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Depot progesterone contraception and return to fertility

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • amenorrhoea associated with Depo Provera has raised concerns about oestrogen deficiency diseases, especially osteoporosis - however ".. studies suggest that there is little cause for concern" (1)
  • amenorrhoea does not indicate hypo-oestrogenism - oestrogen follicular activity may still result in adequate oestradiol levels
  • the measurement of oestradiol levels in women using Depo Provera should only be considered if either,
    • women have symptoms of hypo-oestrogenism e.g. hot flushes, vaginal dryness, or,
    • women have been using this form of contraception for five years or more (with or without amenorrhoea)
  • oestradiol levels are not indicated if either,
    • the woman wishes to change her form of contraception anyway, or,
    • the woman wishes to continue using Depo Provera despite the result
  • if a woman wishes to consider changing from using Depo Provera if the level of oestradiol were low then
    • the oestradiol level should be measured directly before the next Depo Provera injection is due - if the oestradiol level is 100pmol/l or less then a repeat oestradiol level should be taken directly before the next injection is due. If again the result is 100 pmol/l or below then an alternative method of contraception should be discussed
  • delay in return to fertility
    • mean return to fertility with Depo Provera is 5.5 months
    • about 60% of women conceive within 12 months of discontinuation of Depo-Provera (85% within 24 months)


  1. Pulse (2001), 61 (47), 76
  2. NICE (October 2005). Long-acting reversible contraception

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