Blog of the Society for Menstrual Cycle Research

Coming off Depo-Provera can be a woman’s worst nightmare

August 28th, 2014 by Laura Wershler

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Laura Wershler originally appeared April 4, 2012, and has received nearly 600 comments. To avoid confusion, we have closed comments on this re-post.

 

Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies OurselvesQuestions About Side Effects of Stopping Contraceptive Injections.  The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.

On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “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.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.

Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss.  Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.

Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:

Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.

Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.

Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility.  She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”

The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.

In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map.

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

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?

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.

Do you love your LARC?

December 12th, 2012 by Laura Wershler

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.

Nov. 25 to Dec. 1, 2012, was LARC Awareness Week, billed by the California Family Health Council as “a chance to increase awareness about LARCs as a safe, effective, and long-acting birth control method.” Women were invited to contribute video messages on the theme Why I Love My LARC.

This catchy acronym stands for long-acting reversible contraceptive, and the push is on for many more women to choose this form of birth control. Make no mistake, it’s all about control: What the doctor puts in, only the doctor can take out. Ergo, it’s 99% effective. You can quit taking your pills, rip off your patch, or NOT show up for your next Depo-Provera shot. But if you hate the side effects caused by your IUD or implant, you’ve gotta go see a health-care provider to have it removed.

I’ve challenged the Contraceptive Choice Project study that praised the effectiveness of LARCs over the pill, patch and ring. I took issue with the ACOG recommendation that LARCs are the best methods for teenagers. Now there’s more hype with LARC Awareness Week.

According to the awareness campaign, LARCs include the ParaGard (copper) IUD, Mirena (progestin) IUD and Implanon, a non-biodegradable flexible rod, also containing progestin, that is inserted under the skin and left for up to three years. (Here’s a story about the rods going missing in women’s bodies.) Read the patient information about Implanon. Would you agree to have it inserted into your body?

Women who hate Implanon are speaking out. So are women who don’t love their ParaGard or Mirena IUDs. On YouTube, a video by a women with Mirena issues has over 6000 views;  Why I Love My LARC, posted 8 days earlier, has about 100.

The old-school LARC – Depo-Provera – is not on the campaign’s list of LARCs, though it is heavily used in the United States. Holly Grigg-Spall recently reported that “one in five African American teens are on the Depo shot, far more than white teens.” Hmm. Will they all be switched to other LARCs when, or if, they come back for their next shot? Perhaps Depo is not on the list because women can discontinue this contraceptive without clinician intervention. But it’s probably because Depo causes bone density loss – and because this LARC is not a lark. Women are sharing their Depo stories on another re:Cycling post:  Coming off Depo-Provera can be a women’s worst nightmare. You can find more bad news about this LARC than any other.

What about getting your LARC removed if you hate it instead of love it? One re:Cycling blogger shared what happened when she wanted her ParaGard IUD removed:

I HATED the thing but the nurse who was supposed to take it out tried to talk me out of it for a good 20 minutes. Finally I was like ‘”Why do you want me to keep this item in my uterus so badly?” And she said, “I just don’t want to see you get rid of your very effective birth control.”

This is not the only reason why women who end up hating their LARCs will be discouraged from rejecting them. The Affordable Care Act requires all health plans issued on or after August 1, 2012 to provide no-charge access to FDA-approved LARCs. What’s it going to take to convince health-care providers to remove an expensive contraceptive – provided for free – that was supposed to last for three to 10 years?

Maybe a YouTube video about Why I Hate My LARC will help make it as easy to get rid of one as it now is to get one.

Hormone Imbalance: Breaking the Silence

September 5th, 2012 by Elizabeth Kissling

Guest Post by Leslie Carol Botha Women’s Health Freedom Coalition Coordinator, Natural Solutions Foundation

I still remember the first Society for Menstrual Cycle Research Conference I attended in Tucson, AZ in June, 1999. The statement that made the most impact was the collective concern that in ten years there might no longer be a menstrual cycle. It turns out the truer words were never spoken.

In the past 40 years, the pharmaceutical industry has spewed out and packaged and repackaged so many synthetic hormone contraceptives – pills, injections, and implants that virtually eliminate the menstrual cycle.  It also amazes me that in the 30 years I have been involved with the women’s health movement condoms and spermicide are still the safest and most effective contraceptive on the market.

However, a new trend is emerging as condoms and birth control pills are being pushed on the back burner because of ‘human error’. Women and men are not always diligent or careful about condom use, and many girls and women forget to take their pills.  What is now being prescribed to adolescent girls – whether or not they are sexually active — are implants and injections. Health considerations are not taken into consideration, nor are hormone levels. Somehow the pharmaceutical industry still views this as a one-size-fits-all prescription for all women, no matter their age of their state of health.

Menstrual cycle advocates are most aware that birth ‘control’ is about control…controlling the woman’s body with potentially harmful synthetic hormones. What has been overlooked are education and natural methods of fertility awareness.

While our focus recently has been on the politics of birth control, another ugly monster has reared its head and that is the silent epidemic of hormone imbalance. Not only is this the result of taking synthetic hormones for birth control but our environment, our foods, and water supplies are filled with estrogen mimickers upsetting the delicate orchestration of hormones in our bodies.

Another concern is the excess estrogen stored in women’s bodies and passed on genetically to their offspring.  It is possible that their children are hormonally imbalanced at birth.

