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

1
Before Your First Dose of Depo Provera:

Depo Provera. Photo Courtesy of Microsoft Online

Depo-Provera

is a reversible prescription birth control method. Each Depo Provera shot slowly releases a synthetic form of progesterone medroxyprogesterone acetate that can protect against pregnancy for a period of 11 - 14 weeks. This method prevents

ovulation

, so there is no egg available for a sperm to fertilize. It also works by thickening cervical mucus, which makes it harder for sperm to swim. Additionally, the progestin in Depo Provera can 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.

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 a year, you should receive 4 shots.

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

Before you begin using the birth control shot, it is important that you are aware of the bleeding side effects that may occur while on this method. Research has shown that women who have been informed about the potential for either irregular (spotting) bleeding or prolonged, continuous bleeding before beginning this method are more likely to continue taking Depo Provera. You should be aware that even though these bleeding effects could be present at the start, according to Pfizer (the manufacturer of Depo Provera), “in clinical trials, over a third of the women had stopped having periods (this is called "amenorrhea") by month 6. By month 12, over half of the women had 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 Dose – Month’s 1 - 3

birth_control_shot.jpg
Depo Shot Due. Photo © 2014 Dawn Stacey

If you received your first dose during one of the first five days of your period, then Depo Provera will begin to work immediately. With perfect use, Depo Provera is 99.7 percent effective (97 percent with typical use). It becomes even more effective if you switched from another hormonal method and received your first shot within the last seven days of using that method (i.e., combination birth control pills, NuvaRing, the Ortho Evra Patch).

In general, it takes about three months for your body to adjust to Depo Provera. Similar to other hormonal birth control methods, your body needs to get used to the hormone (progestin).

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 reaction is considered completely normal. If, however, you notice that your bleeding is very heavy or if you are concerned, it is important to contact your health-care provider (See: Depo Bleeding – Will It Ever Stop?).

  • Other 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. For some women, side effects may continue until the injection wears off (11 to 14 weeks).

It is also recommended that you make an appointment for your next scheduled injection 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 Dose – Month’s 4 - 6

Depo Provera Shot Reminder. Photo Courtesy of Dawn Stacey

After your second Depo Provera shot or Depo-subQ 104 injection, your body will still be adjusting to the hormone. By now, you have probably been happy with the convenience of not having to think about birth control.

During months four through six, it is still considered normal if you are experiencing sporadic bleeding. Most women who have used this method report that the 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 have noticed changes to your weight. If you have yet to do so, use this doctor’s visit to discuss a possible exercise and/or diet plan with your doctor. Pfizer maintains that if you eat sensibly and exercise often, you can help reduce the changes in your weight that may stem from Depo Provera use.

It is also important to find out from your doctor what you should be doing to adopt a lifestyle that can help maintain bone health (due to the black box warning that Depo Provera use may cause bone mineral density loss). Ask your doctor about recommendations concerning adequate calcium intake through supplements and vitamin D, a diet containing lots of vegetables, and weight-bearing and muscle-strengthening exercises that may help aid 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.

Make an appointment for your next scheduled injection during the same doctor’s visit that you receive your second shot.

  • If you are using the original Depo Provera shot, make your appointment for your third 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.

This will ensure that your pregnancy protection continues.

4
Third Dose – Month’s 7 - 9

Depo Provera Appointment. Photo Courtesy of Microsoft Online

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 been adjusting 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 calcium supplements if your doctor had recommended their use.

Your exercising 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 certain that your pregnancy protection continues, schedule an appointment for your next injection during the same doctor’s visit that you receive your third shot. If you are using the original Depo Provera shot, make your appointment for your fourth 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.

To help counterbalance the weight gain associated with Depo Provera, try out the free About Calorie Count Plus program. Here, you can use the food recommendation tool, determine your diet profile, create a diet plan, and receive support from others.

For more ideas about exercises and nutrition that can help maintain healthy bones:

5
Fourth Dose – Month’s 10 - 12

Schedule Depo Provera Appointment. Photo Courtesy of Dawn Stacey

At this point, you are probably enjoying the hassle-free nature of this birth control method. Plus, as long as you have been receiving your Depo Provera injections on time, your pregnancy protection has been uncompromised.

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

Pfizer indicates that in clinical studies, 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 reported that their periods have stopped by the end of a whole year of use. If your period has not completely stopped by the end of the first year, with continued Depo Provera use, it will most likely stop within the following months.

After a year of using Depo Provera, you will most likely need to schedule an annual gynecological exam where you can discuss with your doctor whether or not to continue with this birth control method. If you choose to stay on Depo Provera, make an appointment for your next scheduled injection.

  • If you are using the original Depo Provera shot, make your appointment for your next injection within 11 to 13 weeks from your fourth one.

  • If you are using the newer Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

This will ensure that your 99.7 percent pregnancy protection rate continues.

6
Final Considerations

Depo Provera Shot. Photo Courtesy of S. Linder

Remember that if you miss a Depo Provera shot or if more than 13 weeks go by since your last injection (14 weeks if using Depo-subQ Provera 104), then be sure to use a backup method of birth control, such as condoms, female condoms, or the sponge.If you wish to become pregnant, you should stop your Depo Provera 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 should not use Depo Provera or Depo-subQ Provera 104 for more than two years (due to the black box warning of bone density loss). A woman should continue with this method (for more than 2 years) only after weighing all other potential options, and it is determined that there are no other birth control methods right for her.

Sources:

Pfizer. (2005). “Depo-SubQ Provera 104” and (2004). “Depo Provera: Contraceptive Injection”.

Jain, J. (2005). "Contraception: Subcutaneous depot medroxyprogesterone acetate for birth control and endometriosis pain”. OBG Management, Vol. 17, No 8.Accessed via private subscription.

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