Question
I am 20 years old and have had two injections of the contraceptive Depo-Provera in the past 12 months.
I was advised that once I stopped taking it my periods would return to normal after a few weeks, but I haven't had a period for about 5 months now.
I've had two pregnancy tests, both of which were negative.
Can you tell me why I haven't had a period?
Answer
You do not need to be concerned about your current lack of periods. It is quite common for this to occur.
It may take up to a year after your last injection for your normal cycle and fertility to return.
Obviously, during this time you cannot rely on its contraceptive effect.
There is no evidence that Depot contraceptives have any long term effects upon a woman's ability to conceive.
You don't mention why you stopped taking Depo-Provera; are you trying to get pregnant?
If your periods have not returned by 12 months after your last injection, and you are wanting to conceive, you could request referral to a gynaecologist.
Simple drugs are available to induce fertility if you prefer not to wait.
Yours sincerely
The NetDoctor Medical Team
Last updated 16.12.2014
Key Facts
Depo-provera hormonal injection
Depo-Provera® is a female hormonal method of birth control. It’s very effective in preventing pregnancy. Depo-Provera® contains a synthetic (man-made) form of the hormone progesterone, called depo medroxyprogesterone acetate (DMPA). The Depo-Provera® injection gives 3 months’ protection against pregnancy. You should get one injection every 3 months (13 weeks) to get the best protection against pregnancy. It’s safe to get your injection up to 3 weeks earlier if you can’t get your next injection in exactly 13 weeks.
When do Depo-Provera® hormonal injections start to work?
Most girls get their first Depo-Provera® injection during the first 5-7 days of a normal menstrual period. You are then protected from pregnancy right after you get the injection. Another way to start Depo-Provera® is “Quick start” – you get the first injection when you haven’t had sex for two weeks (or used a condom 100% of the time) or have a negative pregnancy test. You then need to use condoms for at least 7 days after the injection for additional protection.
How does Depo-Provera® prevent pregnancy?
The injected DMPA suppresses your pituitary gland which stops your ovaries from releasing eggs. Without these eggs, pregnancy can’t happen. The injections also change the lining of your uterus and the mucus in your cervix. By changing your cervical mucus, the hormones make it more difficult for sperm to reach the egg.
How effective are Depo-Provera® injections?
If women get Depo-Provera® injections at the same exact time every 3 months, this method is more than 99% effective. This means that if 100 women get Depo-Provera® injections at the right time, less than 1 woman will become pregnant in a year.
It’s important to mention that life doesn’t always go as planned and we can’t always control that. It is OK if you are several days to a week late for your injection. So if you’re late on your injection (by several days to a week) it will only be 94% effective in the prevention of pregnancy. This means that if 100 women receives a Depo-Provera® injection late, then 6 of them will become pregnant each year. The longer you wait to get your next Depo shot, the less effective it becomes. In the meantime, use a barrier method such as an internal (male) or external (female) condom, until you are able to get your next shot. Depo-Provera® injections do not protect against sexually transmitted infections. So you need to use a condom to lower the chance of getting STIs.
Are there other benefits of Depo-Provera® injections besides the prevention of pregnancy?
Yes. Depo-Provera® injections can cause a decrease in menstrual cramps, lighter menstrual periods (or no periods, which many young women think is a good thing), and less chance of anemia.
Where can I get Depo-Provera® injections?
Your health care provider can give you Depo-Provera® injections. He/she will first want to do a physical exam and ask you about your medical history and your family’s medical history. This way, your health care provider can find out if Depo-Provera® injections are a good type of contraception for you. The first Depo-Provera® injection is usually given during the first 5-7 days after a normal menstrual period begins. When you begin Depo-Provera® injections, you’ll likely need an exam with the injection, the cost may range from $0-$250, and most insurance plans cover the cost. After your initial visit and injection, cost will range between $0-$150 for the injection, and again most insurance plans cover the cost.
