Dr Sarah Brewer answers iVillagers questions about these popular forms of contraception
Periods after the Depo injection
Does taking Depo Provera have any long-term side effects?
Will taking Dianette cause fertility problems?
Will I feel menopausal on Depo?
Irregular bleeding after the injection
Is PCOS or the Pill affecting my cycle?
Trying to conceive after taking Depo
Live discussions on the Sexual Health and Contraception message board
Breakthrough bleeding
Q: I've recently changed the Pill I am taking from Microgynon (which I was on for just over three years) to Eugynon. For the last year I've experienced spotting and bleeding in the seven days leading up to my 'Pill-free week'. It didn't cause physical problems, but it was a bit of a pain. Is this something I should be worried about?
psc_loves_her_moosey
A: Although breakthrough bleeding can occur 'normally' during the first couple of months of being on the Pill, it is a sign that you are not getting a high enough dose of hormones. If this continues, it may increase your chance of an unplanned pregnancy. You must mention it to your doctor, as you probably need either a different blend of hormones, or a slightly higher dose of your current blend. Your doctor is in the best position to decide whether to change your prescription, or to 'wait-and-see'. If it is vital that you do not get pregnant in the meantime, you might want to either abstain or use condoms just in case to be doubly safe.
Periods after the Depo injection
Q: My periods still haven't returned after coming off Depo just under two years ago (I took it for five years). I now want to start trying for a baby. Is there an average time for them to return and when they do return does this mean fertility should be back to 'normal'? I was referred to a gynae by my GP who would not do anything about it. The leaflet I was given when I first had the Depo says that things should be back to normal after six months.
tractorgirl2004
A: As the injection is a slow-release preparation, it does not stop acting immediately three months after the last jab. Research suggests that women trying to conceive after stopping Depo take at least four months longer to become pregnant compared with women stopping other methods of contraception. In some cases, fertility may take up to a year or longer to return. As you have been off Depo for 21 months, it is likely that the lack of periods is due to another cause, which needs to be investigated. As a GP I would have referred you too - and would have been surprised by the consultant's response. Try going back to your GP and seeing whether he/she is willing to refer you again.
Does taking Depo Provera have any long-term side effects?
Q: My family planning clinic doctor told me recently that Depo is not a long-term contraceptive and that I have to come off it (I am a normal weight and a non-smoker). I was also told that it has severe side effects, such as bone thinning and high cholesterol. The literature I was given does not confirm this. Which information is correct?
welovemarmite
A: Long-term lack of periods associated with Depo use is thought to increase the risk of bone thinning and osteoporosis - especially in smokers - although this is not yet proven. Some clinics measure oestrogen levels after a woman has used depot progestogen for five years and offer added oestrogen replacement if levels are low. Research is currently looking into this.
Will taking Dianette cause fertility problems?
Q: I was put on Dianette three years ago having asked to go on the Pill for contraceptive purposes. The doctor pointed out that I was suffering from more spots than normal and prescribed Dianette. I heard that Dianette is a strong Pill bad for any length of time and am worried it will affect my fertility.
an8elica
A: It's usually recommended that Dianette is stopped (and another pill used) three to four months after acne or excess hair problems have resolved themselves. Although it is unlikely to have caused you any harm, it is a good idea to ask your doctor whether or not it should be changed if your acne has resolved.
Will I feel menopausal on Depo?
Q: I am in my mid-40s and have been on the Depo for many years and personally think its wonderful. However, without periods how will I know when I start the menopause, as I thought irregular periods was one of the main features? Also when will I know it's perfectly safe for me to stop taking it without any risk of pregnancy?
cassui
A: You would usually expect to start getting symptoms due to lack of oestrogen when the menopause arrives. As Depo does not contain oestrogens, it will not mask the usual hot flushes and night sweats that affect 75 per cent of menopausal women. If you are one of the 25 per cent of women who do not get significant menopausal symptoms, it can be difficult to know. Your doctor will usually suggest blood tests to check hormone levels at some stage (around the age of 50), as he or she won't want to continue giving you unnecessary depot injections. The average age for menopause is 51 years old. It is usually advised that you use contraception for one year after menopause if this takes you past the age of 50, otherwise, for two years after the menopause.
Irregular bleeding after the injection
Q: I came off the Depo injection at the beginning of the year and was told not to expect periods for around six to 12 months. Literally a month afterwards I had bleeding but this has been irregular spotting and at one stage was happening every two weeks. In the last eight weeks I have had no bleeding whatsoever. I'm a little confused and wondered if anyone had similar problems?
brit2001
A: Irregular bleeding can occur after stopping Depo. Research suggests that women trying to conceive after stopping Depo take at least four months longer to become pregnant compared with women stopping other methods of contraception (for example, ten months instead of the average of six). In some cases, fertility may take up to a year or longer to return. As you are concerned, make an appointment to talk to the nurse or doctor who usually provides your contraceptive advice.
Is PCOS or the Pill affecting my cycle?
Q: I'm 31 and came off the Pill after 12 years in January in order to start trying to conceive in October after my wedding. I was diagnosed with PCOS in 1996 but an ultrasound scan in August 2003 showed no cysts on either ovary. Since coming off the Pill my initial cycles were 28 days, but for the last two months they have been 33 and 35 days. I'm getting increasingly worried about what is going on - should I start trying for a baby now?
petals2004
A: Studies have shown that the different causes of lack of menstruation or changes in menstrual patterns are the same between women who have recently taken the Pill and those who have not, and that they occur with the same frequency so it is likely to be the PCOS rather than the Pill that is affecting your cycle.
One study looking at women aged 30 to 35 years who had not previously had a child suggested that, after stopping the Pill, 50 per cent took up to a year longer to conceive compared to those of the same age who had previously used a diaphragm. Conception rates were almost identical after 72 months, suggesting no permanent impairment to fertility. However, few women aged 30 to 35 would want a delay of up to six years before conceiving once they decide to start a family.
Only you and your partner can decide whether or not to start trying to conceive. If there is no desperate hindrance to starting to try now, then it may be worth going for it. If you get pregnant straight away, great! If you do have difficulty in conceiving, at least you will have had brought forward the time when investigations and assisted fertility techniques can be started.
Trying to conceive after taking Depo
Q: I had my last Depo injection in October last year and have not used any form of contraception since because I've been trying to conceive. I have a daughter who is two and was conceived after one month, so I am very confused as to why I have not fallen pregnant yet. I was not on Depo before I had my daughter, just the Pill.
We have been referred to a fertility clinic for some tests, but is there anything I can do in the meantime to help?
annajwales
A: The luteinising hormone surge usually kick-starts ovulation, and kits (or Calista saliva testing in which you examine saliva under a pocket microscope) are the best way to predict your fertile time. You might want to consult a herbalist - agnus castus is successful in increasing fertility where difficulty in conception is linked with low progesterone levels during the second (luteal) phase of the menstrual cycle (from ovulation to the onset of menstruation). In one study of 45 women with this form of infertility, seven became pregnant during the three-month trial and 25 women had their low progesterone levels restored to normal. Treatment should be stopped as soon as pregnancy is suspected, however. It is also helpful for irregular periods - tending to shorten a long cycle and lengthen a short one.