The NFP files

The Dark Side of Depo-Provera


Getting Back to Normal

"That won't happen to me".

Have you ever told yourself that after reading the list of side effects in the Patient Insert on a bottle of pills? Not only does Depo have a lot of side effects, but they are common. Read the stories on the
web pages run by former Depo users, listed below. Shocking, and totally unnecessary.

Depo-Provera (depomedroxyprogesterone acetate, generic DMPA) is a timed-release form of artificial progestin
(medroxyprogesterone), which is injected at approximately 3 month intervals. It is also used for "chemical castration" of sexual offenders. It works in two ways: by suppressing ovulation (contraceptive) or thinning the uterus so that newly conceived children cannot implant, thus starving them to death (abortifacient). Depo is popular among doctors because it requires an office visit every 3 months, generating more profit than other contraceptives.

Some of Depo-Provera's acknowledged side effects are substantial weight gain, headache, nervousness, abdominal pain or discomfort, dizziness, decreased libido or anorgasmia, backache, leg cramps, depression, nausea, insomnia, white or yellowish vaginal discharge, acne, vaginitis, breast pain, bloating, edema, hot flashes, joint pain, galactorrhea (breast milk discharge), changes in breast size, breast lumps or nipple bleeding, sensation of pregnancy, painful menstruation, heavier menses, ovarian cysts, insulin resistance, PMS, and blood clots.

Some of the side effects are similar to those experienced in pregnancy, where progesterone is present for a long time. Some are far worse. Some are very long-lived, possibly permanent, even after stopping Depo.

A "normal" side effect is the delayed return of fertility after going off the drug. It takes a median time of 10 months following the last injection to achieve pregnancy, with a "normal" range of 4 to 31 months (some users report indefinite infertility). This is unrelated to the duration of use; it doesn't matter how many injections were received.

Check out one of these web pages run by former Depo users. (Try searching for "Depo" for more.) Note how common these side effects are. Plus, there have been other side effects that aren't on "the list".

Shelly's site is full of hundreds of horror stories and many links
Anne's has a place where you can sign up for a class-action lawsuit against Pharmacia and Upjohn. If you can't access that, call the lawyers at 662-844-2137.
Kim has another bunch of info and links
Teresa has a comprehensive page with about a thousand user comments
Stephanie has another good page

There's also a Depo webring (see below on this page) in case you want a few more opinions.

The effects on your marriage are presumably similar to those of other artificial contraceptives. For information on that, see our Practical Theology and Marital Chastity page.

Natual Family Planning is the safe, healthy, effective alternative to this "human pesticide" and others like it (Norplant, pills, etc.).  

Getting off this artificially timed hormone can be difficult, especially if you want to avoid pregnancy. The first step is to learn "normal" NFP well. (Obviously, you wouldn't want to get back on another artificial hormone like Norplant or the Pill, but would want something safe and effective.)  However, the usual NFP rules, which accommodate normal things like irregular cycles, breastfeeding amenorrhea and premenopause, have problems with a hormonal system "outta whack" due to powerful external drugs.

For now, the best advice we can give is to use the return of fertility after childbirth and post-pill guidelines from "The Art of NFP" (see our Resources page ), with the extra caution that we don't know whether cervical mucus will give enough warning of impending ovulation. In addition, D-P will elevate BBT because of the progesterone residue. Than can make the temperature sign confusing, because it can be accompanied by fertile-looking mucus. It appears  that you are infertile as long as the temps are high. For help, call your local CCL Chapter ( is a good place to find them). They will help you through it.  (We have done it, but it was unpleasant because the clients' cycles were messed up for months.)

A nutritional improvement may help to restore normal fertility and cycles. A PMS diet is suggested to accomplish better nutrition. Certain vitamins may be depleted, as is seen with birth control pills. Refer to "Fertility, Cycles and Nutrition" by Marilyn Shannon for specific dosages. It's on our resources page.

So, start charting within the 3 months after getting your last shot. Be aware that cycling may or may not return for a long time. Chart temps, looking for a lowering of high temps that shows you are gradually reducing progesterone. Then look for a change in mucus to the fertile type, assuming then that you are fertile. Then look for ovulation confirmed by a temp rise.

As more and more women get off Depo, more experience on the withdrawal process is gained by NFP researchers. The NFP rules were developed over many years of scientific research and user experience; we hope that beating the Depo problem will not take as long. The question is, how many more women will have to get sick?

(Adapted from CCL's Newsletter, 6/95)

Back to the INFO page
Updated 1/21/2007

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 and her temps were constantly high -- waking temps of 98.6 to 99. I don't remember what her mucus was showing, vaguely remember that she was having different types including stretchy, but at the time, I think she thought she might have a vaginal infection.  Temps stayed up till around Jan of 2000 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 year after the last shot to ovulate.  The interesting thing is that the temps were very 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 return.

Kristina J."

"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...

Mary M."

"Worked with a client who had had 3 - 4 depo shots, about a year.  Her husband complained how ornery she was and how violent she could be with
their children.  I teach the Creighton Model Ovulation System, and she was totally dry.  After three months of charting she became complacent
and discontinued follow-ups.  Since she was so young I felt her 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 upset.  After
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 this client.
Kathy D."

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, however, 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 not experience a true menstruation, she should be referred to her health care provider.

  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 to have
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 period of extended anovulation that may follow pregnancy or lactation.  Recover after
long-term suppression usually does occur; the pituitary recovers first (FSH first, then LH), followed by the ovary, and the endometrium, which may
require three months to regain its normal histologic appearance and enzymatic activity.  In any event, when significant suppression of the
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 pregnancy
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 of S crypts
are very few and, as well, the cervical canal will be very narrow.."

Needless to say, Lorincz's interpretation gives an explanation for the phenomenon that is observed, such as an increase in miscarriages the first
3-6 months postpill (we don't know if the same will occur post-Norplant or post-Depo-Provera).  Odeblad's research clarifies the temporary or even
permanent infertility some women experience postpill.  But for the purposes of NFP, we need to always remember that the bottom line is making
judgements on the basis of the charts.

Persistent mucus is a common post-hormone problem.  When cervical cells are infected, exposed, or damaged (cervicitis, cervical eversion, or cervical
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 just-off-the-pill temperature rule, if  the mucus pattern is ambiguous or absent).
*  For Phase 1: if no temperature-rise occurs by four weeks, apply the End of Phase 1 Rules to any change from a continuous pattern of otherwise unchanging discharge.  Don't use "Patch Rules" as for post-partum.
*  Once cycling resumes,  assume you are in your normal cycles.

Depo-Provera Impairs Arterial Endothelial Function 

 Sept. 5, 2002 — Long-term use of Depomedroxyprogesterone acetate (DMPA [Depo-Provera]) impairs arterial endothelial function measured by cardiovascular magnetic resonance (CMR), according to research published Sept. 3 in Circulation.  DMPA affects arterial ability to "respond to different stimuli and particularly affects the ability of the artery to dilate,"  senior 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 controls during menstruation (P<.01). By inhibiting proliferation of ovarian follicles, DMPA prevents ovulation and decreases  circulating estrogen, which may be potentially harmful to cardiovascular health.

 Although DMPA had been considered a good drug for women with some cardiac risk factors such as smoking, hypertension, or a family history of heart disease, Pennell says that  these findings suggest that women with risk factors for cardiovascular disease "would be wise to review that decision with their physician."

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 the C-6
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 on cholesterol
(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 think 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 progesterone for controlling abnormal bleeding, because they are more efficient at making a thinner endometrium, but in ovulatory women they might make the endometrium too thin for implantation.

Mary D

OK, this really IS the bottom of the page.