Dr Stuttaford's replies cannot apply to individual cases and should be taken in a general context. Please consult your GP if you suffer from any health or special conditions.

I have had ovarian cancer (six years ago) and now have one ovary. I have been on the Depro Provera injection for ten years and I am starting to get side effects (migranes, severe depression, non-existant sex drive etc). Should I be getting side effects after ten years and with only having one ovary, is the depro the right thing for me? Could the dose be too strong? What other contraceptive alternatives are avaible for me (I am 29). Name and address withheld

I am delighted that you have had no further trouble from your ovarian cancer. You should certainly discuss the side effects from Depo Provera with your own doctor or family planning clinic. Together you will all have make the decision about the best form of contraception for you. Migraine can be a side effect of progestogen-only contraception. Officially migraine is not an absolute contraindication to its use but the need for special monitoring and care if it is stressed. Increasingly severe or frequent migraine, or migraine that has a localised effect such as temporary difficulty with speech, vision, numb patches, or loss of limb power, should lead to its immediate withdrawal, as should a rise in blood pressure. Depression is also a side effect of Depo Provera. Any progestogen-only preparation may cause irritability and loss of sex drive. Provided that you are in a regular relationship, and not multi-partnered, an ordinary IUD, without any added hormones might be the choice for you. This is very much a matter for discussion with your medical advisors.

I am 32 and I have a one year old son. I had three miscarriages and a very difficult pregnancy followed by post-natal depression, all of which confirmed our decision to count our blessings and stick with just one child. While sterilisation (for either of us) seems too drastic, we would like a method of contraception that is minimally invasive but also very reliable and can be used on a long term basis, perhaps until sterilisation becomes more of a realistic option. What would you suggest? Name and address withheld

Congratulations on coming to such a wise decision about your future contraception, and of course on the birth of your son. This is a matter for you and your doctor to discuss but I would suppose, without knowing your medical history, that the Mirena coil would be ideal for you. It is said that Mirena is almost as effective as sterilisation, but is reversible. There are some side effects associated with Mirena but in one trial they were significant and persistent in only one in about a thousand cases. The trivial ones, such as spotting, tend to clear up after about three months. Blood pressure has to be checked, there is a slightly increased incidence of gall bladder disease. There is always a chance of infection, but the most common time for this to occur is during insertion.

I had a Mirena fitted for heavy blood loss 15 months ago. It has reduced the blood loss considerably. However I have gained an enormous amount of weight. Is this due to the hormones in the Mirena, or just a coincidence as I am 55 and probably menopausal. I have never used contraceptives before having the coil fitted. M.R, Middlesex

Probably a coincidence but it is possible that you might put on some weight with Mirena, as it is an accepted adverse effect. The dose of progestogen is very small but even so as the occasional woman does put on weight it must be large enough sometimes to affect glucose metabolism. Now that you are 55 your fat distribution will begin to change and your metabolic rate will slow down so that you would be well advised to reduce your calorie intake. Within a year or two your Mirena can be removed

I am 50 and have had an IUS (Mirena) for just over 3 years now. After approximately six months with very irregular bleeding, my periods stopped altogether. Is it possible that I might have ompletely "missed" the menopause when the device comes out after five years? If so, hurrah! K.S, Hove

One in five people prescribed Mirena lose their periods. This is quite normal. Even so it is possible, even probable, that the menopause has occurred while you have been using it even though you are lucky enough not to have any other symptoms. When you finally have the IUS removed, blood tests taken after a suitable lapse of time would demonstrate whether you are post menopausal. If there is any doubt some other form of contraception is recommended for a year after your last period.

My daughter takes carbemazepine for epilepsy and therefore cannot take oral contraception. Would the new IUS Mirena coil be suitable for her needs as it by passes the liver? Sue Shepherd, Bristol

Your daughter should discuss this with the neurologist who treats her epilepsy. Certainly if she is taking carbemazepine for epilepsy she shouldn’t become pregnant. Many of the anti-epileptic drugs affect the enzyme systems and therefore alter the concentrations of oral contraceptions. Whether the small dose of progestogen released by the Mirena coil would be enough to cause any changes to the enzyme levels would have to be debated with your daughter’s specialist. If she has a regular single partner an ordinary IUD might be suitable.

I am 30 and have been on the pill for almost ten years. However, to avoid having periods I frequently take three to four packets in succession without a break for bleeding. Is this at all harmful? Would the contraceptive injection or implant be better for me as I understand that many women do not bleed at all on these? Certain pills, such as Cileste, have caused migraines in the past. Name and address withheld

Many women doctors and nurses do this, even though they wouldn’t recommend it for their patients. Celest is a combined pill. As with any oral contraception if migraine occurs for the first time when taking contraception, or if the attacks of migraine become more severe, frequent or localised, alarm bells should ring and the question of their suitability should be considered. If I was a woman and developed migraine with the pill I certainly wouldn’t use this method. The dose of progestogen delivered by Mirena is minute and migraine it is not mentioned among the possible contraindications or side effects but even so watch out for it.

I have one child. After its birth, 9 years ago, I used Depo Provera. I had some spotting and was advised to take another injection. I "spotted" for 9 months. I have not been pregnant since despite not using contraception. is there any evidence that Depo Provera can cause long term problems with fertility? Leanne Marks, Birmingham

Depo Provera shouldn’t cause long term problems with fertility. Although there should be a pause before becoming pregnant, thereby allowing for the effects of Depo Provera to wear off, it should not be a reason for your inability to conceive. If you want to become pregnant you should consult a gynaecologist with an interest in fertility.

I have recently been diagnosed with narcolepsy and take a "wake promoting" drug called Modafinal daily. I understand that my usual low oestrogen combined pill will no longer be effective - it must now be a pill with at least 50mg of oestrogen which makes me very sick! It seems impossible to find definitive information on exactly which forms of contraception will be effective when taking this drug - even the local family planning clinic and GP seem to be at a bit of a loss - can you help? Shelley Thomas, Milton Keynes

Modafinal, better known as Provigil, is a wonderful drug that can revolutionise the life of people with narcolepsy. It lessens the efficacy of contraceptive hormones as it interacts with the enzyme system that metabolise both. If you have a regular partner an ordinary IUD, rather than an IUS like Mirena that partly relies on the release of progestogen, might be suitable. You should discuss this with your GP.

I have been on the Depo Provera shot (once every three months) for 15 months to help with endometreosis. It has helped immensely, and I have few side effects. However, recent news reports have indicated that the Depo increases my risk of osteoperosis and other bone disorders. I am 24 years old. How long is too long on the shot, and at what point will I be doing irreperable harm? There is no history of bone problems in my family. Mary Gibbons, Minnesota

Depo Provera is an excellent treatment for mild to moderate endometriosis. Occasionally it may cause osteoporosis so that you should have regular bone density checks carried out. Usually hormone treatment for endometriosis is not continued indefinitely. In any treatment of endometriosis many people recommend leaving off the hormones after a time to see what happens next. However if you are happy taking the Depo Provera, and don’t want to conceive at the moment, all well and good - and you might be wise to continue with it. If there is ever evidence of osteoporosis developing, an expert on this problem could recommend ways of overcoming it.


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