The Serious Downside to Contraceptive Implants and Injections

Contraceptive injection

The progestin drugs of implants and injections are not progesterone and so can cause side effects such as depression.

They also cause irregular “breakthrough bleeds” which are not real periods.

What’s the difference between a real period, a pill-bleed, and the breakthrough bleed of a contraceptive implant or injection?

The bleeds on birth control are not real periods

A real period is a withdrawal bleed from the body’s own progesterone. It occurs at the end of an “ovulatory” menstrual cycle, which is a menstrual cycle in which ovulation occurred and progesterone was made. The timing of a real period is about the healthy functioning of the ovaries.

👉🏽Tip: Ovulation is the main event of a menstrual cycle.

A pill-bleed is a withdrawal bleed from the contraceptive drugs ethinylestradiol and a progestin. The timing of pill-bleed is about the dosing of those drugs. There is not (and never was) any reason to bleed monthly on hormonal birth control. Watch the short animation Why Hormonal Birth Control Can Never Regulate Periods.

A breakthrough bleed is the bleed that happens when the uterine lining has been exposed to estrogen, but not progesterone. It’s an “anovulatory” bleed that occurs with progestin-only methods of birth control, as well as perimenopause and PCOS. Read 3 Signs Your Period Is Not Really a Period.

👉🏽Tip: The bleeds on a hormonal IUD can be real “ovulatory” menstrual cycles. Read The Pros and Cons of the Hormonal IUD.

The progestins used in implants and injections

Progesterone is a beneficial hormone for mood, hair, thyroid, bones, skin, and immune function. Read the 7 Superpowers of Progesterone

Unfortunately, there’s no progesterone in any type of hormonal birth control. Instead, contraceptive injections and implants contain the progestin steroid drugs medroxyprogesterone acetate, levonorgestrel, or etonogestrel.

Medroxyprogesterone acetate is the progestin in the Depo-Provera injection. It suppresses ovarian function so severely that it causes bone loss due to estrogen deficiency. Medroxyprogesterone acetate can also cause insulin resistance and unstoppable weight gain.

Levonorgestrel is the progestin in the implants Norplant and Jadelle. It’s derived from testosterone and so can cause androgenic (male hormone) side effects such as acne, hair loss, and weight gain. Levonorgestrel and other progestins can cause ovarian cysts and have been linked with anxiety and depression.

Etonogestrel is the progestin in the implants Nexplanon or Implanon. Like levonorgestrel, etonogestrel can cause ovarian cysts and mood problems, but it’s less androgenic (testosterone-like) so is less likely to cause acne, hair loss, and weight gain.

What has been your experience with contraceptive implants and injections? Please comment.

69 thoughts on “The Serious Downside to Contraceptive Implants and Injections”

  1. this all sound great but my young daughter is suffering with severe PMDD and also has anxiety and depression it has become debilitating even the antidepressants hardly put a dint in her PMDD

  2. Last year I had the nexplanon implant inserted. I visited a walk in clinic and rather unexpectedly they fitted it within 20 minutes, WITHOUT AN APPOINTMENT. Along with the common side effects, I was told to come back in 3 year when it would be replaced. Even though I was lead to believe I could get it removed at any time i.e if I didn’t like it or if I wanted to get pregnant, I was advised to “stick to it ” for at least 3 months.
    For the first 1.5 months I experienced no side effects and no bleeding which I thought was great. However, this all changed. My first noticeable side effect was frequent headaches, which was one of the most common side effects so I wasn’t too worried. Secondly I noticed my ‘periods’ lasted a lot longer (5-10 days) then they used to (3-5 days).
    Once it got to December 2018, 5 months after getting the implant fitted, my bleeding was extremely irregular and lasted 15-30 days at a time.
    We are now in April, 9 months after insertion, and I have developed a long list of side effects (headaches, frequent urination, heavy and long periods, hair loss and damage, increased scarring, increased vaginal discharge, decreased sex drive,mood swings) all of which are constant side effects which do not subside.
    I recently visited the same clinic,where I got the implant fitted( on the same day of arrival), under the impression that I would be able to book an appointment and get it removed ASAP. To my shock I have been placed on a 2 month waiting list to get it removed.
    In summary I would never get the implant fitted again and am extremely uneasy at the thought of any type of hormonal contraception.

  3. This is nonsense. Hormonal contraception doesn’t induce a kind of chemical menopause. They mimic preganancy. Stop using them and you become fertile, unlike menopause. Stop using alarmist rhetoric.

