What Is Depo-Provera?

Depo-Provera is a contraceptive injection that delivers medroxyprogesterone acetate, a synthetic version of the hormone progestin. Approved by the U.S. Food and Drug Administration in 1992, it is designed to provide a long-term birth control solution. The method of action includes inhibiting ovulation, thickening cervical mucus to hinder sperm mobility, and thinning the uterine lining to reduce the chances of implantation of a fertilized egg.

The injection is administered by a healthcare provider once every three months, typically in the upper arm or buttock, and has become a popular choice for approximately 70 million women annually as a long-term contraception due to its convenience of requiring only four birth control shots per year.

How Does Depo-Provera Work?

Depo-Provera operates through multiple mechanisms to prevent pregnancy:

• Ovulation Suppression: By inhibiting the release of eggs from the ovaries, Depo-Provera eliminates the chance for an egg to be fertilized.
• Cervical Mucus Thickening: The drug increases the thickness of the cervical mucus, which impedes sperm movement through the cervix, thereby preventing them from reaching an egg.
• Uterine Lining Thinning: It also reduces the thickness of the uterine lining, decreasing the likelihood of a fertilized egg implanting and growing.
• Sperm Function Impairment: Depo-Provera alters the cervical environment to reduce sperm viability and functionality, further reducing the chances of pregnancy.

Common Uses of Depo-Provera

Depo-Provera is mainly prescribed as a long-lasting, reversible birth control method but is also used to manage menstrual issues, endometriosis, and hormonal imbalances.

Common Uses of Depo-Provera

• Management of Menstrual Disorders: Some doctors prescribe Depo-Provera off-label for treating menstrual disorders such as heavy menstrual bleeding, dysmenorrhea (painful periods), and amenorrhea (absence of periods).
• Treatment of Chronic Pelvic Pain: It may be used off-label to help alleviate chronic pelvic pain, especially in cases related to conditions like adenomyosis.
• Reduction of Ovarian Cysts: Depo-Provera may help reduce the recurrence of ovarian cysts by suppressing ovulation.
• Hormone Replacement Therapy: In some cases, it is used as part of hormone replacement therapy in postmenopausal women to reduce the risk of endometrial hyperplasia.
• Treatment of Hirsutism: Depo-Provera is occasionally used off-label to manage symptoms of hirsutism (excessive hair growth) in women with polycystic ovary syndrome (PCOS) or other hormonal imbalances.
• Reduction of Risk for Endometrial Cancer: Due to its effects on the endometrial lining, it may be used in high-risk women to reduce the risk of developing endometrial cancer.
• Management of Certain Cancers: Depo-Provera has been used in the palliative treatment of certain cancers, such as endometrial or renal cell carcinoma, due to its hormonal effects.

Depo-Provera Brain Tumor Risks

According to a study published in the medical journal The BMJ on March 27, 2024, women who use Depo-Provera for a year or more may face a 5.55-fold higher risk of developing meningioma brain tumors than women who do not receive the birth control shot.

A team of researchers led by Noémie Roland analyzed data from over 108,000 women in the French National Health Data System, focusing specifically on 18,000 women in France who underwent brain surgery for meningioma between 2009 and 2018. Each of these patients was matched with five control subjects to ensure a thorough comparison.

The study evaluated various synthetic progestogens delivered through oral, vaginal, and injectable forms and found an elevated risk of brain tumors across all methods, especially among Depo-Provera patients:

• Depo-Provera (Medroxyprogesterone acetate): 5.55 times increased risk of meningioma
• Medrogestone: 3.49 times increased risk of meningioma
• Promegestone: 2.39 times increased risk of meningioma

With an estimated 74 million Depo-Provera users globally, the findings suggest that millions of women may unknowingly face a higher risk of developing meningiomas, pointing to a potentially significant public health issue.

Understanding Meningioma Brain Tumors

A meningioma is a type of tumor that originates from the meninges, the three layers of protective membranes surrounding the brain and spinal cord. These layers include:

• Dura Mater: The outermost, toughest layer located closest to the skull and vertebral column.
• Arachnoid Mater: The middle, web-like layer positioned between the dura mater and pia mater, containing cerebrospinal fluid that cushions the brain and spinal cord.
• Pia Mater: The innermost, delicate layer that closely adheres to the brain and spinal cord, following their contours.

While most meningiomas are benign (non-cancerous) and grow slowly, they can still cause significant symptoms and complications depending on their size and location within the skull.

Meningiomas are categorized into three grades based on their growth behavior:

• Grade I: Benign tumors that grow very slowly, making up approximately 80% of meningioma cases.
• Grade II: These tumors, though still non-cancerous, have a faster growth rate and are more challenging to manage.
• Grade III: Malignant tumors that grow rapidly and aggressively, accounting for less than 2% of meningioma cases.

Treatment for Grade I meningiomas typically involves surgical removal, which often yields favorable results. In contrast, Grade II and III meningiomas may require a combination of surgery, radiation therapy, and possibly chemotherapy, depending on their growth rate and aggressiveness.

How Does Depo-Provera Cause Meningioma Brain Tumors?

Medical studies have suggested that prolonged usage of Depo-Provera causes meningioma brain tumors, due to the active ingredient medroxyprogesterone acetate (MPA) contained in the birth control shot.

The meninges are the protective layers surrounding the brain and spinal cord, which contain hormone receptors, including those for progesterone that are important for regulating cellular processes.

