How Long Until Depo-Provera Stops Menstrual Periods
Most women using Depo-Provera (DMPA) will experience amenorrhea within the first year of use, with 57% of women reporting amenorrhea by the end of one year of treatment. 1
Menstrual Pattern Changes with DMPA
DMPA causes significant changes to menstrual patterns that follow a typical progression:
- Initial phase: Nearly all patients experience menstrual irregularities when starting DMPA 2
- Progression: These irregularities typically improve over time 2
- End result: Amenorrhea becomes increasingly common with continued use
Timeline of Menstrual Changes
- First 3 months: Irregular bleeding is common
- By 6 months: Many women begin experiencing reduced bleeding
- By 12 months: 57% of women report complete amenorrhea 1
- Long-term use: Higher percentage of amenorrhea with continued use 3
Mechanism of Action
DMPA works through multiple mechanisms that contribute to menstrual changes:
- Inhibits the midcycle luteinizing hormone (LH) peak 4
- Causes the endometrium to become atrophic 4, 3
- Creates small, straight endometrial glands with decidualized stroma 4
- Maintains thick, viscid cervical mucus 4
Counseling Points for Patients
Proper counseling about menstrual changes is crucial for patient satisfaction and continuation:
- Studies demonstrate that patients are more likely to continue DMPA use if counseled about adverse effects before their first injection 2
- Menstrual irregularities are a leading cause of discontinuation when patients aren't properly informed 5
- Patients should be informed that amenorrhea is an expected and medically benign outcome of DMPA use
Important Considerations
Administration Schedule
- DMPA is administered every 13 weeks (up to 15 weeks) 2
- Many providers schedule visits every 11-12 weeks for adolescents to allow for missed or delayed visits 2
Other Side Effects
- Weight gain (particularly in those who show early weight gain at 6 months) 2
- Headache, nervousness, abdominal discomfort, dizziness 1
- Potential bone mineral density effects (though these typically reverse after discontinuation) 2
Return to Fertility
- Return to fertility is typically delayed for 9-18 months after discontinuation 2
- This delay occurs while the endometrial lining returns to its pre-DMPA state and ovulatory function returns 2
Bottom Line
While individual responses vary, most women using DMPA can expect their periods to become lighter over time, with a majority experiencing complete amenorrhea by one year of use. This amenorrhea is considered a beneficial side effect by many users and should be presented as such during pre-treatment counseling.