What You May Not Have Been Told About Coming Off Depo Provera

Yes, God has blessed you with a viable reproductive system and fertility has never been your problem. But that doesn't mean you want to be "dropping a baby" every passing year especially if you are in the "working-class".
So you thought of various contraceptive methods and ended up with Depo provera.
Depo provera, also called the "birth control shot", is a reversible method of contraception; you are given a shot (injection) every three months.
Common side effects include: weight gain, skin pigmentation, reduced sex drive, hair thinning,head aches, spotting ...

But what I really want to draw your attention to is what may likely happen when you STOP taking the shot.
I was amazed at what I saw on a the Society for Menstrual Cycle Research and the withdrawal symptoms that seemed so familiar. Women were sharing their not so pleasant experiences from coming of the depo provera.

Here are a few of them:

Have been on Depo for 26 years straight, am now 47, I was so thrilled with it there was no coming off until this year, living & working in a remote place in an African country, there was no shot available and no chance of it either. It’s been nearly two months and I’m practically off my rocker. My breasts are tender and swollen (one noticeably more than the other), I’m on the verge of tears permanently, irritable, constantly exhausted…. I can only put this down to side-effects of coming off the Depo. I started googling the side effects out of frustration – so glad to have found this site. But will this nightmare ever stop? Help!!!

I was on the depo shot for a year. ive been off of it for 8 months and needless to say it has been absolutely horrible. when i first came off of it i was spotting irregularly for the first 4 to 5 months. after that i started bleeding very heavily every two weeks or less (if not all the time) not to mention bone density, multiple cavities (ive always had good teeth), hair loss and
dry hair, severe mood swings, severe chest pain, anxiety attacks, loss of sex drive, dry skin,very sore breasts,and periods of nausia. i hurt all day everyday. no woman should ever have to go through this…

I was on the depo shot about 3 years had my period maybe once a year if not at all no weight gain clearer skin now ive been off it about 3months have been moody tired gaining weight!!! new pimples every day tender breasts and at first no period but then for two weeks straight then a week off then another week somes spotting and now nothing dont know whats next but im most concerned about the weight gain I didnt even gain this much off of both my pregnancies ive always been slim pretty much the same since I was 16 im.gonna be 24 I was always between 120/130 im.5″9 so im.sure I could use it but its only going to my stomach

I have been on the depo for 3 year always got af before my shot was due and didn’t this time so I decided my body probably needs a break… my depo was due July 14 and since I have been off of it my breast and bottom are huge ive gained 12 lbs!!! every time I eat I feel nauseous and sick for atleast three hours. My breast are extremely senstive and hard as rocks. I get headaches and heart burn. Really bad mood swings and still haven’t had my period. When I was on it I didn’t have any side effects but getting off of it is horrible I hope it goes away soon I seriously thought I was pregnant with all the pregnancy symptoms i didn’t know coming off the depo would be so terrible. I wouldn’t suggest it to anyone!!!!

I was due July 4th to have my depo and skipped it. I had a major surgery on July 10th and am still recovering. I just kept telling my husband..”the last surgery was not this bad, I just can’t get over this”. After reading here today though, all of my symptoms match depo withdrawals!! What!! Who knew?? I do not have sore breasts and have not gained weight, but I’ve also not had my appetite return after colorectal surgery #2. However, I’m feeling anxiety, severe nausea almost constantly, bloating, irritability, I’m emotional, diarrhea, INSOMNIA badly. What gives? I’m actually considering staying off depo permanently now, but another part of me says GET YOUR SHOT NOW BEFORE YOU GO OFF THE DEEP END! I have small children, am about to begin homeschool, one is a toddler, recovering from a massive surgery…I can’t spend the next year suffering like this! Get the shot, or do we have alternatives?

There are over 500 comments similar to the above. Its really funny how some women didn't have serious issues while on the shot but "went through hell" coming off it.

I think there needs to be more research in this area...

Laura Wershler of the Society for Menstrual Research spoke with Dr. Jerilynn C Prior on the effects of Depo provera. Here is an excerpt of the interview:

LW: Thanks for explaining the side effects women experience while taking Depo. What happens and why are women miserable when they stop it?

