Can Depo Provera Treat Endometriosis?

Depo Provera Treats Endometriosis
Depo Provera Treats Endometriosis Pain. Anna Bizon/Getty Images

Endometriosis is a condition where the tissue that normally lines the inside of your uterus (the endometrium) grows in other areas of the body -- most commonly on the ovaries, fallopian tubes, and other organs in the pelvic region. It can cause pain and irregular bleeding.

Endometriosis is a common problem, affecting approximately 5.5 million American girls and women of reproductive age. Symptoms also seem to get worse around the time or your period.

There is no cure for endometriosis. If it is not treated, though, it may lower your chances of being able to become pregnant in the future. Endometriosis is one of the top three causes of infertility. The goal of treatment is to control pain and prevent the endometriosis from getting worse. Treatment can consist of medication and/or surgery. The type of treatment you may seek usually depends on the severity of your symptoms and whether or not you may want to become pregnant.

Depo-subQ Provera 104 is a contraceptive injection that contains the progestin, medroxyprogesterone acetate. It received FDA-approval in March 2005 for the treatment of endometriosis-related pain. This FDA-approval served as the first new medical remedy for endometriosis pain relief in 15 years. Although this FDA-approval does not apply to the original Depo Provera shot, Depo Provera injections can also help treat the pain associated with endometriosis.

How Does Depo Provera Help Treat Endometriosis Pain?

The progestin in Depo Provera is thought to help suppress the growth of endometrial tissue and may also reduce endometriosis-induced inflammation.

During your normal menstrual cycle, your hormones cause the lining of your uterus to thicken in preparation for a pregnancy.

If you don’t become pregnant, the lining of your uterus sheds, and you bleed (this is what causes your period). The hormones that control your menstrual cycle naturally rise and fall throughout your cycle. This rising and falling can cause endometriosis symptoms to become worse. Also, if you have endometriosis, when you have your period, the bleeding not only comes from the lining of the uterus -- the endometrial tissue that has grown outside your uterus also bleeds. When this blood touches other organs, it can cause scarring and inflammation which is what causes pain.

The use of Depo Provera allows your hormone levels to stay stable throughout your cycle. It helps to thin the lining of the uterus -- this can lead to lighter periods or none at all. Depo Provera may also prevent ovulation and lowers the amount of estrogen circulating in your body. The idea here is that the less estrogen stimulation the endometriosis tissue receives, the less cell activity occurs. This slows down the growth rate of the tissue.

Just like the lining of the uterus responds to these hormone levels, the endometriosis tissue does as well.

What Other Medications Treat Endometriosis?

Before the use of hormone therapy (like Depo Provera) for the treatment of endometriosis, GnRH agonists (like leuprolide) have been the main medication prescribed for endometriosis pain-relief . This drug is a version of a naturally occurring hormone, known as gonadotropin releasing hormone, which helps to control the menstrual cycle. When you use leuprolide, it basically stops all hormone and ovarian activity. Leuprolide is also associated with significant side effects, some of which include:

  • Vasomotor symptoms (hot flashes, palpitations, sweating)
  • Bone loss
  • Hypoestrogenic symptoms (vaginal dryness, mood swings, sleep disturbances)
  • Headaches
  • Depression
  • Decreased libido

What Does the Research Say about Depo Provera vs. Leuprolide?

One of the most well-known studies in this area compared Depo-subQ Provera 104 and leuprolide use in 257 women who were laparoscopically diagnosed with endometriosis. There were 153 women who used Depo-subQ Provera 104 and 146 women who used leuprolide during for 6 months. The results showed that:

  • Depo-subQ Provera 104 is equally as effective for treating pain caused by endometriosis as leuprolide.
  • Both Depo-subQ Provera 104 and leuprolide use effectively reduced pain in the five main endometriosis symptoms: pelvic pain, dysmenorrhea, pelvic tenderness, dyspareunia (painful sex), and induration (hardening and thickening of tissue).
  • After 6 months of use, Depo-subQ Provera 104 resulted in less bone mineral density loss than leuprolide. At 12 months post-treatment, bone loss levels returned to pre-treatment levels for Depo-subQ Provera 104 users, but not for those who used leuprolide.
  • Both medications equally contributed to significant improvements in quality of life and total productivity.

The researchers concluded that Depo-subQ Provera 104 treats pain caused by endometriosis as successfully as leuprolide. But women who used Depo-subQ Provera 104 reported less vasomotor (like hot flashes or sweats) symptoms and hypoestrogenic  symptoms (like sleep disturbances, mood changes, and vaginal irritation) and experienced significantly less decline in bone mineral density than women who used leuprolide. So, not only is it a highly effective contraceptive, Depo-subQ Provera 104 is as suitable and effective a treatment option as leuprolide for the treatment of endometriosis-related pain.

Additional research also confirms these results. In fact, researchers reviewed all the studies that investigated the use of progestin for the treatment of endometriosis that were published in the last decade (1993-2003). The combined results of all these studies showed that medroxyprogesterone acetate, the progestin in Depo Provera is just as effective as GnRH agonists (leuprolide) in reducing endometriosis-related pain and in improving health-related quality of life issues. The authors further explain that Depo Provera use in women with symptomatic endometriosis resulted in a significant decrease in pain symptoms and lead to a reduction in new endometriosis tissue growth.

Depo Provera as an Endometriosis Treatment: The Final Word:

Depo Provera has been used to successfully treat endometriosis. The main reason for its effectiveness is that Depo Provera can help prevent ovulation. Depo Provera directly affects the endometrial tissue by causing it to thin out -- this leads to lower amounts of menstrual bleeding -- which leads to pain relief.

However, Depo Provera may be a more temporary treatment for endometriosis. Even though it is effective in the short-term, after stopping Depo Provera, there is a high chance that endometrial tissue growth will return. Depo Provera also does not treat the infertility associated with endometriosis. If you want to become pregnant, surgery may be the best treatment option for endometriosis.

Depo Provera is as effective as leuprolide and other GnRH agonists in treating endometriosis-related pain. But, leuprolide is more expensive and is associated with more uncomfortable side effects. That being said, there Depo Provera comes with a black box safety warning -- when used for more than two years, Depo Provera can increase the thinning of your bones (which leads to an increased risk of osteoporosis). Depo Provera use may also delay the return of your fertility (about 50% of women will be able to get pregnant within 10 months after their last Depo Provera injection, but it can take up to 18 months for fertility to return). Some women report irregular or continuous bleeding when using Depo Provera along with other unwanted side effects. Unfortunately, once you are given a Depo Provera injection, if you are unhappy with the side effects, you must wait out the three month time frame until all of the hormone from this contraceptive gradually leaves your body. So if you are considering using Depo Provera as a treatment option for your endometriosis, make sure you talk to your doctor, so the two of you can determine whether or not the pain-relief that Depo Provera can offer outweighs these potential risks.


Crosignani PG, Luciano A, Ray A, and Bergqvist A. "Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain." Hum. Reprod. 2006; 21(1):248-256. Accessed via private subscription.

Vercellini P, Fedele L, Pietropaolo G, Frontino G, Somigliana E, and Corsignani PG. "Progestogens for endometriosis: Forward to the past." Hum Reprod Update 2003; 9:387–396. Accessed via private subscription.

Continue Reading