The Unique Dangers of Depo-Provera Birth Control Shot

How hormonal disruption leads to immune suppression

“Depo Provera is the only contraceptive to mimic cortisol in the body, which makes its side effects really serious,” said Dr. Joel Brind, PhD, Professor Emeritus of Human Biology and Endocrinology at Baruch College of the City University of New York. Depo has been shown to increase a woman’s risk of both loss of bone density and HIV, each a result of its effects on cortisol levels. 

“There’s no excuse in the western world to have it on the market at all,” Dr. Brind stated. “Not with everything else on the market that is just as effective as a contraceptive.” 

During the 1980s, Dr. Brind specialized in the metabolism of steroid hormones and their relation to various human diseases. He was the lead author of a 2015 systematic review on the link between Depo Provera and increased risk of acquiring HIV. The World Health Organization recognized this evidence in 2017.

Contraceptive drugs generally referred to as “hormonal” contraceptives—from the pill to the implant and the vaginal ring or Depo Provera (“the shot”)—are designed to chemically disrupt and impair the healthy, natural patterns of the endocrine system that allow pregnancy to occur.

Composed of synthetic steroids (which are lab-produced chemicals that mimic the action of natural hormones), a contraceptive’s effects are not limited to the reproductive system. Unfortunately, like natural hormones, these chemical move through the circulation system. As the body’s chemical messengers, hormones regulate and coordinate all biological systems, traveling through the bloodstream and affecting cells throughout the body. 

A supplement of stress

Depo Provera is unique among steroidal contraceptives in its tendency to affect cortisol, Dr. Brind said, along with the female hormones more directly responsible for the reproductive system. Many such drugs, and the Depo Provera injection in particular, can result in a range of less desirable side effects. For instance, Depo’s cortisol-like activity triggers the same toxicity as continuous stress upon the body.

As Dr. Brind explains, cortisol is the hormone that rises under stress. Because it mobilizes proteins from the bones for flight or fight in an emergency situation, surges of cortisol are best reserved for rare moments of genuine danger. A constant infusion into the blood stream as is produced with Depo is detrimental to health as is unrelenting stress.

Cortisol also suppresses the immune system. Dr. Brind noted that loss of bone mineral density is an adverse drug effect that Depo users share with organ transplant patients, who require a steady influx of cortisol to suppress the immune system in order to inhibit the body’s natural rejection of a transplanted organ. These immunosuppressive agents are lifesaving for a transplant patient, but also cause them to be dangerously vulnerable to even minor illnesses.

Depo’s suppression of ovarian estrogen production also contributes to decline in bone mineral density. As post-menopausal women face loss of bone density that comes with the loss of estrogen, the shot can have this side effect in young women who are in the prime years of building their bone density.

Increased risk of HIV

Another serious ramification of Depo’s suppression of the immune system is that this drug causes a greatly increased risk of contracting HIV (human immunodeficiency virus). HIV is incurable, and, if untreated, can develop into AIDS (acquired immunodeficiency syndrome). The use of Depo is associated with a “40–50% increased risk of HIV-1 compared to women not taking hormonal contraception.”

Much of the spread of HIV in the US comes from anal sex, Dr. Brind explained. The lining of the rectum and anus are much more easily injured than the vagina, and allow blood and fluids to be exchanged, including the passage of HIV. On the other hand, as Dr. Brind goes on to say, the vagina has natural defense, with its multi-layer structure. It’s “like external skin,” and is well adapted for intercourse and resistant to injury. Depo has been shown to specifically compromise the integrity of the vagina’s natural mucus membrane and to impair its normal resistance against infection.

“The vagina is relatively resistant unless you’re taking something like Depo Provera,” he added. “It increases in HIV spread in women.”

Healthier options

While Depo Provera and other steroidal contraceptives pose potentially serious threats to a woman’s health, having normal hormone levels and a normal period brings with it the health benefits of better bone health and stronger immune function.  With training, a woman can learn to manage her fertility naturally by using a Fertility Awareness Method, also known as Natural Family Planning.

These medically-designed alternatives to pharmaceutical contraceptives allow the reproductive system to function normally, with balanced hormones, while providing effective family planning. Instead of suppressing the reproductive system, a woman learns to understand and support her reproductive health. Based on a woman’s understanding of the menstrual cycle, these methods equip her to identify her specific fertile and infertile phases and to plan intercourse or abstinence accordingly. These fertility monitoring skills can also help connect symptoms with diagnoses, root causes, and treatment of reproductive disorders, while safeguarding the health benefits of a naturally function menstrual cycle.