Research suggests that MPA from Depo-Provera shot can bind to these progesterone receptors in the meninges, triggering signaling pathways that lead to abnormal cell growth. This increased proliferation of cells in the meninges may contribute to the development of meningiomas.

Symptoms of Meningiomas

Individuals who have received or are currently receiving Depo-Provera injections may experience symptoms of meningiomas, such as:

• Vision changes: Double vision or blurred vision
• Headaches: Persistent or worsening headaches, especially in the morning
• Hearing loss: Hearing impairment or ringing in the ears
• Memory loss: Issues with memory
• Loss of smell: Diminished sense of smell
• Seizures: Episodes of seizures
• Weakness: Weakness or numbness in the arms or legs
• Trouble speaking: Difficulty articulating words or speaking clearly
• Confusion: Mental confusion or disorientation
• Balance loss: Problems with balance or coordination

These symptoms can vary depending on the size and location of the tumor within the brain.

Depo-Provera Side Effects

Depo-Provera usage can lead to various side effects, such as alterations in menstrual cycles, weight fluctuation, headaches, and reduced sexual desire. Additionally, this injectable birth control method may trigger less frequent but severe side effects, including loss of bone density, nausea, changes in hair texture or amount, and skin reactions. While certain side effects may lessen with time, some could be permanent.

Common Side Effects of Depo-Provera:

• Changes in Menstrual Periods: Irregular bleeding or spotting, especially in the first few months. Periods may become heavier, lighter, or stop altogether.
• Weight Gain: Weight gain is a frequently reported side effect.
• Headaches: Headaches, including migraines, can occur.
• Mood Changes: Some users report mood swings, depression, anxiety, or nervousness.
• Decreased Libido: A reduction in sexual desire is reported by some women.
• Breast Tenderness: Tenderness or discomfort in the breasts may occur.
• Delayed Return to Fertility: Fertility may take several months to over a year to return after discontinuing Depo-Provera.

Less Common Side Effects of Depo-Provera:

• Bone Density Loss: Long-term use can lead to decreased bone mineral density, increasing the risk of osteoporosis and fractures; limiting use to 2 years is recommended unless additional use is necessary.
• Nausea and Bloating: Some women may experience nausea or bloating.
• Hair Changes: Hair loss or excessive hair growth can occur on the face or body.
• Skin Reactions: Acne, skin rash, or other skin reactions may develop.
• Allergic Reactions: Rare allergic reactions may include hives, itching, or swelling.
• Injection Site Reactions: Pain, swelling, or redness at the injection site.

Pseudotumor Cerebri Side Effects From Depo-Provera

While rare, Pfizer has faced a number of Depo-Provera lawsuits over pseudotumor cerebri side effects in prior years.

This condition is characterized by increased pressure within the skull, which can mimic the symptoms of a brain tumor without the presence of an actual tumor, which can include;

• Headaches: Severe, persistent headaches are a common symptom.
• Vision Problems: Patients may experience blurred vision, double vision, or even vision loss.
• Nausea and Vomiting: Increased intracranial pressure can lead to gastrointestinal symptoms.
• Tinnitus: Ringing in the ears can occur as a result of increased pressure.

To manage pseudotumor cerebri, individuals may need treatments such as:

• Medication: Diuretics like acetazolamide may be prescribed to reduce cerebrospinal fluid (CSF) production and lower intracranial pressure.
• Lumbar Punctures: Also known as spinal taps, these are used to relieve pressure by removing excess CSF from the spinal canal.

How Much Are Depo-Provera Lawsuits Worth?

Women who received Depo Provera injections and were diagnosed with a brain tumor could be eligible for various types of compensation and settlement benefits. This includes coverage for both immediate and future financial, physical, and emotional impacts.

Types of Damages Claimable:

• Immediate Medical Costs: Expenses already incurred for treatments such as diagnosis, hospital stays, surgeries, and medications.
• Future Healthcare Needs: Anticipated expenses for continuous or upcoming medical needs, including surgeries, rehabilitation, and lifelong medications.
• Past Earnings Loss: Compensation for wages lost during periods of medical treatment and recovery.
• Future Earnings Loss: Payments to cover potential loss in future earnings due to ongoing health issues.
• Reduced Earning Capacity: Compensation for a likely decrease in the ability to earn in the future due to long-term effects of the condition.
• Physical Suffering: Compensation for enduring physical pain from the tumor and subsequent medical interventions.
• Emotional Distress: Damages for emotional and psychological suffering like stress, depression, and anxiety resulting from the medical condition.
• Reduced Life Quality: Compensation for a diminished ability to enjoy life’s activities, hobbies, and day-to-day joys.
• Permanent Impairments: Damages for any lasting disability or disfigurement caused by the illness or its treatments.
• Loss of Consortium: Damages concerning the effects on marital relationships, encompassing affection and companionship losses.
• Punitive Damages: These may be sought to punish the defendant for egregious conduct and to deter similar future actions.
• Incidental Expenses: Reimbursements for out-of-pocket expenses related to the condition, such as travel for treatment, home modifications, and necessary equipment.
• Legal and Court Expenses: Potential recovery of costs associated with legal representation, filing fees, expert testimonies, and other legal expenses.

Additionally, in cases where Depo-Provera use results in a fatality, survivors may pursue a wrongful death claim, potentially recovering costs for funeral arrangements, loss of financial and emotional support, and companionship from the deceased.