your area.

  11. Lola says:

    hi,
    i have been wired i have taken 65shots of depo and burly a week ago i took my 6 shot , and sents i have been takeing it i have not had any trube only when they found a lil bit liquid in my right side but took pills know its better, but now i have been having this problem where i dnt feel when i need to pee, like i yusto know i just get lil accidents or i feel somthing wet , but i dnt pee a lil bit i pee i fell like i pee like a galon. and all this just pappend when i took my 6shot . is this nad what can i take or do to be bk to me my normal self.. plez plez help me

  12. Emma says:

    I had 1x depo shot in Feb and within 24 hours felt terrible, I literally slept most of 2 weeks and when I was awake and at work I could barely function I was so tired, and very irritable. I had a heavy period 9 weeks after the shot and decided then I wasn’t going back for a 2nd go. A couple of weeks after the shot was due I started feeling better, then had a couple of weeks where my boobs were so sore I could only just get my bra on, then I went through a much better phase, not as tired or weepy or irritable and lost all of the previous bloating. Unfortunately this hasn’t lasted and I feel like I’m back on the dep cycle, am bloated very tired and irritable.
    I have been reading Dr John Lees books and think I may need natural progesterone to help balance me out of this cycling phase the only problem is I’m in the ME and have no access to a decent dr, am travelling back to the uk next month for a couple of weeks and struggling to locate a Dr following john lees philosophy; any recommendations would be so welcome.

    • Caitlyn says:

      Hi there,
      I had my first depo shot in April of this year. Days later I felt terrible and told my doctor, and was told that all I could do was wait it out and skip the next shot. In early June I had my first period (only lasted 10 days) and skipped my second shot. It has been a little over a month since then and I am experiencing sore nipples, heartburn, backache, and weightgain.
      My question is, when is it a good time to ask for those hormone replacement pills? I’ve had a terrible experience since that needle went in my arm! I just want my body back. Is there any vitamins I could take to help my body along?
      About me: 23, want a baby in less than or up to 24 months time

      • Jackie McCurdy says:

        Where do you get your shot? I have no evidence other than personal experience but I typically got my shot in my gluteus muscle but a few times the nurse has insisted it be in my arm. After a few times of experiencing exactly what you described I wouldn’t let them do it in my arm again and never had those symptoms when it was in my butt. I thought that maybe it was the uptake of it. Less muscle /fat in my arms so flooded my body faster but like I said, I have nothing except personal experience.

  13. arianna says:

    Hi.on january I was diagnosed with endometriosis. And to get rid of the cyst my doc prescribed depo.i had a shot everymonth…I havent had my periods since after the first shot.almost 5 mnths..now im having small spottings of blood…and its v difficult,because in near future I wud very much like to be pregnant.can u pls tell me hw long the effects will last and why spotting is there?? Thanks

  14. Cari says:

    I have been on Depo Provera for more than seven years, recommended by my doctor to treat my severe and debilitating periods. I have found Depo to be my “miracle cure,” after bleeding (only slightly) for the first nine months. I was more than willing to endure the bleeding, since the pain, vomiting and uncontrollable urination and bowl movements were much, MUCH worse than light spotting.

    Unfortunately, I am now 35 years old, have gained at least 30 pounds over the last seven years, and am having severe cystic acne that is not responding to any treatments my doctors have tried over the last six plus months. They have recommended that I discontinue the Depo, saying it is causing increased androgen levels, therefore contributing to (if not causing) the cystic acne.

    My fear is that the horrible, severe, life altering periods will return. Do you have any information regarding the stop of Depo when it has been administered for this long? Any recommendations or suggestions on how to avoid this? I am literally in a panic, and very hesitant to stop the Depo, although any methods that will prevent the constant explosions on my face seem tempting.

    I also fear that I may gain even more weight when I discontinue the Depo – are you aware of whether this is true? Unfortunately, I only have two weeks to make my decision.

    • Laura Wershler says:

      Hi Cari, Every women’s experience will be different coming off Depo-Provera. Please read this post carefully so you will know what you might experience when you stop the drug. If you do experience heavy bleeding post-Depo, you may want to consider Cyclic Progesterone Therapy as it is explained in this post by Dr. Prior.

      Also, you may find this explanation about painful periods from the Centre for Menstrual Cycle and Ovulation Research helpful:
      http://www.cemcor.ubc.ca/resources/painful-periods

      You are bound to experience hormonal fluctuations, including high estrogen and low progesterone levels post-Depo. The reason for this is explained in this post. This may lead to a return of your symptoms for awhile, so the goal will be to work through this hormonal imbalance to restore normal, ovulatory menstrual cycle function. There are several suggestions in this post that address your concerns about heavy bleeding, weight gain, and acne.

