Depo Provera: A primer

Q: Does Depo-Provera lead to permanent infertility? 

Short A: Nope.

Long A:  Depo Provera (“Depo,” “the Shot”) is one of a family of progesterone-only contraceptive products. It is an injectable product-a shot. It is a really effective and convenient way to prevent pregnancy; you only have to think about it 4 times a year and in clinical studies, less than 1% of women get pregnant on it.  (In real life, about 5% get pregnant – probably because in real-life some women didn’t get their shot on time.)

There are a couple of downsides to Depo Provera. It is, as noted, a shot. Ouch. It can be expensive if your insurance doesn’t cover contraception. (On the other hand, a baby is a whole lot more expensive!) Like most hormonal contraceptive products (say that three times fast), some women will feel a little bit pregnant-bloated, queasy, weight changes, headachy-on Depo, especially at first. Some women gain up to 5-10 pounds on Depo, although most gain only 3-5 pounds. (While 3-5 pounds ain’t nothin’ it’s still a whole lot less than a baby!)  It can interfere with bone mineralization, making osteoporosis and fractures slightly more likely down the road.

There are some big upsides, though, too. Periods often stop, although for the first few weeks/months of use there can be some irregular spotting. (Are all you men out there going, yuck, gross, icky?)  The incidence of pelvic inflammatory disease, endometrial hyperplasia, endometrial cancer, and endometriosis pain are all decreased.  And there are also specific medical conditions which benefit from Depo-Provera:

  • Because the metabolism of Depo Provera doesn’t change with anti-seizure medicine, it’s a good choice for women with seizure disorders.
  • Women with sickle cell disease appear to have fewer pain crises while on depo. 
  • Peri-menopausal vasomotor symptoms (the dreaded “hot flashes“) tend to be better compared to birth control that has estrogen in it.    

Depo Provera does not appear to increase the risk of liver, breast, or ovarian cancers. It probably does not affect blood pressure or coagulation, making it sometimes an okay choice for women who have had high blood pressure, heart disease, or a history of blood clots. It unfortunately does not protect women from sexually transmitted infections so you still need to get a condom on your partner.

So to finally answer your question, Depo Provera does not permanently impair your ability to get pregnant. It can, though, take a few months off the medication (sometimes up to 18) to become pregnant.

And by the way, if you are pregnant and accidentally get the shot, there is no evidence to suggest that any harm will come to the baby as a result of the medicine.

Victoria Rentel, MD (OSU SHS)

Does the HPV vaccine interfere with birth control medication?


Q: Does the HPV vaccine counteract with birth control medication?

A: If you’re asking if the HPV vaccine makes your birth control less effective at preventing pregnancy, the answer is no

If you’re asking if there are any special risks of receiving the HPV vaccine while taking birth control, the answer is: highly unlikely, although this is a matter of some debate in the medical community at the moment.

More than 26 million doses of the HPV vaccine have been given in the United States so far.  In a recent report, the most common side effects were: pain at the injection site, headache, fever and fainting (which is why your doctor has you wait in the office for 15-20 minutes after a shot). These are common side effects with any vaccination.

There have been a lot of frightening reports in the news media that the vaccine can cause blood clots, but there is currently no evidence that the vaccine in combination birth control is unsafe.

According to a recent review in the Journal of the American Medical Association, out of 23 million doses given so far, there were 56 reports of blood clots, 31 of which had sufficient information for clinical review.  Of the 31 people who had a blood clot, 90% had a condition that put them at increased risk for blood clots before they ever received the vaccine: birth control use, family history of blood clots, smoking, being overweight or inactive.  Hormonal birth control itself is a well known risk factor for blood clot formation, so there is really no way to know whether receiving the vaccine had anything to do with those people developing blood clots.  What we do know is that the HPV vaccine provides protection against the viruses that cause 70% of cervical cancers worldwide.

The CDC and FDA are continuing to monitor the safety data as more people receive the vaccine.  If you have questions or concerns you can always schedule an appointment with one of the providers at Student Health Women’s Services.

Angela Walker, Med IV (Ohio State College of Medicine)

Ryo Choi-Pearson, MD (Ohio State Student Health Services)

Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009 Aug 19;302(7):795-6., 

How long can a woman safely stay on birth control?

birth control pills

Q: How long can a woman stay on birth control and not have it be a health hazard?

A: The short answer: For most people, as long as you want.

The long answer: As long as you don’t have any serious underlying medical conditions such as blood clotting disorders, high blood pressure, or you are a smoker over age 35, long term use of the birth control pill is generally regarded as safe.

We used to think that long term use of the pill could affect fertility down the road but this has proven to be untrue.

There is some evidence that long term use of hormonal birth control can increase your risk of certain cancers such as liver or cervical cancer, but combined estrogen/progestin pills have also been shown to decrease your risk of other cancers such as endometrial and ovarian cancers, and possibly even colorectal cancer.

As for an increased risk of breast cancer with long term use of hormonal birth control, the jury is still out. If you have a strong family history of breast cancer, you may want to talk to your health care provider before starting on hormonal birth control.

