Spotting and Bleeding With Depo-Provera

One major drawback of Depo-Provera is the continuous or irregular bleeding (spotting) that can sometimes occur during the first year. While this typically occurs during the first few months, it can persist for up to a year or longer for some people. Learn more about this side effect and what you can do if it persists.

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Depo-Provera is an injectable form of birth control which uses a synthetic form of progesterone to prevent pregnancy for up to 14 weeks. Depo-Provera is discreet and convenient. It is 99% effective when used correctly. However, with typical use, it is only about 94% effective, as some people may forget to get their shots on time.

As a progestin-only contraceptive, it is also a great choice if you are unable to use estrogen-based contraception.

Spotting and Bleeding Symptoms

When it comes to birth control, bleeding remains the number one reason why women discontinue contraception.

With a drug like Depo-Provera, vaginal bleeding is not only a common side effect but one that's expected to occur in about 25% of users in the first year.

There is no way to predict who will experience these side effects or how severe they might be. For most people, symptoms of bleeding will resolve within a year. On the off chance they don’t, a person may be faced with the choice of either abandoning treatment with Depo-Provera or pushing through.

If you begin spotting or bleeding after your first Depo-Provera shot, it may seem distressing but it is generally not permanent. According to the drug manufacturer, around 57% of the people on Depo-Provera will cease having periods by the 12th month.

Treatment If Bleeding Continues

For those who continue to have spotting or bleeding, there may be treatments that can help. Most of these are intended only for short-term use and, while effective, come with their own set of side effects and considerations. Among the treatments currently approved for use by the U.S. Food and Drug Administration (FDA) are the following.

Estrogen Supplementation

Estrogen supplementation has been shown to relieve bleeding by promoting the growth of the uterine lining while stabilizing blood vessels and blood clot. Not only does estrogen enhance Depo-Provera’s contraceptive effects, but it can also be delivered by oral tablet, transdermal patch, or intravaginal ring.

Research has shown that while estrogen provides short-term relief, the effects generally return when treatment stops.

Lysteda

Lysteda (tranexamic acid) is a non-hormonal oral medication which received Food and Drug Administration (FDA) approval in 2009 for the treatment of heavy menstrual bleeding.

In one study, 88% of women on Depo-Provera had no vaginal bleeding within one week of treatment compared to 8.2% in the placebo group. After four weeks, a bleeding-free interval of more than 20 days was found in 68% of those treated, and in none of those who took the placebo.

Side effects are relatively mild and include a headache, back pain, stomach ache, sinusitis, muscle and joint pain, migraine, anemia, and fatigue.

Ponstel

Ponstel (mefenamic acid) is a non-steroidal anti-inflammatory drug used for short-term control of spotting and bleeding. It is not considered a long-term solution as prolonged use can increase the risk of high blood pressure, heart attack, and stroke.

Ibuprofen

If any of these treatments are contraindicated or unavailable, some doctors may prescribe a non-steroidal anti-inflammatory drug like ibuprofen taken three times daily to reduce uterine inflammation and alleviate discomfort.

When to See Your Doctor

If heavy bleeding occurs while taking Depo-Provera, it's important to remember that the drug may not be the source (or only source) of the condition.

Abnormal bleeding should always warrant a thorough investigation, and all other causes—including uterine fibroids, sexually transmitted infection, and cancer—should be ruled out before a course of treatment is prescribed.

A Word From Verywell

Birth control choices are not always easy. If you are on Depo-Provera and faced with side effects you cannot bear, speak with your doctor about treatments that may allow you to continue or explore alternatives that may be less impactful both in the short and long term.

Before starting treatment, learn as much about the drug as you can, weighing the risks and benefits. Studies show that people who were informed in advance about the risks of birth control were most able to tolerate the side effects and less likely to stop. As always, knowledge is key when making informed choices about contraception.

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