      You can download this post in PDF form for future reference here:
      http://menstruationresearch.org/wp-content/uploads/2013/04/Stopping_Depo-Provera_Adverse-Effects.pdf

      There is a way back to healthy menstrual cycle function but it will take time, patience, and support. I wish you all the best.

  15. eleanor says:

    Hi ive been on depo for almost 6 years and I am planning on leaving it so I can get pregnant how long should I wait after leaving the depo before we start trying for another baby, do not want to experience a miss carriage
    . Is there any connection between depo and miss carriages?

    • kristin s says:

      I was on depo for 3-5 months and I ended up getting pregnant… but I didnt realize it because before I knew it the shot killed it… I got off as soon as I could and I refuse to use it again!

  16. Brianna says:

    I recently wrote on here about my period starting about 2 months after I got off the shot. I had a normal period and ended about a week after starting. But about 3 days later I started my job as a gym coach and started bleeding again. Is this normal due to the shot? Or should I get it checked out?

  17. vernessa says:

    I took the shot only once but stopped because I have not stopped bleeding since. From Feb-July. Please help.

    • Miranda says:

      That happened to me before last year, I bled for 6 months straight on my first shot and I never got a shot again, until 2 weeks ago. This time my doctor gave me the shot, the morning my period was suppose to come. I haven’t gotten my period since. No other side effects either! Im actually happy, I tried depo again.

  18. Lisa Leger says:

    Laura is right; read the original article carefully and pay attention to the comments from her, Dr Prior, and me [Lisa]. Click on the links. There’s a lot of good info in this thread, and hopefully enough reassurance. In spite of all the talk of side effects here, most women do recover from hormonal drugs over time, and quicker with a healthy diet and lifestyle. Some need extra support; hormone balancing, repairing the gut. If you are systematic and optimistic, you will get better.

  19. Caitlin says:

    March 5, 2014 i got the depo shot. About ten days later i started my period, even though it had ended the day before the shot. Now July 7, still bleeding. After going to the doctor i was told to just wait it out. When this started it was heavy like the worst part of a normal cycle… it has since gotten extreme and there are rather large clots. Should i be seeking a different doctor or just do as he says and wait this out?

  20. Tricia says:

    I have been on the shot since 2008. I never had a period, rarely see even has spotting. I didn’t have cramps either, so I thought the shot was ideal. This past winter I started experiencing extremely painful cramps, random bleeding, low back pain, and extreme pain and bleeding after sex. The doctor told me he thought it was because the lining if my uterus was so thin from low estrogen from the shot. I decided to come off the shot since it was causing these problems AND I am hoping to get pregnant within the next year. My last shot was in February, so by May it had started to leave my system. I have noticed an increase in nausea and bloating, which I can deal with for the time being. What is causing me major anxiety is the weight gain. I work very hard to maintain my weight, I eat very well and exercise 5-6 days a week. I am getting married in 2 months, and I have already put on 5 lbs, despite INCREASING my exercise routine and getting a little bit more strict on my diet (in hopes of losing a few lbs by my wedding). Instead I continue to gain weight and have ridiculous bloating. I am nervous about fitting into my dress, never mind feeling extremely uncomfortable in a bikini on te beach on my honeymoon! After reading this article, it sounds like I’m pretty much just doomed to gain weight steadily until I start ovulating again. Is there anything that can be done to help these symptoms? I have IBS and several other digestive issues, so I’m actually kind of used to being nauseous and bloated all the time, but this has taken it to a new level. Should I take some sort of progesterone supplement to balance out my hormones?

    • Danielle says:

      My experience was similar to yours, and I hate to be the bearer of bad news but I gained 30 pounds in four months once my last shot wore off. Same as you I eat well and excercise consistently, plus I’m 29 and I’ve always been around the same weight plus or minus 5 pounds. I tried dieting and I still gained weight. I also have IBS believed to be because of the shot. It’s now been 10 months since my last depo shot, and my weight has stabilized so at least I’m not gaining anymore (though I’m still 30 pounds overweight), and I may possibly be starting to be able to lose weight. I also bled for 3 months straight starting in March and had horrible cramps, it seems to possibly be tapering off though. I am a newlywed too, we were married in September, this has made for a miserable newlywed experience. We wanted to start trying for children last month but with the bleeding obviously it isn’t going to happen until that stops. I got a new OBGYN that is awesome, he said he refuses to prescribe depo because my experience in his opinion coming off depo is not uncommon. He thinks it’s likely that in August, a year after my last shot, I will start being more normal. He explained that since depo is an oil based injection it takes forever to flush it out of your system and these symptoms persist until it’s gone. He said there isn’t much of a way to speed up the process (though I have a friend that’s into herbs and I’m doing blood and liver herbal cleanses to see if that helps), but testing your hormones and taking hormones specific to what you need can help ease the symptoms. I am also taking herbs that help with hormone regulation. You can find that stuff at natural food stores and an employee should be able to help you find what you want. Good luck! My doctor did say I have had an exceptionally bad reaction to this, so maybe your symptoms won’t be as intense.

