The most troublesome and serious side effect has been identified as loss of calcium, which has an adverse effect on bone mass. To that end, the US Food and Drug Administration (FDA) issued a black box warning in late 2004 identifying the calcium loss concern, noting that calcium may not completely return once Depo-Provera is stopped.
That's serious enough for an adult whose bones have developed, and for whom early emergence of osteoporosis symptoms may result. But what of a young person, whose skeletal structure is still developing?
One Depo-Provera client who posted to a health blog in 2009 did not provide her age, but is obviously younger than the 70-year-old woman that she claims to mimic in terms of the impact Depo-Provera had on her bones. Amanita thought Depo-Provera as the best response to her heavy menstrual cycles.
"[The outlay of] 40$ every few months for a birth control that made me lose weight and stop bleeding, what could be better? Too bad," she writes, "the fact that I am thousands of dollars in medical debt and can't have a job to pay it back because I'm in too much pain doesn't help. I've had depression and insamnia [sic] for as long as I can remember and I am the same way, a lot worse from the shot. My back is ruined; I walk like a 70 yr old person. I used to ride horses, swim, dance. Now I can't even play with my dog on the floor."
Amanita's description sounds similar to that of Tracey Bourque, who was 33 when she discovered to her dismay that she had the bone density of a 55-year-old woman after using Depo-Provera. Bourque was identified in a CTV (Canada) news report regarding Depo-Provera and a class-action lawsuit launched in Canada in 2005. Depo-Provera, which uses a synthetic version of progestosterone but does not contain estrogen, was approved in Canada in 1997.
Its approval in the US, five years prior to the Health Canada approval, was somewhat rocky. The original manufacturer of Depo-Provera, Upjohn, applied repeatedly for FDA approval and won the support of an FDA advisory committee and the FDA's professional medical staff in 1973, 1975, and again in 1992. The FDA, however, refused to formally approve the drug until late October 1992. Since that time, various studies have raised red flags with regard to the injectable Depo-Provera—administered quarterly—prompting the black box warning two days prior to Halloween in 2004. The Canadian class-action lawsuit was filed some months later.
Bourque, the Canadian woman whose bones were found to be 22 years older than she was, didn't learn about the initial advisory from manufacturer Pfizer (followed by subsequent advisories from the FDA and Health Canada) until two months after stopping her Depo-Provera injections.
"I'm angry and confused," she told CTV at the time. "What is my future now?"