What You Need to Know About Depo-Provera

Pros, Cons, Health Benefits, and Side Effects

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Depo Provera. Photo © 2014 Dawn Stacey

Depo-Provera (medroxyprogesterone) is a reversible method of prescription birth control. Also known as DMPA, Depo shot, or the birth control shot, this progestin-only contraceptive prevents pregnancy for up to 3 months with each shot. 

How It Works

Depo-Provera is a hormonal contraceptive method that slowly releases the progestin medroxyprogesterone acetate and protects against pregnancy for a period of 11 to 14 weeks.

It works by preventing ovulation and by thickening the cervical mucus. This prevents sperm from entering the fallopian tubes and fertilizing any egg that might have been ovulated.

Two Formulations

There are two versions of Depo-Provera. With the exception of the few differences noted below, both injections work the same way and provide the same level of pregnancy protection.

Depo-Provera Injection: The original Depo-Provera formula must be injected into a muscle, either the buttock or upper arm. You must have a shot four times a year (every 11 to 13 weeks) to maintain Depo-Provera’s high effectiveness rate. One shot contains 150 milligrams of medroxyprogesterone acetate.

If you get your first Depo shot within the first five days of your period, it provides immediate pregnancy protection. If you get your first shot during any other time in your cycle, you should use a backup method such as condoms, for at least the next 7 days.

Depo-subQ Provera 104 Injection:  This version contains 31 percent less hormone than the original Depo shot at 104 milligrams of medroxyprogesterone acetate. Because it has a lower dose of progestin, it may lead to fewer progestin-related side effects.

The subQ stands for "subcutaneous," which means this newer shot only has to be injected under the skin, not a muscle.

It has a smaller needle and may cause less pain. Depo-subQ Provera 104 must be injected into the thigh or abdomen four times a year (every 12 to 14 weeks). The level of pregnancy protection is the same as the standard shot.

You can easily switch from Depo-Provera to Depo-subQ Provera 104 at your next scheduled injection. If you do this, you will have immediate pregnancy protection.

Advantages

Compared to other birth control methods, there are a number of reasons why Depo-Provera is appealing to many women.

  • The birth control shot is a great alternative if you don't want the hassle of using a daily birth control method like the pill.
  • You only have to get Depo-Provera injections 4 times a year. Once you get your Depo shot, you don't need to think about birth control for months.
  • Depo-Provera may make your periods very light, and they may stop altogether after a few Depo injections.
  • It is a highly effective and reversible prescription birth control option.
  • Depo-Provera does not interfere with having sex, so it allows for spontaneity.
  • It is a private and discreet contraceptive choice. Nobody has to know that you use Depo-Provera because there are no wrappers or pill compacts.
  • Depo does not contain estrogen, so it can be a good alternative if you cannot tolerate estrogen or use combination contraceptives.
    • Women who are breastfeeding or are 6-weeks postpartum can safely use Depo-Provera.

    Non-Contraceptive Advantages

    The FDA has also approved the Depo-subQ Provera 104 injection for the treatment of endometriosis-related painResearch shows that it treats this pain as effectively as leuprolide, but it is associated with fewer vasomotor symptoms like hot flashes and sweats as well as significantly less bone loss.

    Depo-Provera offers pain relief statistically equivalent to that of leuprolide across all endometriosis-associated areas. This includes pelvic pain and tenderness, dysmenorrhea (menstrual cramps), painful intercourse, and hardening and thickening of tissue.

    After a few injections, Depo-Provera usually stops menstruation, resulting in thinner, more compact endometrial tissue. This, in turn, can stop the growth of endometrial implants, relieving endometriosis-related pain.

    Depo-Provera can also help prevent cancer of the uterus lining. It appears that Depo-Provera use may lower your risk of endometrial/uterine cancer by approximately 80 percent. This protective effect of the Depo shot seems to last for at least 8 years once you stop using it.

    Disadvantages

    It's common for birth control to have disadvantages. Depo-Provera is no different and it's important to know both the pros and the cons before you make a decision.

