Some comments from other NFP professionals:
" ...I had one client back in 99 who had been on Depo. She had 2 Depo
shots, last one in Feb 99. She came to my class in June of 99
her temps were constantly high -- waking temps of 98.6 to 99. I don't
what her mucus was showing, vaguely remember that she was having
types including stretchy, but at the time, I think she thought she
have a vaginal infection. Temps stayed up till around Jan of
and then dropped and stayed down I think.
Following the next menstruation, she had mittleschmertz and decided to
try for pregnancy. She conceived. She says this was the first ovulation
after depo according to the signs. So it took her about a
last shot to ovulate. The interesting thing is that the temps
helpful to her in this situation, CCL conferred with a doc who
instructed us to consider her infertile until the temps dropped which
is exactly what she experienced. Those temps stayed up in the
post-ovulatory area for almost a whole year.
I just gave a conference to public health nurses who told me they
counsel women that it takes an average of 18 months for fertility to
"I have had only one client coming off Depo in April 2001. Her chart
until July 2001 was completely infertile, no bleeding, just green
stamps indicating dryness, or infertility. I have instructed her to
remain on the Early Days Rules, intercourse every other night, and
watch for a change in sensation or beginning of mucus...
"Worked with a client who had had 3 - 4 depo shots, about a
Her husband complained how ornery she was and how violent she could be
their children. I teach the Creighton Model Ovulation System,
she was totally dry. After three months of charting she
and discontinued follow-ups. Since she was so young I felt
fertility would return and tried to encourage her to continue making and
charting her observations but she didn't want to bother. She
became pregnant about 2 yr. after discontinuing depo and was very
having the baby, which, thankfully they fully enjoy, she had a tubal. I
was so shocked she made such a radical decision. Guess all I can say is
keep in touch with these women as they most
often return to fertility. I have always felt I failed with
Just a few more Footnotes:
From the NWFS book, the Basic Instructional Approach on
post-hormonal (reproductive category #6):
When is a woman "post-Depo-Provera"?
The post-Depo-Provera phase begins three months from the date of her
last shot, so charting is in order by then. Some women,
may experience a
delay of one years or more in the return of the menstrual
periods. The temperature level may be somewhat elevated for
several months because of
the synthetic progesterone. The most common occurrence is
prolonged dry days with a gradual return of cycling.
Background on Post-Hormone Possibilities:
There may be a delayed return of bleeding and temperature
rise, perhaps as long as a year, especially with post-Norplant or
post-Depo-Provera. Sometimes the woman will have bleeding
episodes but no temperature rise. She may experience a "dry"
cycle with a temperature rise
and menstrual bleeding. If after 6-12 months the woman does
experience a true menstruation, she should be referred to her health
There may be a variable return of fertility, with sporadic
mucus and bleeding.
Generally, the younger the woman is when she first takes the hormone
and the less established are her cycles, the more likely it is for her
problems with recovery. Women seem to experience more
breakthrough bleeding with progesterone-only pills.
Lorincz reported (International Review of NFP, I/3, 1977) that
"...after cessation of oral 'contraceptive steroids', amenorrhea
persists for six
months or longer. This phenomenon simulates the occasional
of extended anovulation that may follow pregnancy or
long-term suppression usually does occur; the pituitary recovers first
(FSH first, then LH), followed by the ovary, and the endometrium, which
require three months to regain its normal histologic appearance and
enzymatic activity. In any event, when significant
hypothalamic-pituitary system has occurred through the use of oral
'contraceptives' it cannot be expected that ovulation will subsequently
become enhanced when the drugs are discontinued."
Furthermore, Erik Odeblad found in his investigation of cervical mucus
that the Pill accelerates aging of the cervix. He says, "a
rejuvenates the cervix by 2-3 years, but for each year the Pill is
taken, the cervix ages by an extra year. If a woman takes the
Pill for 10-15
years and then ceases taking it in order to achieve pregnancy, she may
encounter some difficulties. Studies indicate that the number
are very few and, as well, the cervical canal will be very
Needless to say, Lorincz's interpretation gives an explanation for the
phenomenon that is observed, such as an increase in miscarriages the
3-6 months postpill (we don't know if the same will occur post-Norplant
or post-Depo-Provera). Odeblad's research clarifies the
permanent infertility some women experience postpill. But for
purposes of NFP, we need to always remember that the bottom line is
judgements on the basis of the charts.
Persistent mucus is a common post-hormone problem. When
cells are infected, exposed, or damaged (cervicitis, cervical eversion,
erosion), there may be a constant secretion of mucus. "Dry"
cycles post another problem, with some women noticing persistent
dryness. They should
be encouraged to be very conscientious in their observations and
advised that the cervical examination may help. Once cycling
begins, "dry" cycles should use the Day 6 rule (as usual, use
evenings only, and watch for mucus),
and a temperature-only rule for Phase 3.
The Basic Instructional Approach for Posthormone is
* Abstain and chart. Then...
* Use the Basic S-T Rules for Phase 3 (or the
rule, if the mucus pattern is ambiguous or absent).
* For Phase 1: if no temperature-rise occurs by four weeks,
the End of Phase 1 Rules to any change from a continuous pattern of
otherwise unchanging discharge. Don't use "Patch Rules" as
* Once cycling resumes, assume you are in your
Depo-Provera Impairs Arterial Endothelial Function
Sept. 5, 2002 — Long-term use of
acetate (DMPA [Depo-Provera]) impairs arterial endothelial function
measured by cardiovascular magnetic resonance (CMR), according to
published Sept. 3 in Circulation. DMPA affects arterial
to "respond to different stimuli and
particularly affects the ability of the artery to dilate,"
author Dudley J. Pennell, MD, from the Imperial College
School of Medicine in London, U.K., said in a news release.
Endothelium-dependent, hyperemia-induced flow-mediated
dilatation, an indicator of endothelial function, was significantly
reduced in the DMPA users to 1.1%, compared with 8.0% in
during menstruation (P<.01). By inhibiting proliferation of
follicles, DMPA prevents ovulation and decreases circulating
estrogen, which may be potentially harmful to
Although DMPA had been considered a good drug for women with
cardiac risk factors such as smoking, hypertension, or a family history
of heart disease, Pennell says that these findings suggest
women with risk factors for
cardiovascular disease "would be wise to review that decision with
Subject: More on Provera
24 Feb 2002
After some reflection and looking some things up this is what I found.
1. In Lobo, PA "Progestogen Metabolism" in Journal of Reproductive
Medicine in 1999: "Progestagens are metabolized differently fromm
endogenous progesterone". The metabolities are dependent on the route
of administration, show significant variation among individuals, and are
metabolized differnetly by different organs. The metabolities of
progestagens have different biologic potencies. Included in this are
progestins (Provera and Depo-Provera).
2.From numerous studies provera and micronized progesterone have
differing effects on the heart - provera having a more adverse effect
(like androgens) .
3.The Depo form of provera (Depo-Provera) binds to androgen receptors,
which is useful in treating sex criminals who are testosterone-laden
4. Provera has 15 times the potency of progesterone. So I
we should be cautious about provera and its effects on the endometrium.
The differences between the C-6 and C-19 progestins
(provera and norethindrone/norgesrel ) definitely work better than
for controlling abnormal bleeding, because they are more efficient at
making a thinner endometrium, but in ovulatory women they might make
endometrium too thin for implantation.
OK, this really IS the
bottom of the page.