Are there side effects from Depo-Provera® injections?
There are possible side effects from Depo-Provera® injections. They can be different for each woman. They include:
- Irregular menstrual periods – longer or shorter menstrual periods, heavier or lighter periods
- Loss of menstrual periods (the longer you get Depo-Provera® injections, the greater chance you will have no menstrual periods at all)
- Weight gain (women gain about 5 pounds each year for the first 3 years). You can help maintain your weight by eating a healthy diet and getting regular exercise. Young women who are already overweight are more likely to gain weight while taking Depo-Provera®.
- Headaches
- Dizziness
- Mood changes, worsening depressive symptoms
- Bloating
- Abdominal pain/discomfort
If you get any of these side effects, talk with your health care provider. It’s important for you to know that most women will have very irregular periods, especially during the first 6 months you are on Depo-Provera®.
Should I be worried about my bones while I am on Depo-Provera®?
Researchers have found that teens are more likely to lose bone density while taking Depo-Provera®; however, bone density fortunately improves in most women after they stop Depo-Provera®. It is unclear if this loss in bone density results in an increased risk of fractures. Girls also lose bone mass during pregnancy so each young woman needs to think about the risks of pregnancy compared to the benefit of effective birth control with Depo-Provera®. Your teen years, especially the years you are going through puberty (11 to 15 years), are particularly important for you to gain bone density. So until we know more, the best advice is to use Depo-Provera® at least two years after you start your menstrual periods, take in 1300 mg of calcium in your diet, take a multivitamin or 400 to 800 units of vitamin D each day, get lots of weight-bearing exercise, and maintain a healthy weight (don’t be too thin). Talk to your health care provider about all options for birth control, especially after you have been on Depo-Provera® for 2 years or you have a strong family history of low bone mass (osteoporosis). Patients at risk for osteoporosis should consider using an alternative form of contraception. If you are 18 years old or older, there is less concern about Depo-Provera® but you should still take in calcium and vitamin D and get plenty of exercise. No matter how old you are, make sure not to smoke while taking medicine that contains hormones.
Should I be worried if I stop getting my menstrual period while I am on Depo-Provera®?
No. Many women stop having their menstrual periods after about 6-12 months of getting Depo-Provera® injections. This is no reason to worry. It’s not a medical problem and it does not mean you are pregnant. It just means that your ovaries are resting, and the lining of your uterus does not grow. So there is no menstrual bleeding. You will get your menstrual period back within 6-18 months after you stop taking the Depo-Provera® injections.
Can any woman get Depo-Provera® injections?
No. Depo-Provera® injections cannot be used by women who:
- Are pregnant
- Have unexplained vaginal bleeding
- Have a serious liver disease
- Have breast cancer
But the good news is that women who can’t use estrogen can still use Depo-Provera®. Depo-Provera® may also benefit patients with sickle cell disease by decreasing sickle cell attacks. Depo-Provera® may also lessen the number of seizures in women with epilepsy.
What if I want to get pregnant? Should I use Depo-Provera®?
If you want to get pregnant in the next year, you should not use Depo-Provera®, since it can prevent pregnancy for 6-10 months after the last injection. However, if timing is not an issue and you don’t want to get pregnant for a couple of years, then you can use Depo-Provera® (if it’s right for you) until up to one year before you want to get pregnant.
If I decide to stop getting Depo-Provera® injections, when should I start using another type of contraception?
If you want to stop getting Depo-Provera® injections, all you need to do is just stop. Even though, the progesterone in the Depo-Provera® injection actually protects against pregnancy for more than 3 months, it’s very important to play it safe and start using another type of contraception 3 months or sooner after your last injection.
Depo-Provera® injections are a long-acting effective method of birth control as long as you return for follow-up injections every 13 weeks/or 3 months. Irregular bleeding and/or spotting is expected during the the first few months of use; however, spotting/bleeding typically lessens after that and in some cases menstrual flow stops all together.