—I completely agree with Dr Fogarty that menstruation is a normal physiologic function and should be viewed as such. A video of Ms K, the patient, describing her problem was played prior to the discussion of the case. Ms K stated that her irregular cycles caused her to be "anxious" and were a source of "aggravation." These terms were direct quotations from the patient.While menstruation is a normal physiologic process, irregular menstruation may reflect abnormality. Abnormal menstrual cycling can and does cause anxiety in some patients.Regarding Dr Littell's concerns, anticipatory patient counseling with regard to contraceptive adverse effects or menstrual changes is too often overlooked in family planning visits. In my view, it is critical to counsel patients regarding expected menstrual changes with depomedroxyprogesterone. In terms of the other potential adverse effects of depomedroxyprogesterone that Littell mentions (depression, weight gain, and osteoporosis), these are poorly documented or undocumented
Davis AJ. Clinical Crossroads: A 21-Year-Old Woman With Menstrual Irregularity-Reply. JAMA. 1997;278(10):822. doi:10.1001/jama.1997.03550100048037
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