Depo-Provera Dosing for Birth Control
Administer 150 mg of Depo-Provera (medroxyprogesterone acetate) by deep intramuscular injection every 3 months (13 weeks), alternating between the gluteal or deltoid muscle. 1
Timing of First Injection
The first injection must be given during one of these windows to ensure immediate contraceptive protection:
- Within the first 5 days of a normal menstrual period (no backup contraception needed) 1
- Within the first 5 days postpartum if not breastfeeding 1
- At or after 6 weeks postpartum if exclusively breastfeeding 1
If starting at any other time, you must be reasonably certain the patient is not pregnant. If initiated more than 7 days after menses started, the patient needs backup contraception (abstinence or barrier methods) for 7 days 2.
Reinjection Schedule
- Standard interval: Every 13 weeks (3 months) 1
- Grace period: Can be given up to 2 weeks late (15 weeks from last injection) without requiring additional contraception 3
- If >15 weeks since last injection: Confirm the patient is not pregnant before administering, and use backup contraception for 7 days 1
Administration Technique
- Route: Deep intramuscular injection only 1
- Sites: Gluteal or deltoid muscle, rotating sites with each injection 1
- Preparation: Vigorously shake the vial or prefilled syringe immediately before use to ensure uniform suspension 1
- Needle consideration: Assess body habitus before each injection—a longer needle may be necessary for gluteal injection to avoid inadvertent subcutaneous administration 1
Critical Duration Limitation
Depo-Provera is NOT recommended for longer than 2 years of continuous use unless other contraceptive options are inadequate 1. This restriction exists because of significant, potentially irreversible bone mineral density loss, particularly concerning in adolescents and young adults during peak bone accretion 1. If use beyond 2 years is necessary, evaluate bone mineral density and reassess the risk-benefit ratio 1.
Alternative Formulation
A subcutaneous formulation (DMPA-SC 104 mg) is available and can be self-administered by patients, offering increased autonomy and access 3. The same timing and interval recommendations apply to the subcutaneous formulation.
Common Pitfalls to Avoid
- Don't adjust dose for body weight—150 mg is effective across all body habitus 1
- Don't forget the grace period—patients have until 15 weeks (not just 13) before requiring pregnancy testing and backup contraception 3
- Don't overlook bone health counseling—this is mandatory, especially for adolescents and those with osteoporosis risk factors 1
- Don't skip the vigorous shake—failure to ensure uniform suspension can result in underdosing 1