What are the recommendations for using Depo-Provera (medroxyprogesterone acetate) for family planning?

From the Guidelines

Depo-Provera (medroxyprogesterone acetate) is recommended as an effective injectable contraceptive option that requires administration every 12-13 weeks, with a standard dose of 150 mg given as an intramuscular injection, and can be initiated at any time if the provider is reasonably certain the patient is not pregnant, as stated in the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1.

Key Considerations

• The injection should be repeated every 12-13 weeks, with a grace period of up to 2 weeks (total 15 weeks) without significant reduction in efficacy.
• Users should be counseled about potential side effects including irregular bleeding patterns, delayed return to fertility, possible weight gain, headaches, and a small decrease in bone mineral density that is generally reversible after discontinuation, as noted in the 2014 study on contraception for adolescents 1.
• Depo-Provera does not protect against sexually transmitted infections, so condom use may be recommended for those at risk.
• The contraceptive works primarily by suppressing ovulation and thickening cervical mucus, providing approximately 99% effectiveness when used correctly.

Patient Counseling

• Patients should be counseled that a backup method (e.g., condoms or abstinence) should be used for at least the first week for contraceptive efficacy.
• A condom should be used at all times for protection against STIs.
• Patients should be informed about measures that promote skeletal health, such as daily intake of 1300 mg of calcium and 600 IU of vitamin D and regular weight-bearing exercise, as recommended in the 2014 study 1.

Suitability

• Depo-Provera is particularly suitable for women who desire long-term but reversible contraception, those who cannot use estrogen-containing methods, or those who have difficulty with daily contraceptive regimens.

From the FDA Drug Label

Medroxyprogesterone Acetate Injectable Suspension, USP is indicated only for the prevention of pregnancy The effectiveness of Medroxyprogesterone Acetate Injectable Suspension, USP is dependent on the patient returning every 3 months (13 weeks) for reinjection In five clinical studies using Medroxyprogesterone Acetate Injectable Suspension, USP, the 12-month failure rate for the group of women treated with Medroxyprogesterone Acetate Injectable Suspension, USP was zero (no pregnancies reported) to 0. 7 by Life-Table method.

The recommended use of Depo-Provera (medroxyprogesterone acetate) for family planning is as a long-term injectable contraceptive in women when administered at 3-month (13-week) intervals 2.

• The effectiveness of Medroxyprogesterone Acetate Injectable Suspension, USP is dependent on the patient returning every 3 months for reinjection.
• The 12-month failure rate for the group of women treated with Medroxyprogesterone Acetate Injectable Suspension, USP was zero (no pregnancies reported) to 0.7 by Life-Table method 2. Key considerations for using Depo-Provera for family planning include:
• Bone mineral density (BMD) loss in women of all ages and the impact on peak bone mass in adolescents should be considered in the risk/benefit assessment for women who use Medroxyprogesterone Acetate Injectable Suspension, USP long-term 2.

From the Research

Recommendations for Using Depo-Provera

• Depo-Provera (medroxyprogesterone acetate) is a highly effective injectable contraceptive that can be administered once every 12 weeks 3, 4.
• It is recommended as a first-line method for women who wish to make an informed choice about reversible methods of contraception 4.
• Pre-use counseling is essential to minimize the effect of menstrual changes, which occur in most patients 4.
• The use of Depo-Provera is independent of intercourse and user memory, making it a great advantage for women with irregular lifestyles or busy schedules 4.

Benefits and Risks

• Depo-Provera has a very low failure rate comparable to modern copper IUDs and lower than many other methods 4.
• The main potential disadvantages of Depo-Provera are menstrual disturbance and weight gain 4.
• Depo-Provera has no appreciable effects on blood pressure or thrombosis risk, making it a simple and effective alternative for women who cannot use the combined oral contraceptive pill 4.
• Long-term clinical experience has established the safety of Depo-Provera, with benefits including contraceptive efficacy and potential non-contraceptive health benefits 5.

Patient Selection and Management

• Appropriate patient selection is crucial for the use of Depo-Provera, taking into account factors such as menstrual cycle, body weight, and mood 5.
• Common patient management issues include effects on menstrual cycle, body weight, and mood, which can be addressed through counseling and management strategies 5.
• Women who have used Depo-Provera for more than 2 years may have a slightly increased fracture risk, but this risk is not observed after discontinuation 6.

Sexual Behavior and Menstrual Bleeding

• Depo-Provera users may experience a modest decrease in libido and sexual activity compared to users of other contraceptive methods, such as the levonorgestrel implant or copper IUD 7.
• Menstrual disturbance is more common with Depo-Provera than with other methods, with 49% of users experiencing amenorrhea 7.
• Women using Depo-Provera may have a lower prevalence of high-risk sexual behaviors, such as multiple sex partners and unprotected sex, compared to users of other methods 7.