We received a question about the use of Depo-Provera.
Depo-Provera is an injection of progesterone that is used to:
The injection is given every 3 months. Many women will stop having their menses (periods) when receiving the Depo-Provera injection regularly (menses will resume when the shot is no longer used). It is an effective form of birth control and, when it eliminates periods completely, it can be an effective way to eliminate symptoms associated with periods. Since periods often are stopped altogether while using Depo-Provera, it can be helpful for those women who are challenged by managing their periods (which can be an issue for some women with Down syndrome). It doesn't protect against sexually transmitted diseases. (Pfizer, the manufacturer of the drug, produced a handout that you can find at this link.
There are some particular issues that we consider for our female patients with Down syndrome such as:
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Depo-Provera does require an injection every 3 months which some of our patients find challenging.
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Depo-Provera can increase osteoporosis (thinning of the bones) which is already more common in people with DS.
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Particularly in the first year of use, the periods (or spotting/bleeding) may be less predictable and more frequent and this can reduce the benefit of trying to reduce the periods (at least in the first year).
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Depo-Provera can contribute to mood changes or depression. We have found this to be a problem, for example, in a woman we are trying to reduce mood swings associated with the menstrual cycle. We may reduce cyclic mood changes but increase overall depression or mood problems.
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Depo-Provera can increase the risk of abnormal blood clotting. We have found a number of our patients with a predisposition to abnormal clotting. This seems to be on the basis of autoimmune conditions (the body's immune system being directed at a component of the body). People with DS are thought to have a higher incidence of autoimmune conditions such as autoimmune thyroid disease, Rheumatoid arthritis, and others. In some autoimmune situations, increased (abnormal) blood clotting is a problem. The use of Depo-Provera for these women may be particularly concerning.
Depo-Provera can be an effective medication for birth control and reducing symptoms associated with having periods. It can be easy to use in the sense that it is an injection every 3 months, there is no need to remember to take a pill every day, there are no issues of manual dexterity that make using a barrier method (eg. condom or diaphragm) challenging for some people with Down syndrome, and it will likely have the benefit of eliminating periods altogether. However, the potential negative aspects of its use should also be considered.
As always, we recommend consultation with your own health provider to discuss the pros and cons.