Either way, the damage has been done. I believe we are at the tip of the iceberg in this silent epidemic and that hundreds of thousands of women are being misdiagnosed and over-prescribed. In most cases, thyroid imbalance is not considered as a cause of depression, and the prescribed fix is generally Prozac or a higher dose of synthetic hormones.

In 2009, I posted an article to my blog, from eHow editor, Shelly Macrea titled: What is Hormone Imbalance?, a very informative article and probably one of the first pieces for a general audience on the myriad of conditions that hormone imbalance can cause.

At the time I had three responses (with an average of 30,000 unique visitors a month.) In June of this year, another post on the article (which by this time was buried in my archives) appeared from a woman suffering anxiety due to hormone imbalance. And then another post appeared and I decided to bring the article out of the archives and re-post it. What ensued was a steady stream of women commenting on almost a daily basis on their extreme anxiety and depression and the myriad of misdiagnosis and drugs they were prescribed. I am posting the link here so that others can read what I believe should be of concern to all of us: Hormone Imbalance Anxiety, A Precursor to Other Health Issues.

In March of this year, I posted Laura Wershler’s article Coming off Depo Provera Can Be a Woman’s Worst Nightmare. Once again, truer words were never spoken. More and more women are now posting about their experiences on this drug – and the ensuing hormone imbalance and health issues.

Women are suffering.

This is an insidious ‘War on Women’. On the one hand we have had to fight for our reproductive rights and the availability of birth control – on the other hand it is the same birth control that is slowly killing us.

Menstrual Considerations in Fifty Shades of Grey

July 25th, 2012 by Laura Wershler

SPOILER ALERT: Plot details in the Fifty Shades of Grey trilogy are revealed in this post.

Second book in the Fifty Shades of Grey trilogy.

Fine literary fiction it is not, but the Fifty Shades of Grey trilogy by E.L. James can certainly claim to be libido-boosting storytelling. Deirdre Donahue at USA Today summarized the books’ appeal in 10 reasons ‘Fifty Shades of Grey’ has shackled readers. She pretty much nailed it. And she’s read the books, which is more than can be said for other writers, including this one who implied that heroine Anastasia (Ana) Steele signs a contract to become hero Christian Grey’s submissive in a BDSM relationship. She doesn’t.

Until he meets Ana, Christian’s sexual history has included only BDSM relationships, those involving bondage, discipline, dominance, submission and sadomasochism.  BDSM plays a role in their love story, but the most sadistic thing that Ana submits to is a shot of Depo-Provera. re:Cycling readers know what I think of this contraceptive: I. Am. Not. A. Fan.

As a menstrual cycle advocate, I pay attention to menstrual mentions wherever they appear. It was impossible for me NOT to hone in on how James handles menstruation and birth control.

Christian quickly ascertains that Ana, a virgin when he meets her, is not using birth control. (His unflinching communication about sexuality is one of the books’ most appealing aspects.) As their sexual affair begins, he uses condoms. Within a week or so he asks when her period is due and says, “You need to sort out some contraception”. But our hero is a rich control freak, so he arranges for “the best ob-gyn in Seattle” to come to his home on a Sunday afternoon. Ana, the narrator:

“After a thorough examination and lengthy discussion, Dr. Greene and I decide on the mini pill. She writes me a prepaid prescription and instructs me to pick the pills up tomorrow. I love her no-nonsense attitude — she has lectured me until she’s as blue as her dress about taking it at the same time every day.”

Alas, Anastasia, just 21, is the perfect example for why researchers with the Contraceptive CHOICE Project are recommending that women under 21 use long-acting reversible contraceptive methods. She forgets to keep taking her pills when she and Christian briefly break up. It’s back to condoms for this couple, until Dr. Greene reappears, confirms Ana is not pregnant, and, after Depo-Provera’s side effects are dismissed as irrelevant because “the side effects of a child are far-reaching and go on for years”,  gives her the shot. I almost had to stop reading.

I get it that James uses Depo-Provera as a plot device, as becomes apparent. But the author’s decision to give Ana Depo-Provera is not in keeping with either Dr. Greene’s or Christian’s characters. I don’t believe for one minute that the best ob-gyn in Seattle would give Depo-Provera to any patient; she’d recommend a Mirena IUD. As for control-freak Christian, he is adamantly committed to Anastasia’s safety, evidenced in many ways. He would never consent to her taking a drug with these potential side effects: weight gain, digestive problems, depression, loss of bone density, vaginal dryness, and — especially — loss of sexual sensitivity and desire. Never! And he’s too smart not to know this.

Christian’s occasionally expressed distaste for condoms also seems to be a plot device considering he uses them so skillfully, and without obvious diminishment to either his or Ana’s pleasure, through 986 pages of the 1594-page trilogy. The tearing of foil condom packets is a leitmotif that in no way hinders this man’s exceptional “sexing skills”.

But James gets full marks for this: Christian Grey is not afraid of blood. While making love in a spacious hotel bathroom, he gently removes Ana’s tampon and tosses it in the toilet. Later, sitting on the bathroom floor, Ana remembers she has her period:

“I’m bleeding,” I murmur.

“Doesn’t bother me,” he breathes.

Coming off Depo-Provera can be a woman’s worst nightmare

April 4th, 2012 by Laura Wershler

Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies OurselvesQuestions About Side Effects of Stopping Contraceptive Injections.  The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.

On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “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.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.

Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss.  Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.

Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:

Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.

Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.

Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility.  She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”

The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.

In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map.

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.