  21. Toni says:

    I am 51 years old and was on the shot for 21 years. My doctor stopped giving me the shot due to my age. The last injection I received was in Dec 2013. I have had several periods since March with no issues other than they are not at the same intervals or for the same amount of time. My biggest issue is the weight gain. I have gained 20 lbs since March. I have not changed my eating habits, but I still keep gaining weight. What is the possibility of having a thyroid problem caused by the shot?

  22. bree goss says:

    My mom made me get off the pill and start taking the depo provera shot once we found out my bestfriend was pregnant. My mom did not want grandkids and ive been in a long term relationship . I am 16 years old and in December of 2013 my mom had me go get the shot. She did not take me mystepdad did. I cried so much as I was getting the shot which my mom told me It would be in my arm so I was in complete shock when they told me to drop my pants. When I got the shot I weighed 105 pounds. As you know when you get the shot your suppose to gain weight and your not suppose to have a period. Just about 3 weeks later I weighed 84 pounds and had uncontrollable bleeding. I went back to the doctor they said start taking the pill again and your bleeding should stop and we will not continue doing the shot. The pill has done nothing. From december 2013 – may 2014 I was on my period. All day everyday. And the cramps never stopped. I just got so use to having cramps I dont feel them anymore. I had not been able to gain weight. I throw up almost everyday . I never have an appetite. If it waznt for weed I would probably be dead because that is the only thing that helps me eat. I have to get my medical marijuana card when im 18 to save my life. Since may of 2014 to now “july 2014″ I still bleed . Not everyday about every 2 days. And then one week out of the month I bleed everyday as if a normal period. But the point is I still bleed almost everyday . Im now 17 and Ive gained about 2 or 3 pounds I weigh about 87. Ive never felt so ugly. I get made fun of everyday now for my weight. I use to feel so beAutiful. I dropped 3 pant sizes… I cant even fit into a size 0 none of my clothes fit and I caN never find anything that fits me. I cant eat I throw up I bleed all the time ive gotten use to the cramps I feel ugly im always dizzy nautious . Its been almost 8 months. The doctors have done nothing and neither has my mom. It feels like im dieng everyday . Thank god for marijuana . Its saved my life . Please listen to me and spread the word. I wouldnt wish this to happen to anyone not even my worst enemy. God bless.

  23. nkb says:

    I am a 40 yr old woman with endometriosis. My endocrinologist/gyn prescribed depo because by not menstruating, my endometriosis stay in check. And it really has helped in that regard. However it has been over 2 years and I’ve been considering an alternative because of the bone loss side effect. Further, I’m fairly sure I’m beginning perimenopause because of the cystic acne I have been experiencing and general mental fogginess.

    However this blog is terrifying me. I really frightened to switch birth control treatments. Do you have some advice?

  24. Lisa Brown says:

    I was on Depo for over 5 years. I broke my elbow and had two surgeries so I missed a shot and decided to go ahead and come off of it, since I am almost 47 years old. I did have two broken bones this year, so that kind of worried me. I feel I have been gaining and gaining the last two months, its been since April. I have a son with type 1 diabetes and a husband with type 2, so we don’t really eat a lot and watch our carbs. I run (jog fast) but the weight just sits. My breasts are swollen and hurt, my stomach is bloated and I actually WISH for a period, so maybe it will kick me back into gear.

  25. Lisa Brown says:

    I was on Depo for over 5 years. I broke my elbow and had two surgeries so I missed a shot and decided to go ahead and come off of it, since I am almost 47 years old. I did have two broken bones this year, so that kind of worried me. I feel I have been gaining and gaining the last two months, its been since April. I have a son with type 1 diabetes and a husband with type 2, so we don’t really eat a lot and watch our carbs. I run (jog fast) but the weight just sits. My breasts are swollen and hurt, my stomach is bloated and I actually WISH for a period, so maybe it will kick me back into gear. If anyone has suggestions on how to feel better, please let me know. vitamins? types of fruit/veggies?

  26. Nicole says:

    I was on the shot for 4 years and stopped about 3 months ago and i am having massive abdominal cramps but to blood..hope thats not too out of the ordinary. And i used to weigh 112 pouns but as soon as i started the shot ive gained a ton of weight cuz now i weigh 180 pounds but i enjoyed the no periods.

  27. Nehal says:

    Hey guys..I am 37 and took my 1st shot of depo on March 28th 2014. I got some bleeding for about 10 days in May. I had to take another shot on June 28th but I have decided not to continue with this as I have gained 10 kgs weight. Is it important to continue with the shots once you have taken ? I also want to know when am I likely to get my periods and return to normal cycle ? I still haven’t got my periods and I am really worried. I also want to know, should I start taking contraceptive pills since the effect of depo must have worn off a month ago. But I don’t know if I have to take pills then when and how do I start !! Because normally pills are recommended to be started from the 4th day of the period and I haven’t got them until now…plz help as I am really worried.

