I am a 44-year-old woman who has been in good health except for increasingly heavy and painful periods. In June 2004 I experienced severe pelvic pain and had a laparoscopy and appendectomy. The pathology report on the appendix showed microscopic endometriosis. In December 2005 I experienced pelvic pain severe enough that I went to the emergency room by ambulance. During a later follow-up with my gynecologist she decided that endometriosis was the culprit and I received a Depo-Provera injection on December 19.

On December 30 I suffered a Central Retinal Vein Occlusion. Since then, I have experienced neurological-type symptoms including tingling, numbness and weakness in my left hand and arm; severe fatigue and overall weakness; bladder-control problems; difficulty concentrating; frequent headaches. A brain MRI shows some “white matter lesions” and one neurologist thought MS was the culprit. The second neurologist thought MS was not the correct diagnosis and felt the Depo-Provera shot was to blame. A spinal MRI was negative, and my cerbral spinal fluid is clear. I have been told that all other tests are “fine”.

Have you ever heard of Depo-Provera causing these types of symptoms? Do you think it is worth seeing another neurologist to rule out MS? If Depo-Provera is the cause, what are my options for treating endometriosis? Note that my retinal specialist is adamant that I should not take any hormones of any kind.

Dr. Joshua’s Answer:

Depo-Provera (medroxyprogesterone) may increase the risk of thrombosis and was possibly to blame for the retinal vein occlusion. Screening for thrombophilia (tendency to form blood clots) may be required, and Depo-Provera needs to be immediately discontinued. Of course, it is a long-acting drug so immediate discontinuation is not possible as such.

I’m not going to second-guess your neurologists. I’m not sure how the Depo-Provera would cause white matter lesions on brain MRI. The diagnostics need to be done by your own neurologist.

I’m happy that brain and spinal MRI were done - your symptoms definitely warranted that. Without seeing the pictures and the radiology report, it’s impossible for me to say what the significance of those white matter lesions is.

Possible side effects of Depo-Provera include weight gain, loss of bone mineral density, headache, dizziness, nervousness, loss of scalp hair, increase in body hair, decrease in sex drive, leg cramps, bloating and menstrual irregularities.

I agree with your retinal specialists that hormones should not be used because of the past retinal vein occlusion.

I trust that your gynecologist is satisfied with the diagnosis of endometriosis as the cause of your heavy period and pain and that all necessary differential diagnostic examinations have been done?

Medical treatment options for endometriosis include anti-inflammatory drugs such as ibuprofen, and stronger painkillers such as opioids are sometimes needed.

Repeated laparoscopic surgery to remove endometrial tissue is an option, and worth considering is surgery to remove the uterus and the ovaries (hysterectomy) for those not wishing to have any more children. Menopause provides relief from symptoms for most women.

This is just to provide you with additional information. Any treatment and examination decisions will have to be done by you together with your gynecologist and neurologist.

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