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Forum Name: Gynecology

Question: Depo and the never ending period!


 aquaholic - 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

User avatar 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.[1]

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.[2]

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]

References:
==========
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.

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