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- Thu Sep 01, 2005 4:14 pm
Hello. I am a 28 year old wife and a mother of 2. I have been on and off Depo for 4 years. I quit taking any b/c for almost 2 years when I decided to go back to Depo. My first injection was in April and I began bleeding within the first few days. I continued to bleed until my next injection in July. The day after my last injection I stopped menstrating for 2 weeks. BUT after that I have again been bleeding forever (or so it seems) :) What can I do to get it under control? I do not want to become pregnant and have tried several other b/c methods. Pill 3 different kinds. Same reaction as Depo. IUD was horrid and caused VERY heavy periods lasting 10 or more days. I hate condoms but am thinking thats the only real alternative. I love the little ammount of thought I have to put into Depo but was looking for birth control not sex control :) How can I get the bleeding to stop and continue Depo? Or can I?
| Dr. Tamer Fouad
- Tue Jan 10, 2006 12:18 pm
Depot medroxyprogesterone acetate (Depo-Provera) is an intramuscular progestin injection (150 mg) that provides approximately 14 weeks of adequate contraceptive levels. Because of the high dose of progestin, ovulation is inhibited in most women.
DMPA acts by the inhibition of ovulation with the suppression of follicle-stimulating hormone (FSH) and LH levels and eliminates the LH surge. This results in a relative hypoestrogenic state. Single doses of 150 mg suppress ovulation in most women for as long as 14 weeks. The contraceptive regimen consists of 1 dose every 3 months. With perfect use, only 0.3 percent of women become pregnant within the first year of using medroxyprogesterone injections.
Disadvantages of Depo-provera include, disruption of the menstrual cycle to eventual amenorrhea occurs in 50% of women within the first year. Persistent irregular bleeding can be treated by administering the subsequent dose earlier or by prescribing temporary low-dose estrogen therapy.
Please consult with your doctor as soon as possible. You need a clinical evaluation to rule out other causes of bleeding first. Once that is done, several options are available.
Persistant bleeding can be treated with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID).
Nonsteroidal anti-inflammatory drug such as ibuprofen (e.g., Advil, Motrin) can be taken at a dose of 800 mg three times daily for 1 to 2 weeks or until bleeding stops.
Supplemental estrogen can be taken on a daily basis for one to two week and includes conjugated equine estrogens (Premarin) taken at a dose of 0.625 to 1.25 mg per day, or ethinyl estradiol (Estinyl) 20 mcg per day, or estradiol (Estrase) 0.5 to 1 mg per day for 1 to 2 weeks.[3,4]
1. Hatcher RA. Depo-Provera, Norplant, and progestin-only pills. In: Hatcher RA. Contraceptive technology. 17th ed. rev. New York: Ardent Media, 1998:467-509.
2. Trussell J. Contraceptive efficacy. In: Hatcher RA. Contraceptive technology. 17th ed. rev. New York: Ardent Media, 1998:779-99.
3. Approach to common side effects. In: Wallach M, Grimes DA, Chaney EJ, et al., eds. Modern oral contraception: updates from The Contraception Report. Totowa, N.J.: Emron, 2000:70-6.
4. Krettek JE, Arkin SI, Chaisilwattana P, Monif GR. Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting. Obstet Gynecol 1993;81(5 pt 1):728-31.