DEAR READERS,
Miss D.R. is a 45-year-old woman from the Kingston 17 area. She has used the Depo Provera as her main method of contraception for over 22 years. She is trying to live a Christian life and is not often sexually active. However, she has, in the past, ventured out a "little bit".
She says she has always used "protection". She has two observations which concern her. She has noticed that after stopping the injection to "rest" her body, whenever she starts back on the method she experiences irregular and prolonged bleeding over several months, then later has no period at all. She is also seeing a light discharge with a "funny scent" which itches a bit. She has been treated for this on more than one occasion, but it recurs. She also experiences itching over her "mons pubis".
Miss D.R. is, in fact, a very successful user of the Depo Provera method of contraception. It has worked almost perfectly for her. Depo Provera is the most commonly used injectable method for birth control purposes. It is a progestin hormone, which is used by more than 15 million women worldwide. It produces:
Inhibition of ovulation Thickening and decrease in the amount of cervical mucus, thus making it more difficult for sperm to penetrate.
It creates a thin atrophic endometrium.
The contraceptive is used every three months and is given by deep intra muscular injection. It is a very effective contraceptive with a failure rate of below 0.3 per cent. The Depo Provera causes Amenorrhea (lack of period) in most women. Many women consider this to be an advantage. This contraceptive is safe for use within six weeks of childbearing and does not hinder breastfeeding once this has been established.
However, because of the change the Depo Provera produces in women's menstrual cycles, some women become frustrated and stop using it. Many women experience an increased number of days of light bleeding while some women go on to experience Amenorrhea. Amenorrhea (lack of period) becomes more common over time with Depo Provera use, as has been described by Miss D.R.
Problems with increased bleeding or amenorrhea are usually addressed by the administration of oral estrogens, prostaglandin inhibitors such as Gardan or Ponstan, or a combination of both. Using the Depo Provera for birth control also has a number of advantages. This injection actually decreases the frequency of sickle cell crisis and of seizure disorder (fits). It is also a very private method of contraception as no pills are taken, visits to the clinic are infrequent and there are no outward signs of contraceptive use at all, a plus for those women who would like to keep contraceptive usage a deep secret.
The funny scented discharge, which Miss D.R. is experiencing along with itching over her mons pubis, which is the hair-covered area of the genitalia, could be due to several causes. Use of the Depo Provera as a contraceptive gives a "minor" protection against sexually transmitted diseases (STDs), but not much.
Miss. D.R. does have a small history of sexual encounters with differing partners. Although she says that she has always used protection, this possible source of infection cannot be ignored. Because of this, Miss D.R. should request that her doctor perform tests such as a High Vaginal Swab (HVS) and a Pap Smear to determine the exact cause of the discharge. This will allow for treatment to be specific. This discharge can also keep recurring if her sexual partners are not also treated at the same time as herself (a "ping-pong" effect).
The common yeast infection can also be difficult to control in some women and may require prolonged "monthly" treatment with oral or vaginal medication to effect a more lasting cure.
A.J.M.
By Dr. A.J. MORGAN
