Guide to What to Expect During the First Year of Depo Provera Use

1
Before Your First Depo Shot:

Starting and Stopping Depo Provera
Before Your First Depo Shot. Photo © Dawn Stacey

Do Your Research on Depo Provera:

Depo Provera is a reversible prescription birth control method. Each Depo Provera shot slowly releases a synthetic form of progestin, medroxyprogesterone acetate, that can protect you against pregnancy for a period of 11-14 weeks. Depo Provera prevents ovulation, so there is no egg available for a sperm to fertilize. It also works by thickening your cervical mucus—this makes it harder for sperm to swim. The progestin in Depo Provera can also thin out or prevent the uterine tissue that builds each month. This makes it difficult for a fertilized egg to implant into the uterine wall since there is not enough lining there to receive it. Depo shots can also help treat the pain associated with endometriosis.

In order to have pregnancy protection for a full year, it is important to schedule your Depo Provera or Depo-subQ Provera 104 shots approximately every 12 weeks. Over the course of one year, you should receive 4 depo shots.

Your body may go through changes as it adjusts to the progestin in Depo Provera. To increase your success with depo, it may be helpful to know what to expect during the first year of use.

Before you begin your first depo shot, it is important that you are aware of the possible bleeding side effects that may occur while using Depo Provera. Unfortunately, there is no way to know ahead of time if these side effects will occur or how long they will last for. Research suggests that women who know ahead of time—before using depo—about the potential for either irregular (spotting) bleeding or prolonged, continuous bleeding are more likely to continue using Depo Provera. It may be encouraging to know that although these bleeding effects could occur when you start using depo, over a third of women had stopped having periods by month 6 of use. By 12 months, over half of women's periods have stopped. Many women are willing to go through the initial bleeding in exchange for the chance of not having to have a period anymore.

2
First Depo Shot (Months One-Three)

birth_control_shot.jpg
First Depo Shot. Photo © Dawn Stacey

Your Very First Depo Provera Shot:

If you receive your first depo shot during one of the first five days of your period, then Depo Provera will begin to work immediately (meaning, you are protected against getting pregnant). With perfect use, Depo Provera is 99.7 percent effective (97 percent with typical use). Depo will also provide you with continuous pregnancy protection if you have switched from another hormonal method and received your first depo shot within the last seven days of using that method (such as combination birth control pills, NuvaRing, the Patch).

Generally speaking, it takes about three months for your body to adjust to Depo Provera. Similar to other hormonal birth control methods, your body needs this time to get used to the hormone (progestin) in depo.

As your body is adjusting to Depo Provera, it is likely that you will experience irregular bleeding (spotting) and/or prolonged bleeding (like a continuous period). This symptom is considered completely normal. If, however, you notice that your bleeding is very heavy or if you are feeling concerned, it may be a good idea to contact your doctor.

  • Other depo side effects that you may experience include: skin reactions, weight gain, and pain (associated with the actual injection).
  • Less common side effects include: change in sex drive, depression, nervousness, dizziness, nausea, change of appetite, headaches, skin rash or spotty darkening of the skin, sore breasts, hair loss and/or increased hair on the face or body.

As your body adjusts to the progestin, these side effects should lessen and go away. For some women, these side effects may continue until the depo shot wears off (11 to 14 weeks).

It is also recommended that you make an appointment for your next scheduled depo shot during the same doctor’s visit that you receive your first shot.

  • If you are using the original Depo Provera shot, make your appointment for your second injection within 11 to 13 weeks.
  • If you are using the newer Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

3
Second Depo Shot (Months Four-Six)

Second Depo Shot
Depo Shot. TEK IMAGE/Getty Images

Depo Shot #2:

After your second Depo Provera shot or Depo-subQ 104 injection, your body will still be adjusting to the progestin hormone. By now, you have probably been happy with the convenience of not having to think about birth control. If you are satisfied with your depo decision (or are still unsure but want to continue using Depo Provera), it is time for your second depo shot.

During months four through six, it is still considered normal if you are experiencing sporadic bleeding. Most women who use Depo Provera report that their irregular spotting tends to lessen with each shot. In fact, by the end of month six, 39 percent of women usually have had their periods stop completely.

At this point, you may or may not notice changes to your weight. How come? Well another common Depo Provera side effect is weight gain. Use this doctor’s visit to discuss a possible exercise and/or diet plan with your doctor. If you eat sensibly and exercise often, you can help reduce the changes in your weight that may stem from using Depo Provera.

