Am I at risk for infertility or osteoporosis?
Dear Dr Mitchell,
I am 17 years old and I’ve been on the Depo shot for about a year now. I’ve heard that the shot can leave you sterile and also cause osteoporosis. Do I have a greater risk in any of these, since I started on the depo at a young age? I am really thinking of changing my form of contraceptive.
Depo Provera is a progesterone only hormonal form of contraception which is given by an injection in the muscles every 90 days. It is very effective in preventing pregnancy and is a safe and appropriate choice especially for women who cannot take oestrogen. This is especially so in women who have had a history of a clot in the leg (deep vein thrombosis) and in patients with sickle cell disease.
The use of the Depo Provera injection suppresses the production of oestrogen by the ovaries. There has been some concern that women using the Depo Provera injection might develop osteopenia (thinning of the bones).
A study done in New Zealand in women who used Depo Provera for at least five years showed that these women had significantly reduced bone density in the lumbar spine (bones in the lower back) and in the neck of the femur (leg bone). However a subsequent study done by the same investigations showed that the effects were reversible following discontinuation of the Depo Provera injection in women who used it for at least three years.
The use of Depo Provera before 21 years and use for more than 15 years are definite risk factors for decreased bone density. Information on the effects of the Depo Provera injection on bone mineral density during adolescence is very limited. Oestrogen supplementation can be considered when long term use of Depo Provera is to be undertaken in adolescents. This may be in the form of oestrogen tablets taken daily. Adolescents known to be at higher risk for low bone density should consider using alternative forms of contraception, especially if this is to be used on a long term basis.
You should consider using the oral contraceptive pills and the female or male condom as a back up. Remember that the only contraceptive method that is effective against sexually transmitted disease and HIV infection is the condom (male or female).
Sexually active teenagers are at significantly increased risk of developing cervical cancer in the adult years. The use of the oral contraceptive pills from a young age increases your risk for cervical cancer. The Human Papilloma Virus (HPV) is the underlying cause of cervical cancer and the fact that you do not use a barrier method such as the male or female condom increases your risk of exposure to HPV and subsequently cervical cancer.
Abstinence is probably the best option for you at age 17 years. If you think this is impossible then the condom is a must at all times, irrespective of your choice of contraception.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