  4. My 21 year year old daughter had Nexplanon implanted. Within days of the implant, she was at th ER with shortness of breath and heart palpitations. Severe fatigue and tiredness followed along with anxiety. The implant was removed within 2 weeks. It’s 5 months later and she is still experiencing fatigue, anxiety, brain fog, dizziness and difficulty focusing. What kind of panel should we have her doctor run? She’s desperate to go back to feeling herself again.

  5. Thank you for this article. I completely agree, playing around with hormones is dangerous. I have had implannon twice followed by nexplannon, 7 years in total. I had it taken out for good when I realised my menstrual cycle had been put on hold and it did not feel right anymore. Several years after I had been diagnosed with an overactive thyroid and a heart condition due to bad palpitations. It was not worth it. I have never gotten a warning from any of the nurses and feel I was encouraged to have it done when I was too young and did not know any better. Please, listen to your body, it knows better!

  6. This is really on point. I am on the provera implant and the side effects is unbearable. Despite being on a weight loss diet, i still gain weight. The worst part is that, I have been diagnosed of fibroid. Wouldn’t advice anyone to try it.

  7. I had been suffering from extremely heavy and painful periods and decided to see a doctor after I could not tolerate them any longer (after about a year). I explained that I reacted horribly to the pill, so the doctor recommended I take the depo-provera shot instead to help me. I trusted the doctor’s recommendation and had the shot. The side affects of this shot are horrible (I don’t understand how this is even on the market). I would rather feel like a human and also bleed abnormally than have the side affects of this shot. I ordered and I am half way through reading your book. I wish I had known about it before seeing the doctor, it is extremely helpful in so many ways.
    QUESTION: I am wondering if you have advice on what to do while dealing with the depo provera shot (I am on week 2). Is there anything I can do to help my body flush it out? What happens after the chemicals are supposedly out? Will my body be in such shock that I may never feel normal? Is there anything I can do now to help the shock reaction? I am also wondering if I should take the advice you give for getting off the pill in the same way for getting off depo-provera? Or is there something extra women have to do to regain balance after receiving such a powerful and debilitating does of birth control?
    Thank you so much for your response!

  8. Depo Provera has turned my life upside down. I am 38 and received one injection of depo in March 2017. My Dr. said it would help migraines. From March 2017 until today, I have bled 225 days. About a month after the depo “expired,” I woke one morning in full fight or flight mode. That nervous feeling hasn’t left me since. My legs constantly ache. I can’t sleep and have that awful “tired but wired” feeling day after day. I’m working with an ND, and hope he can help me. In the last two months, my periods have returned to a more normal length (7 days), but are coming every 14-20 days. Hopefully this is progress?? I am testing and so far I’m not ovulating.

  9. What good comes from recommending any form of contraception?
    Given the devastating effects the contraceptive mentality has had on our culture, we can see just how correct the Catholic Church has proven to be in its unending prohibition on its use.
    Those who suggest or promote contraception are doing a great disservice to women and to society at large.
    For proof just ask yourself what is the purpose of a uterus, ovaries, and all the reproductive body parts. You can see clearly they are designed specifically in order to bring new life into this world.
    By its definition contraception seeks to pervert the natural process in women and prevent their bodies from achieving the goal (bearing of children) for which they were made.
    Lord, have mercy.

    • Ok, women’s bodies weren’t just made for child bearing. Birth control helps women to go to school, educated them, erases their period pain and can help them be sexually active without having a child. Just because birth control isn’t great for our bodies, doesn’t mean it should be obliterated

      • Women should know the truth about hormonal birth control, but at the same time should definitely have easy access to it as well as other methods including condoms, copper IUD, and soon Vasalgel for men.

        And fortunately, there are plenty of other ways to treat period pain.

  10. I have had the implant for 4 years, the main reason i got it was because I was in so much pain everytime i had my period that i wanted to die, it was unbearable period pain, a nurse i worked with recommended the inplant when i told her about my probelm. Since then i have had no pain and its really improved my life in that im pain free. I had periods for the first 3 years and the replacement implant has stopped my periods. Im looking further into the implant because i have noticed that in the last 4 years I have had increased anxiety and i have been feeling down alot but i have assumed its been because of family and work stress. I really want to reduce my anxiety and mood swings so considering having the implant removed for a short time to see if i will still have pain and if my mood will get better? What do you think? I’m 28yrs old and no kids.