  28. Jackie McCurdy says:

    I finished taking depo provera about 1-1/2 years go at the suggestion of my doctor regarding my inevitable approach to peri menopause. My mother had a hysterectomy after I was born so there was no evidence of what my likely menopausal course would be except from my sister. My sister, 52 now, had just started night sweats and hot flashes about her 50th birthday so the thought was I needed to be off depo before that. To be safe, I came off at 46.

    I had some breakthrough bleeding in the last year and a half but no real period until this month and WOW! My cycles were never crazy heavy when I was a teen / young adult. I was never crampy, or moody. Often times it was a surprise when it came on. I never had a desire to get pregnant and really was happy when I heard about depo in my late 30s. No period? Yes, please! We did the bone density tests and monitored my symptoms and since I was asymptomatic and bone density testing was not concerning I stayed on depo for almost 8 years.

    My ‘first’ period is now in its 8th day with no signs of stopping. The stories of months scared me a bit but my sister, who was never on depo has been menstruating for almost 6 months because of the perimenause so I’m glad Dr. Prior mentioned that it was a typical symptom of perimenause and not just coming off depo, I am now getting night sweats and hot flashes.

    Anyway, I just wanted to say THANK YOU! This article has calmed my nerves. I’ll wait another few days and if it’s still not slowing I’ll go get some ibuprofen and schedule an appointment with my doctor for hormone shots. I guess I was expecting sparkles and a balloon, at least, welcoming me into menopause but instead it’s pretty much as it was when I was 12 and got my first period.

  29. Jessica G says:

    I’ll start off by saying this is the most informational blog I have read and I’m hoping someone has some helpful insight for me.
    I started depo when I was 19 in 08/2007 because I went to the Dr with heavy periods which included what I called meat chunks. They told me I was losing too much of my uterine lining and also did a transvaginal ultrasound which showed I had a small cyst on one of my ovary. The Dr decided I needed to go on Depo, which was fine with me as long as it stopped the problems.
    On depo I gained 30lbs. In 2012, I decided to get healthy (balanced diet with vegetables and whole grain) and lost all of it and got back to a health BMI. My last Depo shot was May 2013, because my husband and I would like to start a family. I started working out harder to “sweat” the depo out of my system faster and consumed lots of water. I gained 10lbs back regardless of the extra workouts. Oct-Nov of 2013 my breasts were extremely tender! One day I woke up at the end of Nov and the breast pain was gone but I was extremely emotional.
    No periods until Feb 14. When that happened I had cycles every 10-14 days and they were heavy and painful. I recorded my fertility out of optimism and on day 8 of my cycles I was “ovulating” according to the ovulation test. After 3 months of bleeding that often/much I went to the doctor because I was getting extremely tired. She put me on a 10 day progesterone pill. It didn’t stop the short cycles as I was bleeding again on the 10th day of the pill. She sent me on to a gynecologist who did another transvaginal ultrasound.
    He didn’t have much to tell me besides I hadn’t been ovulating at all. I had 5 follicles on my 1 ovary that day and I had “fluid above my cervix” He didn’t have any help for me either (kind of felt shunned for using Depo) and told me to wait it out or he’d put me on Clomid. (which I don’t want!)
    For the last 2 months I had extremely light periods. (no cramps, mostly clear fluid with a little red) This month my cycle hasn’t come at all, but I have a lot of clear/white fluid down there. It’s been 50 days since my last period in June. I’d like to be “normal” before we start trying to conceive to ensure I’m healthy enough to carry. Have I stopped cycling all together? What is going on? I already eat healthy and exercise, so what other options do I have besides clomid? My husband and I wanted to start trying in August, but I’m scared to with all these inconsistencies and fear of multiples with clomid.

    • Lisa Leger says:

      Could the clear fluid “down there” be cervical mucus? Perhaps you’re trying to ovulate. Clear or cloudy discharge is a sign of fertility and indicates high estrogen levels related to ovulation. Wouldnt it be nice to know that your cycles are returning? I suggest you get back to charting and study more on mucus observations. chart as much detail as possible (moods, energy, libido, as well as discharge and temps.0 this info will be helpful in diagnosing your return to fertility. best of luck – Lisa

  30. Laura Wershler says:

    Hi Katrin,

    As long as you identify the source of any quotes you take from this or other posts and link back to the site so your readers can find the original, I’m fine with it. Thanks for asking.

    Laura

  31. Lisa Leger says:

    I agree with Laura, I am comfortable being quoted so long as proper referencing protocols are observed and please do include a link back to the thread.
    Lisa Leger

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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.