Depo Provera: Prolonged Use And Stroke Risks

Depo-Provera is a popular birth control shot, which is injected into a woman's arm or buttocks to prevent pregnancy. It is a convenient and safe method of contraception, which does not require any daily action. However, there are some disadvantages and side effects associated with its use. One of the major drawbacks of Depo-Provera is the continuous or irregular bleeding that can sometimes occur during the first year of use. While this is typically observed during the first few months, it can persist for up to a year or longer in some cases. This bleeding is caused by an imbalance in the hormones estrogen and progesterone, which regulate the thickening and shedding of the uterine lining. Apart from this, other possible side effects of Depo-Provera include nausea, weight gain, headaches, sore breasts, and depression. It is important to note that Depo-Provera can also increase the risk of certain serious health issues, including stroke.

Depo-Provera's side effects

Depo-Provera, or medroxyprogesterone, is a contraceptive injection. It is a safe and effective form of birth control, but like any medicine, it may cause side effects in some people. It's important to note that not everyone experiences these side effects, and many people use Depo-Provera without any problems.

The most common side effects are changes in menstrual periods, especially during the first year of use. These changes can include irregular bleeding, spotting, or amenorrhea (absence of periods). About half of the people who use Depo-Provera stop getting their periods while on the medication, which is considered safe.

Other possible side effects of Depo-Provera include:

• Slight bruising or a small, permanent dent at the injection site
• Weight gain
• Nervousness
• Dizziness
• Headaches
• Hot flashes
• Acne
• Hair loss or thinning
• Breast pain or tenderness
• Abdominal pain or discomfort
• Nausea, bloating, abdominal distension, diarrhea, vomiting, or constipation
• Fatigue
• Leg cramps or back pain
• Depression, insomnia, anxiety, or irritability
• Upper respiratory tract infections

It's important to note that these side effects are usually mild and often go away within a few months as the body adjusts to the medication. However, if any side effects are bothersome or persistent, it is recommended to consult a healthcare professional.

In rare cases, Depo-Provera may cause serious health issues, such as an increased risk of DVT (deep vein thrombosis), pulmonary embolism, stroke, and myocardial infarction (heart attack). It can also increase the risk of developing probable dementia in postmenopausal women aged 65 and older. Additionally, an increased risk of invasive breast cancer has been associated with the use of estrogen plus progestin therapy. Therefore, it is important to discuss the benefits and risks of Depo-Provera with a healthcare professional before starting this medication.

The risk of stroke in postmenopausal women

Stroke is the fourth leading cause of death and a major cause of disability. While the age-adjusted stroke risk is higher in men than in women, more strokes occur in women due to their longer life expectancy. Women account for 60% of all stroke events.

Risk Factors

The menopausal transition is a time when many women develop cardiovascular risk factors. During the ten years after menopause, the risk of stroke roughly doubles in women. This is likely due to the 60% decline in endogenous estrogen levels during the menopausal transition, leading to a relative androgen excess, which could contribute to increased cardiovascular risk factors in women.

Hormone Therapy and Stroke

Randomized clinical trial data indicate that the use of estrogen plus progestin, as well as estrogen alone, increases stroke risk in healthy postmenopausal women. The Women's Health Initiative (WHI) trial found that estrogen plus progestin increased ischemic stroke risk by 44%, with no effect on hemorrhagic stroke. In the WHI trial, among postmenopausal women with a hysterectomy, it was found that conjugated equine estrogen (CEE) alone increased the risk of ischemic stroke by 55% and had no significant effect on hemorrhagic stroke.

Meta-analyses of existing trials have confirmed these findings, suggesting a roughly 30% elevated total stroke risk with hormone therapy use compared to no use. However, the results from animal studies suggest that administration of estrogen and progesterone is neuroprotective and decreases the incidence of stroke.

Route of Administration

It is hypothesized that transdermal estrogen may be safer with respect to stroke risk than oral estrogen due to the lack of exposure to first-pass liver metabolism and the lack of increase in clotting factors and inflammatory markers. Limited observational data is available, but a nested case-control study of postmenopausal women in the United Kingdom's General Practice Research Database suggested a greater risk of transient ischemic attack (TIA) associated with current use of oral estrogen compared to transdermal patches.

