Understanding Depo-Provera
Depo-Provera is an injectable contraceptive containing the hormone progestin, administered every three months (12-13 weeks) [1.3.1, 1.3.4]. It primarily works by preventing ovulation (the release of an egg), thickening cervical mucus to block sperm, and thinning the uterine lining [1.2.4]. While highly effective, with perfect use reaching over 99% effectiveness, there are several reasons why an individual might consider stopping the injection [1.8.1].
Key Reasons to Stop Taking Depo
Deciding when to stop Depo-Provera is a personal choice made with a healthcare provider. Key factors include:
1. Desire to Become Pregnant
One of the most common reasons to stop is the desire to conceive. Because Depo-Provera is a long-acting contraceptive, fertility does not return immediately. On average, it can take about 10 months after the last shot to become pregnant, with most women conceiving within 18 months [1.6.3, 1.6.4]. The duration of use does not seem to affect how long it takes for fertility to return [1.3.5]. If you plan to get pregnant within the next year, your doctor may suggest a different birth control method [1.6.1].
2. Long-Term Use and Bone Density Concerns
The U.S. Food and Drug Administration (FDA) has a strong warning on Depo-Provera's packaging, recommending that it not be used as a long-term birth control method for more than two years unless other methods are inadequate [1.3.2, 1.2.1]. This is due to the risk of significant bone mineral density (BMD) loss [1.5.3]. The loss is greater with longer use and is a particular concern for adolescents and young adults who are in a critical period of building bone mass [1.5.3, 1.5.6]. While some bone density may be regained after stopping the injections, it may not be completely reversible [1.5.3].
3. Managing Side Effects
Many users experience side effects that can influence the decision to stop. Common side effects include:
- Irregular Bleeding: Spotting and irregular periods are the most frequent side effects, especially in the first year [1.2.7]. While about 55% of users stop getting periods altogether after one year, the initial bleeding can be bothersome [1.3.1].
- Weight Gain: A significant number of users report weight gain. One study noted an average gain of 5 pounds in the first year, which increased over time [1.2.7].
- Mood Changes: Some individuals report depression, anxiety, and nervousness [1.2.1, 1.2.7]. Those with a history of depression should be monitored, and the medication may be discontinued if depression recurs [1.3.2].
- Other Side Effects: Headaches, dizziness, decreased libido, and bloating are also reported [1.2.1].
4. Serious Health Risks
In addition to bone density loss, prolonged use has been linked to other serious health issues. A recent study found that using Depo-Provera for over a year increased the risk of meningiomas (a type of brain tumor) by more than five times [1.2.2]. Other potential risks include blood clots and liver function disturbances [1.3.2]. If a patient develops a serious condition like a thrombotic event (blood clot) or jaundice, the injections should be discontinued [1.3.2].
The Process of Stopping and What to Expect
Stopping is straightforward: you simply do not get your next scheduled injection [1.2.6]. After stopping, the body begins to readjust its natural hormone cycle. It can take three to six months for side effects from the medication to fade and for your cycle to start regulating [1.4.6]. Some people may experience irregular bleeding, headaches, and mood changes as their body adjusts [1.4.2].
Comparison Table: Continuing vs. Stopping Depo-Provera
| Feature | Continuing Depo-Provera | Stopping Depo-Provera |
|---|---|---|
| Contraception | Highly effective (96-99%) pregnancy prevention [1.8.1, 1.8.3]. | Contraceptive effect wears off. Need for alternative birth control. |
| Menstrual Cycle | Periods may become lighter or stop completely after a year [1.3.1]. Irregular bleeding is common initially [1.2.7]. | Return of regular menstrual cycles, though it may take several months [1.4.6]. Irregular bleeding possible during transition. |
| Fertility | Ovulation is suppressed [1.2.4]. | Fertility returns, but there is often a delay of 9-10 months on average [1.6.1]. |
| Bone Health | Risk of significant bone mineral density loss with use longer than 2 years [1.3.2]. | Bone loss ceases. Some bone density may be regained over time [1.5.1]. |
| Side Effects | Potential for weight gain, mood changes, headaches [1.2.1]. | Side effects from the shot will fade. Temporary withdrawal symptoms like irregular bleeding may occur [1.4.6]. |
Switching to a Different Method
If you stop Depo but still require contraception, it's crucial to switch without a gap in coverage. You can start most new methods, like the pill, patch, or ring, up to 15 weeks after your last injection to ensure continuous protection [1.7.4]. It's best to discuss the transition with a healthcare provider to choose the best option for your needs [1.7.3]. For example, when switching to birth control pills, you can start them on the day your next shot would have been due [1.7.3].
Conclusion
Deciding when to stop taking Depo-Provera is a significant healthcare choice that balances its convenience and effectiveness against potential side effects and long-term risks. Key considerations include the desire for pregnancy, the manufacturer's recommendation to limit use to two years due to bone density loss, and the management of side effects [1.3.2, 1.6.6]. Always consult with a healthcare professional to discuss your personal health history, future plans, and the best course of action for your contraceptive needs.
For more information from the manufacturer, you can visit Pfizer's patient information page. [https://labeling.pfizer.com/ShowLabeling.aspx?id=522&Section=PPI] [1.3.5]