Ask Jerilynn: First let me say that I have looked in the recent medical literature and been unable to find any studies of women’s experiences on stopping Depo. One would surely hope that drug regulatory bodies have required research on the return to fertility in women taking Depo.
Here’s what I think is happening, and I’ve formed this understanding based on what women described in their posts: Women’s reproduction has been suppressed by Depo for months or years. This means that (figuratively speaking) the hypothalamus, pituitary and ovaries have ‘forgotten how’ to coordinate their usual complex and amazing feedback needed for normal ovulatory menstrual cycles.
However, our bodies are programmed to work hard to regain reproduction so there is a kind of rebound over-stimulation of estrogen levels (the easiest hormone to get the ovary to produce). The result is erratic but high estrogen levels causing nausea, sore breasts, fluid retention and abdominal bloating, mood swings and heavy or prolonged vaginal bleeding.
With high estrogen levels and weight gain, plus the “hypothalamic incoordination,” ovulation doesn’t occur and therefore no progesterone is produced. Progesterone – the hormone produced after ovulation in normal menstrual cycles – is needed to counterbalance the high estrogen levels. I believe that it is this estrogen-progesterone imbalance that is leading to all these miserable symptoms.

LW: Many women who have shared their experiences on my previous post also seem very concerned by the delayed return to normal menstrual cycles, with some experiencing no bleeding for months. Others seem to have flooding and continual flow. What’s up?

Ask Jerilynn: We’d have to study this to be sure, but I suspect that the women who have no flow for months on stopping Depo likely are younger, have gained the least weight and are under the most situational/emotional/physical stress. On the other hand, those who have heavy and/or prolonged vaginal bleeding are likely older (and often perimenopausal—when ovarian hypothalamic coordination has normally become dysfunctional) and have usually gained more weight.
Therefore I believe that the varying responses in vaginal bleeding depend on whether women were on the young-thin-stressed side when starting and stopping Depo versus normal to now overweight or obese. Another possibility is that women have become perimenopausal during their years on Depo. Thus when they stop Depo they are now in a symptomatic perimenopause that the Depo was preventing or treating.

LW: Some women have noted extreme weight gain upon stopping Depo. Can you explain why this might be happening?

Ask Jerilynn: If estrogen levels are high and progesterone levels are low, the natural result is inappropriate hunger and weight gain. Progesterone levels following ovulation make women burn about 300 more calories a day, which obviously helps prevent weight gain. I think this weight gain side-effect of stopping is also due “estrogen dominance.”

LW: Another common experience that disturbs women as they stop taking Depo-Provera is extremely sore breasts. What causes this?

Ask Jerilynn: This is directly caused by the “estrogen overdrive” as the body tries to recover from the suppression caused by Depo. Sore breasts tell us that our estrogen levels are higher than the highest normal mid-cycle estrogen peak. If it is sore when you press your palm onto your nipple, you don’t need a blood/urine/saliva test to know your own estrogen is higher than it ever should be in the normal cycle.

LW: Why are some women getting acne or pimples on their face and backs?

Ask Jerilynn: Whenever women are overweight and not making enough progesterone (because they are not ovulating) the body makes more male hormones that lead to oily skin and acne.

LW:  What about the hot flushes that some women are experiencing? These symptoms are typically associated with perimenopause, the transition to menopause.

Ask Jerilynn:  Yes. Some women who have become perimenopausal while on Depo will have had their hot flushes and night sweats effectively treated by the progestin. Therefore, when they stop, they experience the symptoms of perimenopause including night sweats and daytime hot flushes.
That brings me to another educated guess—many women stop Depo in their 30s and 40s because they want to have a family or because their doctors advise them to. They may already be starting into perimenopause but the signs, such as hot flushes, are masked while on Depo. However, off Depo the estrogen swings (that may be high both because of stopping Depo and because of changes related to perimenopause) cause hot flushes and night sweats. If you’d like more information about perimenopause here’s a recent open-access scientific review.
Heavy flow is one of the most common experiences of early perimenopause that at least a quarter of all women experience. When you add the estrogen excess production on stopping Depo to perimenopause (“Estrogen’s Storm Season”) you get really, REALLY heavy flow. No wonder women are so frustrated and doctors are so puzzled.

