Depo-Provera is a long-acting birth control injection given every three months to prevent pregnancy. It contains medroxyprogesterone acetate, a hormone that prevents ovulation and thickens cervical mucus, making it harder for sperm to reach an egg.
This contraceptive injection is available by prescription and must be administered by a healthcare professional into the gluteal or deltoid muscle.
Depo-Provera should only be used under medical supervision and is not recommended for women with unexplained vaginal bleeding, severe liver disease, or a history of blood clots, stroke, or other thromboembolic disorders.
Indications for use
Depo-Provera (also known as the depo shot) is used as a quarterly contraceptive to prevent pregnancy by stopping ovulation and changing the consistency of cervical mucus. Each injection provides protection for at least three months and should always be prescribed and monitored by a healthcare professional.
It’s important to note that Depo-Provera does not protect against sexually transmitted infections (STIs). Condoms should still be used during all sexual activity to help prevent infection.
How to use
Depo-Provera 150 mg/mL should be injected into the gluteal or deltoid muscle by a qualified healthcare professional.
When to start
The following table gives information on initiation of Depo-Provera:
If Depo-Provera is started more than seven days after your period begins, you should use a back-up method of contraception, such as condoms, or avoid sexual intercourse for the next seven days.
Follow-up injections should be administered every 12 to 13 weeks. The maximum time between injections is 13 weeks (91 days). Before starting Depo-Provera, a pregnancy test should be done to ensure you are not pregnant.
Missed dose
If more than 13 weeks (91 days) have passed since your last Depo-Provera injection, you should take a pregnancy test (beta-hCG) to rule out pregnancy before receiving another dose. If pregnancy is confirmed, Depo-Provera should not be used.
If you restart the injection late but are not pregnant, use a back-up contraceptive method for seven days after the new injection.
Side effects
The most common side effects of Depo-Provera include:
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Headache;
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Nervousness or mood changes;
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Abdominal pain or discomfort;
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Weight changes;
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Pain or irritation at the injection site.
Other possible side effects include dizziness, nausea, vaginal discharge, light bleeding between periods, missed periods (amenorrhea), or breast tenderness.
Depo-Provera may also increase the risk of blood clots, stroke, pulmonary embolism, deep vein thrombosis, or heart attack. Seek immediate medical attention if you experience symptoms such as weakness on one side of the body, slurred speech, blurred vision, difficulty breathing, chest pain, or swelling in one leg.
Depo-Provera may have a small increased risk of benign brain tumors (meningiomas). Although the overall risk is low, discuss any history of meningioma with your doctor before using this method.
Women who become pregnant while using Depo-Provera have a small risk of ectopic pregnancy, in which the embryo develops outside the uterus. Contact your healthcare provider immediately if you experience severe abdominal pain or unusual bleeding.
Decreased bone density
Depo-Provera can cause a decrease in bone mineral density over time, which may increase the risk of bone loss or fractures. For this reason, the FDA and ACOG recommend that Depo-Provera generally not be used for longer than two years unless other contraceptive options are not suitable.
Calcium- and vitamin D–rich foods, regular exercise, and avoiding smoking can help reduce the risk of bone loss. Your doctor may monitor your bone health if you use Depo-Provera long-term.
Does Depo-Provera cause weight gain?
Depo-Provera may cause weight gain in some people. Clinical studies have shown an average increase in body weight during use, which may be related to changes in metabolism or fluid retention. Maintaining a balanced diet and regular physical activity can help manage this side effect.
Return of fertility
After stopping Depo-Provera, the return of fertility can be delayed. On average, it may take 9 to 10 months from the last injection for ovulation and regular menstrual cycles to return, although this varies by person.
Contradictions to use
Depo-Provera should not be used in the following situations:
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Known or suspected pregnancy;
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History of incomplete miscarriage;
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History of deep vein thrombosis, pulmonary embolism, heart attack, or stroke;
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Active thrombophlebitis;
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Unexplained vaginal bleeding;
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Known or suspected breast cancer;
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Severe liver disease.
Depo-Provera is also not recommended for use before a woman’s first menstrual period (menarche).