When should I stop taking the Depo (medroxyprogesterone acetate) shot?

From the Guidelines

You should stop taking the Depo-Provera (medroxyprogesterone acetate) shot if you want to become pregnant, are experiencing severe side effects, have been on it for more than 2 years due to bone density concerns, or have developed certain health conditions, as recommended by the most recent guidelines 1. When considering stopping the Depo shot, it's essential to weigh the benefits and risks, prioritizing morbidity, mortality, and quality of life. The decision to stop should be based on individual circumstances, such as the desire to become pregnant, severe side effects, or the development of certain health conditions like unexplained vaginal bleeding, suspected pregnancy, liver disease, breast cancer, blood clots, stroke, or heart disease. Some key points to consider when stopping the Depo shot include:

• Fertility may take 6-12 months to return after stopping, as noted in studies 1
• Temporary side effects like irregular periods, headaches, or mood changes may occur as the body adjusts to the hormonal changes
• It's crucial to consult with a healthcare provider to discuss reasons for stopping, potential side effects, and alternative contraception options to avoid unintended pregnancy
• The American Family Physician guidelines 1 provide recommendations for managing missed doses and transitioning to new cycles, but these may not directly apply to the decision to stop the Depo shot altogether
• Bone density concerns, although a potential risk, have been found to be largely reversible after discontinuation of the Depo shot, as reported in studies 1 Ultimately, the decision to stop the Depo shot should be made in consultation with a healthcare provider, taking into account individual circumstances and prioritizing morbidity, mortality, and quality of life. Stopping the Depo shot requires no special procedure, simply omitting the next scheduled injection, but it's essential to discuss alternative contraception options with a healthcare provider to avoid unintended pregnancy 1.

From the FDA Drug Label

The use of medroxyprogesterone acetate is not recommended as a long-term (i.e., longer than 2 years) birth control method unless other options are considered inadequate.

Stop Depo Shot Considerations:

• The FDA recommends not using medroxyprogesterone acetate for more than 2 years unless other birth control options are inadequate.
• Women with osteoporosis risk factors should consider alternative birth control methods.
• Patients who develop thrombosis, have a history of breast cancer, or experience severe side effects should discontinue use.
• BMD should be evaluated when a woman needs to continue using medroxyprogesterone acetate long-term 2.
• In adolescents, interpretation of BMD results should take into account patient age and skeletal maturity 2.
• BMD recovery post-treatment in adolescents showed that longer duration of treatment and smoking were associated with less recovery of BMD following the last injection of medroxyprogesterone acetate 2.

From the Research

When to Stop Depo Shot

The decision to stop using the Depo-Provera shot, also known as medroxyprogesterone acetate (DMPA), depends on various factors, including the individual's health, personal preferences, and reasons for using the contraceptive. Here are some points to consider:

• Side effects: Common side effects of DMPA include menstrual irregularities, weight gain, and hair loss 3. If these side effects are severe or persistent, it may be necessary to stop using the Depo shot.
• Menstrual changes: DMPA can cause changes in menstrual bleeding patterns, including amenorrhea (absence of menstruation) 4, 5. If these changes are unacceptable or cause concern, it may be necessary to stop using the Depo shot.
• Bone mineral density: Long-term use of DMPA (>2 years) can have a negative effect on bone mineral density, particularly in women over 40 years old 6. If there are concerns about bone health, it may be necessary to stop using the Depo shot or consider alternative contraceptive methods.
• Contraceptive needs: If an individual's contraceptive needs change, such as wanting to become pregnant, it may be necessary to stop using the Depo shot.
• Health risks: DMPA has been associated with a range of health risks, including weight gain, blood pressure changes, and thrombosis risk 5. If an individual has pre-existing health conditions or concerns, it may be necessary to stop using the Depo shot or consider alternative contraceptive methods.

Considerations for Stopping Depo Shot

Before stopping the Depo shot, it is essential to consider the following:

• Alternative contraceptive methods: If an individual stops using the Depo shot, they will need to consider alternative contraceptive methods to prevent pregnancy.
• Return to fertility: After stopping the Depo shot, it may take several months for fertility to return 7.
• Follow-up care: Regular follow-up care with a healthcare provider is essential to monitor any changes in health or contraceptive needs after stopping the Depo shot.