Informed Consent: Depo-Provera
Informed Consent: Depo-Provera
Depo-Provera (medroxyprogesterone acetate or MDPA) is a three month injectable contraceptive, which became available in the world in 1969 and the US in 1992. Today, around 1 in 4 contraceptive users have tried the Depo-Provera injection.
Depo Provera
What it is: Depo means deposit + Provera is a brand name for medroxyprogesterone acetate (MPA) which is a synthetic progestin. Depo-Provera is an injectable shot given every three months in one large dose of 150 mg.
How it prevents pregnancy: It works through multiple actions by drying up cervical mucus, thinning the uterine lining, and suppressing the brain signals (gonadotropin release) that trigger ovulation. What this means is that your hormone levels while using Depo-Provera will sink to menopausal like levels - having both low progesterone and low estrogen consistently.
Failure rate: Typical use: 6% (or 94% effective) Perfect use: 1% (or 99% effective)
Ovulation preserved?: No, the mechanism of action is mainly ovulatory suppression, sometimes lasting many months beyond your last shot.
Side effects: Spotting, breakthrough/irregular bleeding patterns, amenorrhea (no period), heavy bleeding, abdominal pain, bloating, cramps, constipation, dizziness, headache/migraine, weakness, fatigue, hot flashes, weight changes, pain/redness/itching at the injection site, delay in return to fertility, and others. Nearly one-half of the 12.5 million people who had used Depo-Provera (46%) discontinued use due to dissatisfaction, the highest of all methods.
Mental health effects: low libido, mood swings, anxiety, depression, nervousness
Serious physical health risks: include bone loss during use, higher breast and cervical cancer risk. All hormonal birth control increases osteoporosis risk, but we know that women, on average, regain lost bone after they stop taking Depo. Those with osteoporosis risk (sometimes unknown to them) do have more broken bones while on Depo. Depo also increases the likelihood of stillbirth post-treatment when users first used the drug as a teenager, and especially if it was used before first ovulation
Body systems that may be impacted: 11/11 systems. Cardiovascular system, digestive system, endocrine system, exocrine system, immune system, muscular system, nervous system, reproductive system, skeletal system, renal system, respiratory system.
How long it should be used for: In order to mitigate serious health risks, Depo should be used for less than 2 years, though it is commonly used for longer.
Why do you bleed so much on Depo? It’s not totally clear yet, but it probably has to do with the shots (in)ability to suppress your estrogen levels as well as the thinning of the uterine lining.
Why is it so hard to get off Depo? When getting off any contraceptive, the body overcompensates. This may be true for the hormone estrogen, which will cause a variety of symptoms in the first 6 months to a year after stopping Depo. We sometimes call this post birth control syndrome and it can include hypothyroid like symptoms, acne, and breast tenderness.
History of Depo-Provera:
1960: Depo-Provera is introduced by Syntex and the Upjohn Company as a treatment for endometrial and renal cancer
1967: First attempted FDA approval as a contraceptive, rejected
1969: Depo-Provera was introduced into Zimbabwe through the Family Planning Association of Rhodesia (FPAR), and, by 1974, it became the most commonly used form of contraception and by 1980, almost 100,000 Zimbabwean women were using Depo-Provera. Zimbabwean women also reported coercion under threat of losing their jobs on white-run commercial farms, and that the drug had been administered without their consent. They were also denied medical treatment for their children if they did not submit to taking Depo-Provera.
1972: Researchers study macaques in Bermuda by injecting them with Depo-Provera. The male stopped sexual reproduction with the females on contraceptives. TRIGGER WARNING / / / This caused the adult alpha male to “attempt rape, masturbate and behave in a turbulent and confused manner. He approached females, inserted his fingers into their genitalia, stroked and sniffed them, however anxiously”
1973: US government discovers that Depo-Provera causes breast cancer tumors to develop in a study on beagles and refuses further testing the drug as a contraceptive
1970’s: Despite lacking approval, licensed physicians administered Depo-Provera to Black and Native American patients
1978: FDA approves administering Depo-Provera as a cancer therapy
1978: Second attempted FDA approval as a contraceptive, rejected
1981: In 1981, Minister of Health Herbert Ushewokunze bans the use of Depo-Provera in Zimbabwe. The reasons being that the drug is harmful, didn’t gain approval in the US, and that the drug was administered on racist grounds. “Depo-Provera was seen as “a symbol of the intrusion of Western imperialism and racism” into the bodies of Third World women.”
1983: Third attempted FDA approval as a contraceptive, rejected
1992: FDA board warns “Never has a drug whose target population is entirely healthy people been shown to be so pervasively carcinogenic in animals as has Depo-Provera.”
1992: Depo-Provera becomes available in 90 countries
1992: On the fourth attempt, FDA approves use as a contraceptive in the US
1994: When Depo-Provera was approved in India, India's Economic and Political Weekly reported that "The FDA finally licensed the drug in 1990 in response to concerns about the population explosion in the third world and the reluctance of third world governments to license a drug not licensed in its originating country."
Late 1990’s: Depo-Provera becomes popular in low cost clinics and schools with high Black student populations in the US
1999: Oregon State Legislature drafts a bill requiring select sex offenders to be evaluated for treatment with Depo-Provera to reduce the risk of reoffending.
2004: Injectable Depo was introduced in 2004 under the name Depo-SubQ Provera 104 and was also approved for the treatment of endometriosis
2005: A $700 million class action lawsuit is filed against Pfizer by users of Depo-Provera who developed osteoporosis.
2013: Ethiopian immigrants living in Israel are injected with Depo-Provera without informed consent. Social workers noticed the birthrate among Ethiopian immigrants in Israel had halved in a decade
Other facts about Depo-Provera
Other demographic data: Depo-Provera use is nearly three times as common among women without a high school diploma or GED compared with those with a bachelor’s degree
Doesn’t protect against STI/D’s: Some studies suggest that Depo-Provera might increase your risk of vaginal infections including STI/D’s, possibly related to a hindrance of your microbiome
Liver stress: The large dose given at once may overtax your liver
Delay in return of fertility: Fertility is supposed to return around 3 months, but may take up to 1-2 years, depending on the person and underlying health issues that may or may not be related to the use of the injection
Depo-Provera needs to be seriously scrutinized as a high risk contraceptive. There is no reason that otherwise young, healthy people should be using a contraceptive that accepts such high levels of risk in order to prevent pregnancy. If we were more informed of the history of Depo-Provera, or its associated risks, many people would not make the choice to use this option. With so many options available now, and this one being particularly carcinogenic with such a short window of use (<2 years), I personally think it is important to talk about phasing OUT contraceptives that damage us. I advise everyone reading this to look at alternatives to Depo-Provera.