Getting Pregnant After Coming Off The Depo Shot

So you’re coming off the depo shot and now want to get pregnant. How long does it take to get pregnant after depo? And is there anything you can do to speed it up? Dr. Mare explains wait time expectations and more in this article.

By Dr. Mare Mbaye

Getting pregnant after any type of hormonal birth control is a topic that comes up often in the office. There are so many misconceptions about how birth control can affect fertility and whether or not it needs to be “cleansed” out of the body (hint: it doesn’t—you can read more about getting pregnant after stopping birth control in our blog.  I get questions about the depo-provera shot specifically, though, because as a longer-acting medication, timing matters a little more when it comes to pregnancy.

What Is Depo?

First off, what is depo and how does it work? Depo-provera (aka depot medroxyprogesterone acetate or DMPA) is a common form of progesterone-only birth control shot that can be great for those who want something quick and effective without the hassle of daily or weekly administration. The active hormone is progestin, which is simply a man-made version of our natural progesterone hormone. High levels of progesterone signal the ovaries to stop ovulating and also cause the cervical mucus to thicken, preventing sperm from ever reaching an egg if ovulation does occur. This birth control method is given as a shot once every three months in the office, making it very convenient. The depo injection shot creates a reserve or depot (hence the name—clever, right?) of progestin in the body at the site of the injection that delivers a steady amount of hormone, which is why the doses can be spread out so far. About 50% of women on depo will stop having their menstrual period after about one year.

Effectiveness, but With One Big Downfall

This is the big reason why I always ask women who are not done having children and want to go on depo how soon they would like to be pregnant again. If the answer is in a year or less, then the depo injection is usually not my first choice, even if you’re only getting one shot. This is because of how unpredictable the return to normal fertility and a regular menstrual cycle can be. While you can definitely get pregnant three to four months after a depo-provera injection wears off, not everyone does. It can sometimes take up to ten months or more to ovulate again, and it can take up to 18 months for normal periods to restart.¹ This irregular bleeding can be quite distressing for some women. Be sure to learn more about the causes of irregular periods after stopping birth control. 

Getting Pregnant After Depo

The good news? Chances of pregnancy are still great, even if it may take a little more time. Pregnancy rates at the one year mark after stopping depo are over 80%, and at the two year mark they’re over 90% (which is the normal fertility rate).²

Coming off the Depo Shot: A Unique Experience for Everyone

Why do some women take longer than others to return to normal fertility? We don’t know for sure. There are likely many factors that contribute to each woman’s response to a depo provera contraceptive injection, making it hard to pinpoint one specific issue. Just like anything else in life, every patient has a unique experience.

One important factor to consider, though, is weight. The FDA includes on the depo label that women of a healthy weight tend to return to normal fertility faster than those who are overweight and obese.³ This has to do with absorption of progesterone which differs based on each person’s metabolism.⁴ With the newer, subcutaneous version of depo (compared to the intramuscular shot), the delay in ovulation appears to be substantially decreased, with one study showing return to ovulation for 97% of women who received subcutaneous depo.⁵

Women of a healthy weight tend to return to normal fertility faster than those who are overweight and obese.

On the other hand, the time frame of depo provera CI use does not seem to matter. Your individual return to normal fertility is the same whether you’ve had six months of depo shots or six years.⁴

How to Get Your Period Back After the Depo Shot

So what can you do to speed up your return to ovulation after getting off the depo shot? Unfortunately, not much. This is always difficult to hear, but the body has to have the time it needs to metabolize normally. There are no cleanses, diets, or supplements that will make the process go faster. In fact, some of those things may have ingredients that could potentially be harmful to a new pregnancy.

There are no cleanses, diets, or supplements that will make the process go faster. In fact, some of those things may have ingredients that could potentially be harmful to a new pregnancy.

Thankfully, knowing when things are back to normal is much easier than waiting for it to happen. You can be sure you’re ovulating normally again when you resume your regular periods or by testing for ovulation using ovulation tests. However, this does not mean you can’t get pregnant before your periods come back—ovulation occurs about two weeks before any period, ⁶ so pregnancy can occur before you actually have that first menstrual period.

Use the Wait Time to Prepare for Pregnancy

Hurrying up and waiting is never fun, but the time can be used effectively to prepare as best as possible for pregnancy. Here are some ways:

• Start taking a prenatal vitamin.
• Plan ahead and stop your depo shots well in advance of when you want to get pregnant. An alternate birth control method may be a good idea in the interim.
• Exercise regularly, and eat a balanced diet to help increase your metabolism and maintain a healthy weight. Moderate weight loss in overweight patients has the added benefit of boosting fertility.
• Have regular, unprotected sexual intercourse once you’re ready to conceive. As mentioned before, if your periods haven’t returned or are not regular, you may still get pregnant.
• Make sure you are using FDA-cleared fertility lubricant that will not harm sperm.
• Use ovulation predictor kits (aka OPKs or ovulation tests) to figure out when ovulation returns so you can time sexual intercourse effectively. The form of birth control you were previously using does not change the efficacy of these methods.

All of these are safe, healthy ways to optimize yourself for pregnancy when coming off the depo shot.

As always, use your healthcare provider and speak to your doctor when you have concerns, but especially if it’s been 24 months since your last depo shot, and you’re still not having regular periods or if you haven’t conceived 12 months after having normal periods again (if you’re 35 or over, contact your healthcare provider after 6 months instead).

Also, reach out to organizations like Planned Parenthood that offer a wide array of sexual health and contraception services. They are equipped with professionals who can provide more information about the depo shot, managing menstrual irregularities or dealing with painful periods.

Sources:

1. Mansour D, Gemzell-Danielsson K, Inki P, Jensen JT. Fertility after discontinuation of contraception: a comprehensive review of the literature. Contraception. 2011;84(5):465-477. doi:https://doi.org/10.1016/j.contraception.2011.04.002 
2. Pardthaisong T, Gray RonaldH, Mcdaniel EdwinB. Return of fertility after discontinuation of depot medroxyprogesterone acetate and intra-uterine devices in northern Thailand. The Lancet. 1980;315(8167):509-512. doi:https://doi.org/10.1016/s0140-6736(80)92765-8 

3. Highlights of prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020246s036lbl.pdf 

4. Schwallie PC, Assenzo JR. The effect of depo-medroxyprogesterone acetate on pituitary and ovarian function, and the return of fertility following its discontinuation: A review. Contraception. 1974;10(2):181-202. doi:https://doi.org/10.1016/0010-7824(74)90073-0 

5. Jain J, Dutton C, Nicosia A, Wajszczuk C, Bode FR, Mishell DR. Pharmacokinetics, ovulation suppression and return to ovulation following a lower dose subcutaneous formulation of Depo-Provera. Contraception. 2004;70(1):11-18. doi:https://doi.org/10.1016/j.contraception.2004.01.011 
6. Roos J, Johnson S, Weddell S, et al. Monitoring the menstrual cycle: Comparison of urinary and serum reproductive hormones referenced to true ovulation. The European Journal of Contraception & Reproductive Health Care. 2015;20(6):438-450. doi:https://doi.org/10.3109/13625187.2015.1048331