Since you are continuing with Depo Provera, you should also talk with your doctor about ways of adopting a lifestyle that can help you maintain your bone health. Why? Depo Provera has a black box warning that advises women that continued depo use may cause bone mineral density loss. Because of this, this depo shot appointment is also a good time to ask your doctor about recommendations about maintaing adequate calcium intake—through: 

  • Supplements and vitamin D
  • A diet containing lots of vegetables
  • Weight-bearing and muscle-strengthening exercises that may help in countering any potential calcium loss to your bones.

Your doctor may also suggest that you stop smoking (if you are a smoker) and to limit or cut out any alcohol consumption.

You should also make an appointment for your next scheduled depo shot during the same doctor’s visit that you receive your second shot.

  • If you are using the Depo Provera shot, make your appointment for your third injection within 11 to 13 weeks.
  • If you are using Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

This will ensure that your pregnancy protection continues.

4
Third Depo Shot (Months Seven-Nine)

Exercise During Depo Use
Exercising During Depo Use. Hero Images/Getty Images

Ready for Your Third Depo Shot?

By the time you are ready for your third Depo Provera shot or Depo-subQ Provera 104 injection, there is a good chance (close to 40 percent) that your irregular bleeding and periods have stopped because your body has adjusted to the progestin in this method.

At this point, it is important to be maintaining a healthy lifestyle to help counteract any weight gain or calcium loss associated with Depo Provera. Keep taking your calcium supplements if your doctor had recommended their use.

You should also be exercising! Your routine should including weight bearing exercises that will help to keep your bones strong. Plus, regular, heart healthy exercise that will help burn off extra calories.

  • Weight-bearing exercise can include: walking, hiking, or running
  • Heart-healthy forms of exercise include: bicycling, yoga, or swimming

To make sure that your pregnancy protection continues, schedule an appointment for your next depo shot during the same doctor’s visit that you receive your third shot. If you are using Depo Provera, make your appointment for your fourth injection within 11 to 13 weeks. If you are using Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

As you continue your Depo Provera use, here are some more ideas about exercises and nutrition that can help you to maintain healthy bones and less weight gain:

5
Fourth Depo Shot (Months Ten-Twelve)

Depo Provera Shot
Depo Provera Appointment. Tetra Images/Getty Images

Your Final Depo Shot of the Year:

At this point, you are probably enjoying the hassle-free nature of this birth control method. Besides showing up for your depo shot appointments, you have nothing else to remember to do! Plus, as long as you have been receiving your Depo Provera injections on time, you have had continuous pregnancy protection.

From this point on, you should be continuing with an exercise and diet plan to help maintain good bone health and weight.

You may also be experiencing the added benefit of not having your period anymore. After nine months of Depo Provera or Depo-subQ Provera 104 use, about half of women’s periods have either almost stopped or have completely stopped. For the remaining women, 57 percent say that their periods have stopped by the end of a whole year of depo use. If your period has not completely stopped by the end of the first year, don't fret. With continued Depo Provera use, it will most likely stop within the following months.

After using Depo Provera for a year, you will most likely need to schedule your annual gynecological exam. You can arrange to receive your fourth depo shot during this appointment. This is a good time to discuss with your doctor whether or not to continue with your depo shots. If you choose to stay on Depo Provera, make an appointment for your next scheduled injection (11-14 weeks).

6
Depo Provera Use: Final Considerations

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Depo Provera Shot. Photo © Dawn Stacey

Thing to Keep in Mind About Depo Use:

  • It is super important that you receive your depo shot on time, every time. If you miss your Depo Provera shot or if more than 13 weeks have gone by since your last injection (14 weeks if using Depo-subQ Provera 104), be sure to use a backup method of birth control, such as condoms, female condoms, or the sponge.
  • If you want to become pregnant, you should stop your depo shots one year before the time you plan to begin trying to get pregnant. This is because it takes an average of nine to 10 months (sometimes more than a year) to regain fertility and begin ovulating after receiving your last Depo Provera shot.
  • It is recommended that most women not use Depo Provera or Depo-subQ Provera 104 for more than two years (due to the potential for bone density loss). You should continue with your depo shots (for more than 2 years) only after weighing the benefits vs. risks of continued use, and you and your doctor have determined that there this is the birth control method for you to be using.

 

Sources:

Allen RH, Cwiak C, Kaunitz AM. "Progestin Injectable Contraceptives." The Handbook of Contraception. Springer International Publishing, 2016. 125-138.

Westhoff C. "Depot-medroxyprogesterone acetate injection (Depo-Provera): A highly effective contraceptive option with proven long-term safety." Contraception. 2003;68(2):75–87.

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