How soon can I change injections?

Dear Dr Mitchell,

I have been using the Depo Provera injection for about a year now, but I am not comfortable using it. I am not experiencing a lot of side effects. I am just not comfortable not having my monthly period. I have gained a little weight but my biggest concern is my monthly period. I am reading about the monthly injection Mesigyna. However, I would like to know how soon will I be able to change from Depo Provera to Mesigyna?

The Depo Provera injection is an effective form of birth control which contains progesterone only. The fact that there is no oestrogen in the injection makes it a suitable choice for women who cannot take oestrogen. This includes women who have a history of deep vein thrombosis or pulmonary embolism (clot in the leg, veins or in the lungs), women who have oestrogen-dependent cancers such as breast cancer, sickle cell anaemia, where there is a high risk of developing a clot in the leg and women who have severe hypertension. The injection works to thin out the lining of the uterus while it prevents ovulation and so over a long period of time, usually by one year, the menstrual period usually becomes irregular and very light or stops completely. This may be considered an advantage in some women who normally have heavy periods especially those who have fibroids or endometriosis with associated low blood count.

It is actually quite beneficial not to have the period in this case.

However, some women think it is feminine to have a period every month and do not like this feature of the Depo Provera contraceptive injection. Weight gain may also be a feature of the Depo Provera injection in some women.

Mesigyna contains both oestrogen and progesterone and is given every month as opposed to every 90 days for the Depo Provera. This monthly contraceptive injection is associated with the menses coming every month and simulates the normal menstrual cycle. You can actually switch from the Depo Provera to Mesigyna at the end of the 90 days when the Depo Provera would no longer have any significant contraceptive effect in your system. The return of the regular menstrual cycle may not be immediate on discontinuation of the Depo Provera injection and some women have been known to have extended intervals of no menses for up to six months or even longer on discontinuation of the method.

However, this is no cause for concern or alarm. The absence of the period, however, does not mean that you cannot become pregnant so you should start the Mesigyna 90 days after the last Depo Provera injection. Before making the switch, consult with your doctor to ensure that there is no contraindication to the use of oestrogen.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. See responses to your questions in All Woman. We regret we cannot provide personal responses.