From the Guidelines
Yes, a patient can receive Depo-Provera (medroxyprogesterone acetate) while on her menstrual cycle.
Key Considerations
- The first injection is typically recommended within the first 5 days of the menstrual cycle to provide immediate contraceptive protection, as stated in 1.
- If administered during this time, no backup contraception is needed.
- The standard dose is 150 mg given as an intramuscular injection every 12 weeks (3 months).
- If the injection is given later in the cycle (after day 5), the patient should use a backup contraceptive method, such as condoms, for 7 days after the injection, as recommended in 1.
Mechanism of Action
- Depo-Provera works by preventing ovulation, thickening cervical mucus to block sperm, and thinning the uterine lining.
- Administering it during menstruation ensures the patient is not already pregnant before starting the medication, as Depo-Provera should not be used during pregnancy.
Potential Side Effects
- Patients should be aware that Depo-Provera may cause irregular bleeding or spotting, especially during the first few months of use, and this is normal, as noted in 1.
- Other potential side effects include weight gain, delayed return to fertility, menstrual bleeding irregularities, and bone mineral loss, which is largely reversible after DMPA discontinuation, as discussed in 1.
From the FDA Drug Label
To ensure the patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of a normal menstrual period or within the first 5-days post-partum.
The patient can receive Depo-Provera (medroxyprogesterone) only during the first 5 days of her menstrual cycle, as this ensures she is not pregnant at the time of the first injection 2.
From the Research
Administration of Depo-Provera
- Depo-Provera (medroxyprogesterone acetate) is a highly effective contraceptive with a very low failure rate 3.
- The recommended dose is 150 mg administered every 3 months by deep, intramuscular injection in the gluteal or deltoid muscle 4.
Menstrual Cycle Considerations
- Most women in clinical studies of Depo Provera experienced menstrual irregularities, and as use continued, amenorrhea became common, reported by 57% of the women by the end of a year of treatment 4.
- Menstrual disturbances, such as irregular and/or excessive menstrual bleeding, diminish with long-term use of the contraceptive, and a high percentage of users become amenorrheic 5.
Initiation of Depo-Provera
- Initiation of Depo-Provera can be done on different days of the menstrual cycle, but it is recommended to start within the first 7 days of the menstrual cycle to ensure contraceptive effectiveness 6.
- When Depo-Provera is initiated later than Cycle Day 7, ovulation may occur in some women, and approximately 90% of women have poor quality cervical mucus within 24 hours after injection 6, 7.
- It is recommended that women use a backup method of contraception for 7 days when the first injection of Depo-Provera is provided after the seventh day of the menstrual cycle 7.
Contraindications and Side Effects
- Contraindications for Depo-Provera include undiagnosed vaginal bleeding, known or suspected malignancy of breast, thromboembolic disorders, cerebral vascular disease, and liver dysfunction 4.
- Common side effects of Depo-Provera include weight gain, headache, nervousness, abdominal pain or discomfort, dizziness, and asthenia 4, 5.