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ASK DR. KATE 08.07.2008 BY DR. KATE

Dr. Kate,

I have read about the black box warning on Depo-Provera and I am worried about my health. It warns not to use the medication for more than two years, and I have been on it for eight years. My doctor told me that I am healthy and I should be fine. I may be fine now, but am I setting myself up for osteoporosis in the future? I have asked several pharmacists, and have gotten a different answer from each one. I would love to trust my doctor, but I feel some doubt since there is a warning out. The only thing that keeps me from switching birth control is that I love that I only have to worry about it every three months, as well as the fact that I have not had a period in years. Would you advise me to switch birth control, or do you think it is ok to continue it?

Doubting Depo

Dear Doubting,

A lot of my patients who use Depo-Provera share your concerns. I'm happy to say, though, that there's no reason you have to stop using Depo. The black-box warning comes from studies that show that women who use Depo for more than two years have some bone loss--in some cases "osteopenia," or weaker bones than normal for a woman of that age. But there are some important points that I counsel my patients about:

Women who breastfeed their babies show this same kind of bone loss. And no doctor would advise a new mom to not breastfeed her infant because of worry about her bones. Even mothers of an entire brood of kids who breastfeed for years don't appear to be at greater risk of osteoporosis in their later years...

...because women who breastfeed or use Depo-Provera appear to regain the bone mass later. Most women don't stay on Depo forever, or breastfeed forever (though it may feel like it at the time)...

...but most importantly, even women who have used Depo-Provera for years don't have a higher risk of breaking their hip or another bone when they're older. There are countries, such as Thailand, where it's not uncommon for women to use Depo for two decades or more once they've finished childbearing. If there was an epidemic of broken bones among these women, we would know.

In the end, we need to weigh the risks of any birth control method against the risks of pregnancy. As we know, pregnancy is always more risky than contraception for the vast majority of women. And many women who have been denied their next Depo shot by their doctor because of this warning don't start another effective method of birth control. Inevitably, they then have to deal with an unplanned pregnancy.

If you have found a birth control method that works for you, and it sounds like you have, I wouldn't stop it until you want to get pregnant. Your body will be better off--including your bones.

Have any of you met resistance from doctors for wanting to continue using Depo-Provera for years?

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5 Comments

Angie said:

Thank you THANK YOU - especially for the sentence "even women who have used Depo-Provera for years don't have a higher risk of breaking their hip or another bone when they're older."

I've been on Depo for about 7 years and LOVE it. LOOOOVE it. However, I've gotten mixed messages from my doctors about the safety of long-term use. I've chosen to believe my OB/GYN over a previous internist that suggested I discontinue the Depo.

In fact, I'd be a candidate for sterilization (I don't want kids) except that Depo is actually handier - I relish not having any periods/PMS/etc! Long live Depo Provera!!

August 7, 2008 3:06 PM

Michelle said:

Thank you for this post!! It's so reassuring - I love being right about stuff :)

I was told by my college doctor that I HAD to come off Depo because it was EVIL AND BAD and no, I couldn't go on the normal pill because I was TOO FAT and it WON'T WORK and wah wah wah wah wah.

So I went to another (male!) doctor, told him what the Uni doc had said - he gave me an ironic look and said "I don't think you need to be worried about breaking bones, dear... you're hardly fragile." I loved him... he was so effing cool.

So now I have another doctor who's happy to keep me on it as long as it's working for me... and it has been for about six years now!

August 8, 2008 6:22 AM

HW said:

I was on the shot for four years and I was denied another shot by my university nurse. She told me that since I was 22 my bones might have chance to recover and the bone density to return to normal.

I had a lot of problems when I came off the shot like bleeding continously for a year and fertility concerns.

It was fine when I was on it though. I gained about 2 stone in weight but that came off as soon as I stopped the shots.

August 9, 2008 1:17 PM

Childfree Sexpot said:

Great article! I have been on Depo since 1996 (started on it at 16) and I absolutely love it. My gyno says long term use is fine but as a precaution has me get regular bone density tests. All of them have been perfectly normal and I haven't had a period in over a decade.

August 16, 2008 2:28 AM

Depo-Provera Side Effects said:

My name is Janet Smith and i would like to show you my personal experience with Depo-Provera.

I am 38 years old. I have been taking Depo-Provera for 8 years. This drug may not be the answer for everyone but for me without it my life is not pleasant. Bleeding in my shoes for days each month, terrible to the floor cramping and pain. First shot, period gone, have gone off it, takes months for it to come back but when it does it is just as bad. My mood changes when I am due to have my shot, I can feel it happening, and I will admit that I depend on it to keep me more level. I can feel the PMS when my 12 weeks is up, during the 12 weeks I have no side effects. My mom has some bone density issues and my doctor has suggested that perhaps I go off, not going to happen, it is monthly miracle, and although I understand the effects are different for everyone I say sometimes to have a more normal cycle you need to not have one.

I have experienced some of these side effects-
possibly weight gain, had been gaining weight before, mood swings when I need to get my shot, none that I get complaints about when I am on it, decreased sex drive

I hope this information will be useful to others,
Janet Smith

October 24, 2008 7:41 AM

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