  11. My 19 yr old daughter had a Mirena inserted 3 mths ago to treat painful periods ( suspected endo but not confirmed) and for contraception. In the past two attempts at taking birth control pills triggered anxiety/panic attacks. Was hopeful Mirena might be different but the anxiety and panic attacks are ramping up again. The Drs have never really validated that these hormal options are responsible for her escalating anxiety/panic ( she is an anxious type anyway). Is there anything she can take to help mitigate this negative side effect? If she didn’t have painful periods she might be convinced to try Daysy/condoms. What is the current wait time on appointments at your Sydney clinic? Thank you for any advice

    • Have just checked in with Lisa and on a cancelation list. Have just purchased your manual and read that taking NAC would be good for endo and helps reduce anxiety. I guess my daughters preference going forward would be to stay on the Mirena if she could take some supps to help manage the anxiety effects… is this possible? Or are some women intolerant to hormonal bc?

  12. Lara, I wonder why you choose images of tattooed persons frequently on your blog. I think you are trying to appeal to the hip crowd. It looks tacky and unprofessional, giving the idea that we should believe what you write because it’s hip. (What’s most interesting is that it’s now common in the supposedly nonconformist subculture, and yet they are all getting tattooed… = conformity.)

    • Interesting. I think I just like the visual aesthetic of tattoos. But I guess that could feel not inclusive for some people.
      I changed the picture. Does that one work better?

      • (I can only roll my eyes so far) …Because it is her page, that is why Casey. The only thing that is tacky and unprofessional THESE days is your judgement. Good grief. What is interesting is your opinion is irrelevant. If you actually did the research you would see that there is a very small percentage that has tattoos. Most likely because there are people, like you, comfortably judging and forcing others to conform to an out of date idea of “hip” leaving those of us who don’t have tattoos uncomfortable with our own choices for our happiness. THEIR body, THEIR choice. Keep YOUR judgment to YOURself. For the sake of humanity.

    • If you’re truly in menopause, then you’ll probably need treatment with natural hormones. Please see Chapter 10 in the new edition of my book coming Sept 14.

  13. Hi Lara, I’m a 46 yr old who recently had a surprise pregnancy. Unfortunately I miscarriaged at 13weeks. I’m just wondering if you are able to give me some advice on what I can do to balance my hormones out again as I’m feeling blue. My doctor wants my to go on the contraceptive implant but I really don’t want to. I’m sorry to ask but would really love to hear your thoughts and point me in the right direction. Thankyou

  14. Hi Lara,

    I hope someday you can dedicate an entire blog post to uterine fibroids. In the meantime, are there any supplements that can help shrink them or prevent more from occurring? Thank you so much!

    • There’s not much that can shrink them, but iodine can be helpful to slow their growth. I discuss fibroids in Chapter 9 of my book and yes, I will try to write a blog post one day soon.

      • Hopefully there will be more options in the future. May I ask you, what are your favorite supplements for Adrenal Fatigue? I do take Magnesium and Zinc, but I am very Fatigued and Insomniac. Thank you, Lara

  15. Hi Lara,

    I took a 17 hydroxyprogesterone blood test 2-3 after ovulation so during my luteal phase and it came back 319 ng/dL. Is this too high? Also they tested my progesterone 8 or 9 days post ovulation (according to daysy) and I tested at 4.9 ng/dL. Is this too low for progesterone? did I even ovulate?

  16. Hi Lara,

    I got a 17-hydroxyprogesterone test done 2 days or so after ovulation (so in my luteal phase) and it came back high at 319 ng/dL. What could this mean or is this result normal? Also, had progesterone tested 8 or 9 days after ovulation and result was 4.9 ng/dL. Have I ovulated then? is this too low for progesterone? Thanks so much!!

  17. Hi Lara,
    I will be having blood work done for hair loss. Dr. is checking thyroid and iron. Is there anything else they should check?

    • Zinc and and male hormones or androgens. But keep in mind you won’t actually see androgens on a blood test if you’re taking hormonal birth control.

  18. Dear Lara,

    Thank you for all you do! I’ve been struggling to repair my period for going on 3 years now. I’m 27 and had been taking the pill for close to 7 years when I decided to stop taking it. I didn’t have a period for over a year. After reading your book, I decided to try vitex and I finally had a period within a week! I still had extremely long cycles (40+ days), but at least it was something. I took vitex for about 6 months, as recommended, and have not had a period since. I follow an anti-inflammatory diet. I also have GI issues, specifically sensitivities to gluten and dairy. I’ve had blood tests done and all my result were normal, with the exception of vitamin D, which I now supplement. I also take magnesium, zinc, and a probiotic. My basal temperatures are typically very low, usually below 97.

    I’m not sure what else to do. Should I try taking vitex again? Should I focus on restoring my gut health? It seems that my GI and period problems are connected, but I’m at a loss for how to address them.

