Blog of the Society for Menstrual Cycle Research

Depo Provera and menstrual management

April 8th, 2014 by Holly Grigg-Spall

Melinda Gates speaking at the London Summit on Family Planning; Photograph courtesy Wikimedia Commons

A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”

I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.

In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation.  Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.

Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.

When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?

It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?

3 responses to “Depo Provera and menstrual management”

  1. Leslie says:

    Thank you Holly for expressing our concerns. I have had many women and other practitioners reach out to me from Africa and India. The women are suffering and the practitioners do not know what to do. And of course their resources are limited.

    One very overweight woman in Africa (going thru Depo withdrawal) mentioned to me that their communities are engulfed with plastic – so now the exposure to xenoestrogens must also be taken into consideration. And the alternatives are slim to none.

    Another medical group from South Africa just reached out to me as well. Their country is initiating an Implanon campaign in conjunction with the HPV vaccine campaign. (Merck & Co is the manufacturer of both these drugs.)

    No safety testing has been done on the use of Implanon with the vaccine. And even if it had been done – the results would not apply in this demographic.

    I just asked the group from India if the HPV campaign had been implemented in conjunction with Depo in their country – but have not had a response back from them yet.

    Many of us have woken up to the fact that the Depo ‘injection’ is nothing less than the birth control ‘vaccine’ that Bill Gates has touted all of these years.

    I will be sending the link to this article on to my colleagues in Africa and India. Thank you Holly.

  2. Melissa says:

    I thought they stopped prescribing that….. ‘Aid’ often is about manipulating foreign markets and branding ourselves as saints to get away with it. If no one will take depo here because its horrible, then a new market is needed. This isnt about empowering women, or if it is, the people behind it are incredibly stupid.

  3. Melissa says:

    Also another interesting tidbit: Depo is also used in to chemically castrate sex offenders…. (!!!!!!!!!!)

    I wonder sometimes how much of the efficacy of hormonal birth control is due to women not wanting sex as much!

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