Off Depo Provera But Still No Period, What's Wrong?

Question:

Hello, I am 30 years old and was on the Depo-Provera shot for 3 years during which time I did not have a single period. I had my last shot in January 2008 and still have not had a period. My husband and I would like to start a family in the next 2-3 years and I am getting increasingly worried that this will not be possible. I am also suffering from very bad vaginal dryness (could this be related?)

I am currently doing some voluntary work in Argentina now and it is difficult to see an English speaking doctor. Is there something I can do to help my self in the short-term or should I consider returning home to seek medical advice?

Answer:

Hello T. from Argentina,

I am surprised that you can't find an English speaking doctor in Argentina. Maybe you should look for a Reproductive specialist specifically as most of them do speak English. If you still can't find one, then you should return to the U.S. for consultation.

Certainly, something is not working correctly which is preventing the ovary from ovulating, hence no periods. This is not due to the Depo Provera, since it does not last this long. It can delay periods for 1-3 months but not usually longer. There is something else going on and you need to undergo evaluation. The vaginal dryness is because you are probably not producing estrogen, which occurs with ovulation, and the vaginal gland is estrogen dependent. You don't want this to go on much longer because the vagina will actually begin to shrink and intercourse will be difficult and painful.

In order to get pregnant, depending on the cause of the problem, you need a treatment that will get you ovulating again. There are various options, but it depends on the cause. In the meantime, you might want to consider going on the birth control pill in order to get you cycling again (it overrides the ovaries so is not correcting the problem), which will give you estrogen. Many parts of your body require estrogen. You should be able to get this from a non-English speaking doctor while you plan to return to the U.S. for consultation.

Thank you for writing and good luck!

Sincerely,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com