Angie Walker, Med IV (Ohio State University College of Medicine)

Mary Jane Elam, MD (Ohio State University Student Health Services)


What are good options for birth control?

Q:  I’m currently on the pill.  Are there other good options for birth control? 

A: There are lots of birth control options out there, each with their own pros and cons.  Here is a quick primer on all of them.  Remember, this is a general discussion – you can always make an appointment with Student Health Women’s Services to determine which option is best for you. 

Oral Contraceptive Pills (OCP’s, “the Pill”) – These work by preventing ovulation as well as thickening cervical mucus to prevent sperm penetration. There are so many different birth control pills on the market that it would be impossible to list them all here, but they all fall into 2 main categories: combination estrogen/progesterone pills and progesterone only pills. 

The pill is easy to use and allows for spontaneity of sex – you don’t have to fish around your purse for one when the mood strikes.  The failure rate is very low; with perfect use, only 1-2% of users become pregnant per year (although the failure rate is slightly higher in “real life”).  The major down side with the pill is that they do not provide protection from STIs, and they can cause side effects such as nausea, bloating, weight gain and increased risk of blood clots, especially in smokers and women over 35.  Also, for some people it’s hard to remember to take a pill at the same time every day.

Vaginal ring – Sold under the brand name NuvaRing, the vaginal ring releases the same hormones as one of the combination pills. The ring is typically left in for 3-4 weeks and then taken out for one week. The pros: it’s good for people who tend to forget to take their pills. The cons: it can cause the same side effects as the pill; you and/or your partner might feel it during sex; it could be expelled unintentionally; and there is the potential “ick” factor of having to insert and remove the ring yourself.

Injectable Contraceptives (“Depo,” “the shot”) – Depo-Provera is an injection that prevents pregnancy for 3 months.  It works like other hormonal contraceptives by preventing ovulation and thickening cervical mucus.  With Depo-Provera, you only have to remember to get a shot once every 3 months instead of taking a pill every day and it has one of the lowest failure rates: only 0.3% of people become pregnant in the first year if using it correctly.  It can cause side effects such as irregular menstrual bleeding, weight gain and breast tenderness and some women may not return to regular ovulation for 6-18 months after discontinuing Depo-Provera, so if you’re thinking about getting pregnant in the near future, this might not be the method for you.

IUD – The IUD is one of the most widely used forms of birth control in the world, but for various reasons it’s gotten a bad rap here in the United States.  The IUD is a small T-shaped device which contains either copper (Paragard) or a hormone (Mirena).  It is inserted into the uterus by your health care provider, and prevents pregnancy by making the uterus a hostile environment for sperm (the exact mechanism isn’t entirely understood).  The IUD is an effective, long term form of birth control; Paragard works for 10 yrs and Mirena for 5 yrs and the failure rate is less than 1%.

The downside to the IUD is that the initial cost is high (although it works out to be a good deal if you compare it to the cost of 10 years worth of pills or shots) and there is a slightly higher risk of pelvic inflammatory disease (PID) if a woman has an STI at the time of insertion.  However, modern IUD’s are safe and effective and therefore can be used by most sexually active women who receive proper STI screening tests.  The IUD can cause menstrual irregularities and an increased risk of spontaneous abortion in women who become pregnant with the IUD in place. 

Male condom – The old standby!  Condoms are cheap, plentiful, effective and easy to use.  With perfect use they are 98% effective in preventing pregnancy (but again, in real life this is more like 85%).  The biggest benefit of condoms is that for STI prevention, the male condom is still #1!  The downside is that they can interfere with the spontaneity of sex, they can tear, people with latex sensitivity can’t use them, and some partners are reluctant to use them.  Ladies, if your partner is unwilling to wear a condom for your protection, maybe it’s time to rethink whether you really want to be having sex with him!

Female condom – The female condom is a polyurethane sheath placed inside the vagina. It has the potential to protect against STIs, but not as well as the male condom. They do allow you to take protection into your own hands when your partner refuses to use a condom but the downside is that they are more expensive than male condoms, have a higher failure rate than male condoms (21% of users typically become pregnant within one year of use) and the polyurethane version can make some weird noises during sex.

The withdrawal method (“Coitus Interruptus”).  While it doesn’t cost you a dime, the withdrawal method provides no protection against STI’s and has a failure rate of 15-25%!  And it’s not just because guys tend to stay in when it’s time to get out – during sex, a sperm-containing fluid will often leak out of the penis before the man actually ejaculates and this can lead to pregnancy.   

Rhythm method – This is where the couple plans sex around the woman’s cycle and abstains when she is most likely to be fertile.  I like to quote my 7th grade Sex Ed teacher about this one: What do you call people who use the rhythm method?  Parents!

Abstinence – The most effective birth control method ever invented – it’s totally free, has no side effects and has a guaranteed 100% success rate in preventing pregnancy and STI’s!  When in doubt, this is always your best bet.  But when the time is right, make sure you know about the other options!

Angela Walker, Med IV (OSU COM)

Ryo Choi-Pearson, MD (OSU SHS)