Depot progesterone contraception and return to fertility

• amenorrhoea associated with Depo Provera has raised concerns about oestrogen deficiency diseases, especially osteoporosis - however ".. studies suggest that there is little cause for concern" (1)
• amenorrhoea does not indicate hypo-oestrogenism - oestrogen follicular activity may still result in adequate oestradiol levels
• the measurement of oestradiol levels in women using Depo Provera should only be considered if either,
  • women have symptoms of hypo-oestrogenism e.g. hot flushes, vaginal dryness, or,
  • women have been using this form of contraception for five years or more (with or without amenorrhoea)
• oestradiol levels are not indicated if either,
  • the woman wishes to change her form of contraception anyway, or,
  • the woman wishes to continue using Depo Provera despite the result
• if a woman wishes to consider changing from using Depo Provera if the level of oestradiol were low then
  • the oestradiol level should be measured directly before the next Depo Provera injection is due - if the oestradiol level is 100pmol/l or less then a repeat oestradiol level should be taken directly before the next injection is due. If again the result is 100 pmol/l or below then an alternative method of contraception should be discussed
• delay in return to fertility
  • mean return to fertility with Depo Provera is 5.5 months
  • about 60% of women conceive within 12 months of discontinuation of Depo-Provera (85% within 24 months)

Reference:

1. Pulse (2001), 61 (47), 76
2. NICE (October 2005). Long-acting reversible contraception