From the Guidelines
Depo-Provera (medroxyprogesterone acetate) injections can be used for long-term contraception with no mandatory time limit, as the American College of Obstetricians and Gynecologists (ACOG) does not advise limiting DMPA use to 2 years 1. When considering the use of Depo-Provera, it is essential to weigh the benefits of effective contraception against potential risks, such as bone density loss.
- The medication is administered every 12-13 weeks (about 3 months) and is highly effective in preventing pregnancy, with a probability of becoming pregnant with typical use of approximately 6% in the first year 1.
- Patients should discuss their individual health history with their provider to determine the appropriate duration, taking into account factors like age, bone health, and other medical conditions.
- Regular check-ups with a healthcare provider can help monitor for any potential side effects, such as menstrual irregularities, weight gain, and bone density loss, and determine if continuing with Depo-Provera remains the best option for each individual.
- It is crucial to counsel patients 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, to mitigate the risk of osteoporosis 1.
- While bone density concerns arise because the medication can reduce estrogen levels, which may affect bone mineralization, particularly in adolescents whose bones are still developing, bone density typically recovers after discontinuing the medication 1.
From the FDA Drug Label
Medroxyprogesterone Acetate Injectable Suspension, USP should be used as a long-term birth control method (e. g. longer than 2 years) only if other birth control methods are inadequate. In a controlled, clinical study, adult women using Medroxyprogesterone Acetate Injectable Suspension, USP for up to 5 years showed spine and hip BMD mean decreases of 5–6%, compared to no significant change in BMD in the control group.
The maximum duration for treatment with Depo-Provera (medroxyprogesterone acetate) injections is not explicitly stated in the drug label. However, it is recommended that Medroxyprogesterone Acetate Injectable Suspension, USP should not be used for more than 2 years as a long-term birth control method unless other methods are inadequate. In clinical studies, women have been treated for up to 5 years with significant bone mineral density loss observed. 2
From the Research
Maximum Duration for Treatment with Depo-Provera
The maximum duration for treatment with Depo-Provera (medroxyprogesterone acetate) injections is not strictly defined, but there are considerations regarding its long-term use:
- Bone mineral density (BMD) loss is a concern with long-term Depo-Provera use, particularly in adolescents and young adults 3, 4, 5.
- Studies have shown that BMD loss is more pronounced during the first 2 years of use and then stabilizes, with an average annual loss of less than 1% after 2 years 4.
- The World Health Organization (WHO) and other health organizations have not established a specific maximum duration for Depo-Provera use, but they recommend careful consideration of the benefits and risks, particularly regarding BMD loss 3.
- Some studies have followed women using Depo-Provera for up to 10 years, with no significant adverse effects on BMD or other health outcomes 4.
Key Considerations
- Women who may wish to conceive within the next two years should be advised that Depo-Provera may not be the best contraceptive choice, as fertility may be suppressed for up to 22 months after the last injection 3.
- Healthcare providers should monitor women using Depo-Provera for potential side effects, such as irregular bleeding, weight gain, and headaches, and provide guidance on managing these effects 6, 7.
- Women should be informed about the potential risks and benefits of long-term Depo-Provera use and be involved in the decision-making process regarding their contraceptive choices 3, 4, 5.