Dose of Hormone Therapy

Most recent observational data suggest a dose-response relationship between oral CEE and risk of stroke. Women taking higher doses of CEE were more likely to develop a stroke, with a dose of 1.25 mg/day associated with a 63% increased risk. However, no association with stroke was observed among users of low-dose hormone therapy.

Hormone therapy is still the most effective treatment for menopausal symptoms, but there is no timing for exposure in midlife that seems to protect women from stroke. More research is needed to determine the safest and most effective formulation, dose, and duration of hormone therapy that will treat vasomotor symptoms without increasing the risk of stroke.

Depo-Provera's effect on the menstrual cycle

Depo-Provera is a birth control method that can be injected at the doctor's office or at home every three months. It is a man-made hormone, medroxyprogesterone, which is similar to the natural hormone progesterone.

Effect on the menstrual cycle

Irregular bleeding is the most common side effect of the Depo-Provera shot, affecting 70% of women during the first year of use. This may include breakthrough bleeding, spotting between periods, lighter periods, or no periods at all. After a year of use, about 50% of women will stop getting their periods altogether. This absence of a period, known as amenorrhea, is considered safe and common for those using the shot.

For those who continue to menstruate, periods may become heavier and longer, although this is less common. This side effect may resolve after several months of using Depo-Provera.

Other side effects may include a change in appetite, a change in sex drive, and an increase in facial and body hair.

Most women will adjust to the hormone levels of the birth control shot within several months or after a few rounds of treatment. Serious problems are rare.

Depo-Provera's long-term effects

Depo-Provera, or medroxyprogesterone, is a long-acting injectable contraceptive that is administered at intervals of 90 days. It is a popular birth control method due to its safety and convenience. However, like all medicines, it can cause certain side effects, and it is important to be aware of its potential long-term effects.

One of the most common long-term effects of Depo-Provera is changes in the menstrual cycle. Many women experience irregular or unpredictable vaginal bleeding, with some experiencing excessive bleeding. However, it is important to note that with prolonged use, the irregular bleeding tends to diminish, and a high percentage of users may even stop having periods altogether (amenorrhea). This side effect is temporary and reversible, as periods should return to normal within a few months after discontinuing the use of Depo-Provera.

Another notable long-term effect of Depo-Provera is weight gain. Studies have shown that the mean weight gain after one year of therapy is 2.5 kg, and this weight gain tends to increase with longer durations of use. Additionally, the endometrium may become atrophic or "resting" with prolonged therapy.

While Depo-Provera is generally well-tolerated, it is important to be aware of its potential rare but serious side effects. These include an increased risk of thromboembolic events such as deep vein thrombosis, pulmonary embolism, stroke, and myocardial infarction. It is worth noting that these risks are typically associated with high doses of the medication. Additionally, an increased risk of developing probable dementia and invasive breast cancer has been observed in postmenopausal women aged 65 and older.

Other less common long-term side effects of Depo-Provera include acne, hair loss, breast tenderness, headaches, nausea, depression, insomnia, and anxiety. These side effects may vary among individuals, and it is always recommended to consult a healthcare professional for personalised advice and to report any bothersome or persistent side effects.

Depo-Provera's effect on fertility

Depo-Provera is an injectable birth control method that is administered four times a year. It contains medroxyprogesterone, a hormone that prevents the ovaries from releasing an egg and thus stops pregnancy.

Effect on Fertility

It is important to note that Depo-Provera does not usually lead to permanent or long-term infertility. However, there is a delay in the return of ovulation once someone stops taking the shots. This delay can last for a few months, with an average of six months or more, and in most cases, infertility does not last more than two years.

A study of 796 Thai women who stopped using Depo-Provera found that the median delay to conception was 5.5 months, plus an estimated 3 months for the last injection of Depo-Provera to wear off. Another study found that it took an average of 170 days (for people taking a 45mg dose) and 226 days (for a 75mg dose) for ovulation to return.

It is recommended that people stop using Depo-Provera about a year before they want to become pregnant. Approximately 50% of people who stop using it will get pregnant within 10 months, and the majority will do so within 18 months of their last shot.

Other Side Effects

Other side effects of Depo-Provera include weight gain, spotting or prolonged bleeding, depression, abdominal pain, nervousness, dizziness, and breast pain or tenderness. It can also cause bone density loss, so users should switch to a different birth control method after two years to prevent excessive bone loss.

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