LW: Many women are told to just “wait it out.” This could mean months of not ovulating, ages without a menstrual period, or putting up with flooding menstruation. Do you think that’s a good idea? If not, what would you suggest?

Ask Jerilynn:  Based on what I’m guessing is going on hormonally, and also on a woman’s age, her desire or not for pregnancy, and on her current body mass index, here are some suggestions:
Heavy vaginal bleeding:  My first suggestion—something every woman should know— is ibuprofen. One tablet four times on every heavy-flow day, decreases flow by almost a half. See this article about how to manage flooding or heavy vaginal bleeding. You can take ibuprofen on your own and track your own cycles by downloading and completing the Daily Perimenopause Diary.
Having such a record will help your health care provider to understand what you are experiencing as well as allowing you to know for yourself what is going on. If ibuprofen does not sufficiently decrease heavy flow so you can cope, you will likely need to ask your physician’s help. You will need a prescription in order to take what I next recommend, cyclic or daily progesterone.  What works best is to print out this information sheet for on Cyclic Progesterone Therapy, one for yourself to stick somewhere obvious and one to take to your doctor.
However, if your flow has been so heavy and long that you already have iron loss anemia (commonly called a “low blood count”), have had continuous flow for over a month, or are bleeding enough to become dizzy when standing, you need a more powerful solution than cyclic progesterone. The answer is progesterone every day for three months (plus ibuprofen on every heavy flow day).  I’ve written this article on heavy flow to take to your family doctor.
No flow for three months after stopping Depo: I suggest starting to take natural, bio-identical progesterone (see Cyclic Progesterone Therapy) for two weeks and stop for two weeks. Don’t be discouraged if you don’t get a period when you stop it. Just keep doing that two weeks “on” and two weeks “off” progesterone until your flow returns. Even without flow, this treatment will increase bone density (based on a trial we did years ago).
If, in the course of taking cyclic progesterone you start getting irregular flow, follow the instructions (and picture) in that handout carefully. Most of all, think of this as restoring a normal balance of your own hormones and ovulatory menstrual cycles.
When you start noticing stretchy mucus about the middle of the month, this means your estrogen levels are recovering. Now you can actively start working on becoming pregnant, if this is your desire. You will take the progesterone for two weeks or fourteen days but start checking for your urinary LH peak (with a fertility kit you can buy over the counter) in the evening when you notice stretchy vaginal mucus. Only begin the progesterone after you see the LH peak (a positive test) or after the stretchy mucus decreases. The reason is that if you take the progesterone too early it could suppress that necessary LH peak.
Sore breasts, bloating and/or nausea: These symptoms mean high estrogen levels, usually without any or enough progesterone. Increasing exercise, increasing vegetables and fruits, and decreasing junk/snacks and desserts (except fruit) will decrease estrogen levels in premenopausal women. Although I can’t promise that for women in perimenopause, it will certainly help you feel better. After you’ve started on these lifestyle changes, I’d suggest beginning cyclic progesterone 14 days after the start of a flow or any time if you are not getting flow regularly. Follow the suggestions about how to take progesterone on the Cyclic Progesterone Therapy. If sore breasts get better but still persist, you can also try (gradually) decreasing your caffeine and alcohol intakes.
Hot flushes and night sweats: To start, I think it is important to realize that the experience of hot flushes or night sweats means you are in perimenopause. So, although it is not much help, you can blame some of what you are experiencing on perimenopause instead of just on stopping Depo!
CeMCOR recently proved that progesterone is effective for treatment of menopausal hot flushes in a randomized, placebo-controlled trial. We are now testing its effectiveness for perimenopausal hot flushes in a similar controlled study. If you live anywhere in Canada, you could potentially participate.
If, as is typical in very early perimenopause, you are waking at night feeling hot (and often sweaty or irritable) on only a few nights a month, and usually around flow, then cyclic progesterone works. Take it for 14 days, but if you typically have night sweats on the first few nights of flow, continue it a few more days.
However, if hot flushes are coming day and night and are troublesome any old time, then take progesterone daily instead of cyclically.

I hope this bit of information was helpful. If you have had any such experiences coming off depo  please feel free to share.