      • It’s possible that I am not. I’ve struggled with eating disorders over the years. I now try to maintain a healthy balance of good starches, wild/grass fed meat, and leafy greens by following the recommendations in your book and blog. Thanks for the reminder. I needed to reread that post today. I was vegetarian for years, and vegan too- although for only about 6 months, and I did not take any supplements then. I am learning to be patient and treat my body with care, understanding that it will take time for my body to heal.

  19. Hi Lara,

    I desperately need your help. I have been tested for some hormones and my prolactin, Free testosterone, and SHBG are normal but my total testosterone is high (65 ng/dL) which is higher than 6 months ago when tested. Also my 17-hydroxyprogesterone is high (319.00 ng/dL) I have 35 day cycles and ovulate each month according to daysy. What does high 17-hydroxyprogesterone mean and what is good treatment for it?

    • If it was taken during your luteal phase, a 17-hydroxyprogesterone reading of 319 is only mildly elevated. But it can mean something called Nonclassic Adrenal Hyperplasia (NCAH) which does cause androgen symptoms. Natural treatment are things like licorce (please see my Androgen Excess post), and of course, please speak to your doctor.

      Reference range for 17-hydroxyprogesterone:
      Follicular phase: < 80 ng/dL Luteal phase: < 285 ng/dL

      • I am getting it retested during my follicular phase because I read that can be more accurate. If I have the NCAH should I treat it the same way I would pcos as far as natural treatments?

  20. Hi Lara . I’m 39 and have been experiencing thinning hair all over my head for four years. Not shedding – just growing thin to the point of cobweb texture . The hairline has now thinned considerably and I’m battling to keep it. It’s depressing me to the point of near suicide. It was once so shiny and thick. I was on Microgynon when this started – for about 6 years – then 2 year ago I switched to Yazmin . Yazmin seemed to help for a while – then WHAM! Thyroid nodules ( although ‘normal’ levels) reflux, rapidly thinning scalp hair , pins and needles. Eventually everything settled – the nodules went away on their own too – but the hairloss continued. I even started on spironolactone with Yazmin and it didn’t really help. I stopped both spiro and Yazmin In March just gone . A month after stopping Yazmin – I did have a period . It was lighter than previous non pill periods but it arrived nontheless so I was pleased ? And I had no migraine which I always had when on the pill free week of taking the pill. Since stopping the pill – I’ve seen some shedding but I’m also noticing further thinning. I’m scared this is it for me ?? What do you think ? There Trichologist I see said to go back on spiro but I’m very confused now about what I should do ?

  21. I’d love to stop taking the pill but have very heavy bleeding and debilitating pain, hysterectomy is not recommended for other health reasons, and the mirena was hell for me (tried it twice). What else is there?

  22. Hi Lara,
    What´s your opinion on a candida cleanse and do you have any recommendations on how to do it? (i.e. what supplements are best)…

    I´ve been getting recurring yeast infections, and I used to take antibiotics for acne so I think candida may be the culprit.

    Thank you so much for all you do!

    • The probiotics I prescribe for yeast infections include:
      1) Saccharomyces boulardii
      2) combination of the strains Lactobacillus rhamnosus, GR-1™ and Lactobacillus reuteri, RC-14™

  23. I’ve heard that the copper IUD can raise estrogen as well. That all cooper can raise estrogen and in turn cause weight gain etc.

  24. Dear Lara,

    Have you noticed an incidence of Hypothyroidism or Hashimoto’s after Depo? I don’t know very many people who have had Depo, but I am suspicious. My mother found out she was Hashimoto after Depo. However, she had also received some drug after my birth to dry up her breastmilk as she was told there was no reason to breastfeed. Tragedy, we know. But I wonder if that drug was involved or if it was the Depo. Both were pushed on her. Anyway, as a side note, what amount of vitamin D is okay to take when you don’t counter it with Magnesium or K2? Will 4,000 IU of vitamin D alone cause an imbalance? Thanks!

  25. I have been hearing from other menopausal women that their doctor’s are recommending Mirena as the Progestogen component for their HRT, to offset the patch etc not as a contraceptive. Is the progestogen in the Mirena of benefit to women in menopause i.e for osteoporosis?

    • The progestin (levonorgestrel) in Mirena is of no benefit for mood or breasts or bones or any of the things that receive a benefit from progesterone.
      Instead, Mirena is used solely to prevent the build-up of the uterine lining that occurs with estrogen replacement. In the thinking of a conventional doctor, that’s all a progestin is for.
      The better plan is to use micronised progesterone (Prometrium) as the progestin component of HRT. It protects the uterine lining AND is also beneficial for mood, breasts, and bones.

