Women's Health Community

Dear An: There can be several reasons to have spotting or breakthrough bleeding on DepoProvera. When a woman uses hormonal birth control it can make the lining of the uterus more unstable--so it is easier to have some of it begin to shed.

Sometimes the lining is less stable because the hormones make the lining much thinner (actually this is good as a thin lining is a healthy lining). . Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods.


Sometimes the lining is unstable because the hormones can make parts of the lining out of synch. This is the most common reason for breakthrough bleeding in newer Depo users.

Lastly, if one has a new chlamydia infection, that too can make the inflamed lining less stable. This is not likely be the reason for your spotting if you are in a monogamous relationship.

In all these types spotting can be triggered by sex or even heavy exercise.

Bottom line, unless you have risks for an new sexual infection, you can choose to self monitor and see if the spotting resolves. If your cramping or poor cycle control persists you should return to your GYN or clinic.

Yours,
Jane