    • Scheduling is important and you must remember to make your injection appointment every 12 weeks. If it's been more than 13 weeks since your last shot (or 14 weeks since your last Depo-subQ 104 shot), make sure to use a backup birth control method because you could be at risk for getting pregnant.
    • The package insert of Depo-Provera contains a black box warning about possible bone loss: "Women who use Depo-Provera may lose significant bone mineral density (BMD)." BMD measures how much calcium is stored in the bones. Using the Depo shot over time can result in a calcium loss, but calcium starts to return once this method is stopped. Because of this warning, Depo-Provera is generally not recommended for adolescent girls.
    • Due to the possibility of bone density loss, it is also recommended that you shouldn't use Depo Provera or Depo-subQ Provera 104 for more than two years.
    • Many women stop using Depo-Provera during the first year of use due to spotting/irregular bleeding and/or continuous bleeding. This side effect is especially common during the first 3 months of Depo use. Unfortunately, there is no way to know ahead of time whether or not you will experience these bleeding issues.
    • In a small number of cases, women have experienced skin reactions in the area where they received the Depo shot. The skin around the injection may also get dimpled or feel lumpy.
    • Pfizer, the manufacturer of Depo-Provera, recommends that you stop your Depo injections one year before you would like to become pregnant. It takes an average of nine to 10 months (and sometimes even a year or longer) to regain fertility and begin ovulating after receiving your last shot.
    • Some studies show weight gain with the Depo-Provera shot. The manufacturer states that women gain an average of 5.4 pounds the first year and will have gained 8.1 pounds by the end of the second year.
    • Some women report mild pain associated with the Depo injection.

    Unfortunately, there is no way to stop the side effects that can result from Depo-Provera use. There is the chance that these side effects may continue until your Depo injection wears off in 12 to 14 weeks.

    Less Common Side Effects

    Over the first year of Depo shots, you may notice a few changes as your body adjusts. Additionally, some of the less common side effects include changes in sex drive and appetite as well as hair loss and/or increased hair on the face or body. In a few women, it may cause depression, nervousness, dizziness, nausea, or headaches. A skin rash or spotty darkening of the skin or sore breasts may also occur.

    Additional Considerations

    If you are currently using another hormonal method, you can switch to Depo-Provera. You should receive your first Depo shot within seven days after the last day of using your current method. 

    • If switching from combination birth control pills, arrange to get your first Depo shot within seven days after taking your last active pill.
    • If switching from the Ortho Evra Patch, plan your Depo-Provera injection within seven days after removing your patch.
    • If switching from the NuvaRing, schedule your first Depo shot within seven days after taking the ring out.

    STD Protection

    Depo-Provera offers no protection against sexually transmitted infections. You must use a condom. 

    Who Can Use It

    Depo Provera can be a safe birth control option for most healthy women. It is important that you discuss your complete medical history with your doctor before receiving an injection.

    Depo-Provera is not recommended for women who have the following:

    • Breast cancer
    • Thrombophlebitis, a history of thromboembolic disorders, or cerebral vascular disease
    • Risk factors for osteoporosis: bone disease, excessive alcohol or smoking, a family history of osteoporosisanorexia, or use of steroid drugs
    • Significant liver disease
    • Adolescent girls since this is a critical period for bone mineralization
    • Undiagnosed vaginal bleeding
    • Desire to become pregnant within the next year

    Associated Costs

    Under the Affordable Care Act, most insurance plans must cover doctor visits related to birth control and the shot itself is free under most plans. Medicaid may cover the cost as well. Any changes to the Affordable Care Act may affect whether insurance plans cover contraception. Check with your insurance plan to see what your coverage and costs may be.

    If you do not have coverage, you will need to pay out-of-pocket for the medical exam. Your cost may be as much as $250 for the first visit and as much as $150 for further visits.

    Prices for the injections alone vary, but the typical cost for each injection can range between $30 and $75. The total cost for a full year of use may vary from $200 to $600 and may vary if additional office visits are required.

    You may incur additional costs if you are more than two weeks late for your next scheduled shot. Your doctor may require a pregnancy test before your next injection, so you will need to pay for that as well.

    Effectiveness

    Depo-Provera is 94 percent to 99 percent effective. With perfect use, less than 1 out of every 100 women who use Depo-Provera will become pregnant in one year. With typical use, 3 out of every 100 women who use Depo-Provera will become pregnant.

    A Word From Verywell

    Since it was first approved by the FDA, Depo-Provera has been a popular option for birth control. Whether or not it is right for you depends on many factors. Many women have found that a couple years of regular injections makes managing birth control easier. Speak with your doctor to see if it's a good fit and be sure to ask any questions you have along the way.

    Sources:

    Nezworski L, Murray S. Use of Depot Medroxyprogesterone Acetate in Current Gynecologic PracticePostgraduate Obstetrics & Gynecology. 15 April 2010; 30(7):1–6. 

    Planned Parenthood. Birth Control Shot. https://www.plannedparenthood.org/learn/birth-control/birth-control-shot/how-effective-is-the-birth-control-shot

    Schlaff WD, Carson SA, Luciano A, Ross D, Bergqvist A. Subcutaneous Injection of Depot Medroxyprogesterone Acetate Compared With Leuprolide Acetate in the Treatment of Endometriosis-Associated Pain. Fertility and Sterility. 2006; 85(2): 314-325. 

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