  26. Thank you so much, Lara! I had been on hormonal birth control on and off due to irregular menstrual cycles from the time I was 18 up until I was 25. I tried several different brands of the Pill, as well as the Nexplanon. Each and every one of those gave me crippling nausea and back, but Nexplanon was the worst; it caused me to lose almost half my hair and depleted my body of vitamins (especially B12, and my doctor did not believe that Nexplanon was causing this). I had NO idea how damaging these were until I got the Period Repair Manual. Almost a year off hormones and I feel almost back to normal. My cycles are still slightly irregular (usually they are 32-37 days long, sometimes they will be 40-45 days), however, I feel great overall. I’m going to re-read your book to figure out how to shorten my cycle, and I’m going to recommend it to all of my friends currently on the Pill (they’re struggling with the side effects).

  27. Hi Lara,

    I am new to your blog having recently read your very informative book. I’m 36 and experiencing spotting for the first time. My cycles are usually 33-35 days with ovulation around day 21-23 (I suspect I ovulate as I experience ovulation pain each time) however over my last 3 cycles I started spotting. On the first 2 cycles it occurred on day 14 both times and lasted a couple of days, this last cycle it’s happened post ovulation (day 19 which is early for me) and started on day 21 What’s going on?

  28. Hi Lara, thanks as always for your thoughtful and informative articles. I am wondering how reliable the fertility awareness method, Daysy, etc can be for someone who has always had irregular cycles (never on the pill). I have tried to track my basal body temp and it has always been both low and extremely erratic, with no clear indication I can identify of ovulation. This would be my preferred method of contraception if I could trust it. My boyfriend suggested a copper IUD, but having had so many health and hormonal issues, that still makes me uneasy.

    • You can trust Daysy. Put it this way, if it gives you a green light (which means ‘not fertile’ and safe to have unprotected sex), then you can trust that because it is 99.4% reliable.

      If you have irregular cycles (and possibly anovulatory cycles), then the main issue is that you may not see many green lights.

      Have you used a proper ‘ovulation thermometer’ to track your temperatures through the entire cycle? If you’re certain you’re not ovulating, then the next step is to figure out why not. I discuss different possibilities in Chapter 7 of my book.

  29. I’m presently about to undergo endometrial ablation – I’m fifty and have had heavy, irregular periods for the past year. However, I’m wondering if the mirena coil might be a better solution? I’m worried that the endometrial ablation might cause problems, as I’ve read that some women experience pelvic and back pain subsequently. I think I may have a fibroid, as my GP mentioned that one showed up on a scan some time back.

  30. Thanks for addressing endometriosis in this post (and all other posts, frankly.) I recently re-read your book paying particular attention to the endo mentions and birth control/ Mirena sections, b/c I had decided the pain had gotten so bad to try going back to the pill. I have since decided against the pill, but recently was reminded you recommended Mirena. But, I am still hesitant b/c there would still be side effects but seemingly less than the pill. I ‘m concerned that if I did experience too many undesirable side effects I have to deal with getting the doctor to take it out. If you could write even more on MIrena for its specific use for endometriosis, that would be very helpful. Thank you again for all your research and information you write about on endometriosis.

    • Yes, I will write more about endometriosis. I’m thinking about it a lot these days because I see so many patients who are suffering. I keep hoping there’s going to be a major medical breakthrough because I’m sure they’re working on immune-modulators as new treatments.

    • Also, in terms of getting your doctor to remove Mirena, it should be a very simple conversation. Simply say: “Dear doctor, I don’t want this IUD in my body anymore. Please remove it for me.” End of discussion. It’s your body.

  31. I wondered if having a 35 day cycle is normal? I think I ovulate around day 23 or so. And can I have pcos even with a normal cycle and ovulation?

      • I have been using daysy and I contact them each cycle and they say I have ovulated (for the past 2 cycles I have done this). Can I have pcos if I am ovulating monthly? My periods were irregular after my baby due to a medication I was on but for the past 3 months they have been 35 day ovulatory cycles so I am wondering if I have pcos after all. Elevated testosterone but insulin was 7.4 and LH and FSH both 5.5 on day 3 of my cycle. I just need someone who actually understands pcos because no doctor I’ve seen does!

        • Is that a recent testosterone reading? As I explain in my book, PCOS is not a permanent state. If you have elevated testosterone in the past, then a PCOS diagnosis was probably correct. But it can improve as you start to ovulate and have regular cycles. And then you may reach the point when the diagnosis does not apply anymore.

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