History Of Depo Provera

The History of Depo-Provera

Melissa D. Turley

LIS 342

University of Illinois at Springfield

 In this ever-changing world of medicine, the advancement of the different forms of birth control still amaze me. Women have a choice between the old fashioned pill, Norplant implants, Net-En, and the Depo-Provera injection, just to name a few. In my research I found that the Depo-Provera injection was the most effective, noninvasive form of birth control available today.

What is it?

Depot Medroxyprogesterone Acetate, more commonly known as Depo-Provera, is a synthetic injection of progesterone, a normal hormone that women have. This injection in its synthetic form contains crystals that slowly dissolve, resulting in a delayed release becoming effective for a longer period of time, in this case 13 weeks. Trusting that the patient has the 150 mg injection readministered intramuscularly on a strict schedule of every 13 weeks, Depo-Provera is between 99.5 and 99.7% effective, making this the most effective method of birth control, aside from abstinence (Speroff, et.al., 2001).

Depo-Provera works by increasing women's levels of progesterone in the body, thereby altering ovulation by causing interference in the pituitary hormone that regulates the cycling of ovaries. Ovaries then will not go through their regular cycle, will not create nor release an egg, and therefore there is nothing to be fertilized. This also results in most patients not experiencing menstruation while on Depo-Provera (Chez, 2001).

There are a couple of additional effects of Depo-Provera that act as a back up in cases where an egg is released. The uterine wall is thickened, taking on a resting or atrophic appearance, making it not ready to receive a fertilized egg. It also causes thickening of the cervical mucus, creating difficulty for sperm to pass through. When the cervical mucous becomes scant, viscous and sticky, as it does during pregnancy and during the late infertile portion of the menstrual cycle, it interferes with the movement of the sperm into the uterus. Some tests have shown that some sperm may penetrate the cervical mucus, but rarely reach the uterine cavity or oviducts. Even if this occurs, the uterine walls, and ovum are not primed for acceptance of the fertilized egg (Osathanondh, 1995a).

Safety of Injection

Although Depo-Provera has been used for more than 30 years, the FDA only approved its usage in October of 1992 (New York Times, 10/30/92). The injection is considered safer than the birth control pill because it only contains progesterone, whereas the pill contains both progesterone and estrogen. Estrogen has been associated with more health risks, making Depo-Provera safe for usage in those unable to use estrogen related medications due to health reasons (Osathanondh, 1995a).

A natural question would be if it were safe for a woman not to have a period every month. According to the American College of Obstetrics and Gynecology (Kaunitz, 2000), if the body is not producing the eggs, and has thickened the uterine wall, then there is nothing for the uterus to expel every month, which is the purpose of the menstruation process. If a woman becomes interested in getting pregnant, she would need to discontinue the injection, but realize that it could take anywhere from four months to a year for their body to return to normal and the effects to wear off. In some instances it could take up to two years, but the body will be able to receive an egg again, and pregnancy can be achieved. There have not been any signs of long-term effects resulting in infertility. Of course, women that were irregular before starting the injection must realize that they may have a more difficult time conceiving (Speroff, et.al., 1999).

Depo-Provera is also one of the only safe methods of birth control for breast-feeding mothers. The progesterone does not have any affect on the quality of the milk, and may even extend the quantity produced. The manufacturers of Depo-Provera suggest, in their patient information insert, that mothers wait until the child is six weeks old before starting the injection, because this is the age of the youngest child studied for the effects, but many doctors think this is overly cautious, and feel they can start immediately after giving birth (Gable,2003).

Cautions

In any situation that has to do with the human body, we must always evaluate any health problems that one might not think could relate to other issues. Depo-Provera in some instances has might increase cholesterol and other blood fats, so users should have these checked regularly (Osathanondh, 1995b). Long-term use can increase risk of osteoporosis due to a loss in bone density. Although these problems will not affect most users, they should always get regular check ups. Of course, make sure they are not pregnant before starting the injection. Finally, the most common risk found is that people think the shot will protect from hepatitis, HIV, and other sexually transmitted diseases. The only protection against those factors would be condoms or abstinence. Also, this form of birth control should not be used if the potential user has abnormal bleeding yet to be diagnosed, severe liver disease, ever had a liver growth, being treated or have a history of breast cancer, had a stroke, recently had blood clots in the legs or eyes, a recent pulmonary embolism, or if they are allergic to progesterone of course (Osathanondh, 1995a). If in perfect health, or poor health, nobody should ever start any type of medication without consulting a physician first.

Side Effects

As stated in the Depo-Provera ®Contraceptive Injection Patient Information Insert released by the Pharmacia & UpJohn Company (Hatcher, 1999), side effects may include but are not limited to:

Bloating

Breast tenderness

Depression/ Mood changes

Headaches

Fatigue

Skin changes

Decreased libido

Excessive hair growth/loss

Nervousness

Nausea

Abdominal discomfort

Back pain

Increased allergic reaction to regularly slight allergies

Weight