MY VILIFIED FRIEND!

In my practice, I have made a few observations over time. One of the most misinterpreted and misrepresented topic is contraceptives. Wherever there is a gathering of two or more women, this very important friend of the gynecologist is always taking a beating.
 

The range of myths surrounding these trusty utilitarian solutions are so diverse and sometimes completely outlandish, I am left disturbed. But it is my job to enlighten my clients and I do it with utmost dedication because I love the end a result: a woman empowered to make an informed choice and doing it freely.
 

But today I feel compelled to stand up for one of my friends, the 3-monthly contraceptive injection, medroxyprogesterone acetate, commonly known us Depo Provera. Depo, as usually referred to, is one of the most commonly used contraceptives among women in Kenya. I prefer to visualize Depo as a woman with a sunlight smile and a gap in the middle of the upper row of her teeth!
 

Depo is a favorite for young women who have just embarked on the motherhood journey. And yes, she has always been encouraged by midwives and doctors at large for her support in breastfeeding (not interfering with lactation), a good companion for those recovering from mummy brain (we all know how pregnancy messes with memory and no one wants to forget their contraceptive when the baby is still a few months old!), and ultimately, stays around for short periods at a time, hence allowing one to dump her when the need arises!
 

But despite all these cool reasons for having Depo as a friend, the poor girl is always blamed for everything that goes wrong. From mood swings to irregular menses to libido issues and oh yes, weight gain! Not to say that isn't always true, but let's try and unbundle this friend of ours.
 

With contraceptives, there will never be a one size fits all, which is the reason why scientists are still in the laboratories developing more and more contraceptive options. Each one comes out with a list of documented possible side effects . Not every woman gets to experience all those listed, some are mild, some may never come to pass and yet others may be the reason for discontinuation of a method and selection of a new one.
 

As I alluded to before,  most women tend to seriously seek contraceptives once they already have a baby. Taking a step back, three years prior, we had a young lady in her twenties who was settling into her career, probably hadn't afforded a car yet, lived alone across town from her boyfriend but spent most weekends with him going dancing, hiking and participating in all charity runs and walks. She was hardly ever home and cooked once a month!
 

The happy couple got engaged and started planning for a life together. The wedding plans gobbled all their time and they could hardly get time to relax. The pressure on the two increased with traditional ceremonies, wedding gown choices, venues, menus and budgets raising the stress levels.
 

After the wedding, they sigh with relief and are happy to make a home together.  As a husband, he is overjoyed at the prospect of becoming a dad. He drops his wife to work every morning and picks her in the evening. She is happy to finally have someone to cook for and dinner together every evening becomes a family tradition.
 

Then comes the baby. The very precious first born. Everyone is excited. Mummy is encouraged to eat for two as she is breastfeeding and her mother-in-law sends food over every week! At the six-week clinic visit, the pediatrician is happy with the baby's development and weight gain, and mommy is beaming with pride. She sees the gynecologist and after counselling, opts for Depo as her contraceptive option. She only needs to see her doctor every three months and this gives her freedom.
 

With the baby's weight chart shooting up, so do the pounds begin to pile on mommy. No one sees it coming. In African culture, she is becoming a woman. Her appetite doubled under the guise of good breastfeeding.  Suddenly it is time to resume work and she is still wearing maternity clothes as nothing in her wardrobe fits. Coupled with the responsibilities of the baby, she doesn't even notice the weight creeping up.
 

Then comes the office colleagues who start with the comments. Her friends tease her about how marriage must be working well for her and her mom is happy that her daughter finally has curves!

She hates it! Can't stand the weight but is helpless. She tries to work out at home but responsibilities are too many to allow her the time. She long gave up her outdoors activities and hasn't danced in two years. Her husband bought her a car for Christmas in appreciation of the happiness she has brought him this past year. She no longer has to walk anywhere anymore.
 

One day over lunch with colleagues, one mentions how her sister has gained weight on Depo and bam! There is her answer! She has finally found the scapegoat for her undesirable weight! There goes all the will power to do something about it. Since as a family they do not intend to have another baby soon, she cannot stop her contraceptive just yet.
 

Allow me to speak on behalf of my friend Depo. Only about a third of women on Depo will gain significant weight directly attributed to the method. As for the rest of us, a vegetarian menu is an option and let us meet at the gym!