Is vaginal bleeding common while on the Depo-Provera (medroxyprogesterone acetate) shot?

From the Guidelines

Yes, vaginal bleeding is common while on the Depo-Provera shot (medroxyprogesterone acetate 150 mg injected every 3 months). Irregular bleeding, spotting, or prolonged bleeding is experienced by many women, especially during the first year of use. This side effect typically improves over time, with approximately 50% of users experiencing no menstrual bleeding (amenorrhea) after one year of use. The bleeding occurs because Depo-Provera thins the endometrial lining of the uterus, which can lead to breakthrough bleeding as the body adjusts to the hormone. If bleeding is heavy or concerning, patients should contact their healthcare provider, as occasionally additional treatment with estrogen supplements or other medications may be recommended to manage persistent bleeding. Most irregular bleeding with Depo-Provera is not dangerous but represents an expected side effect of the medication. Users should be reassured that this pattern often improves with continued use, though some may experience irregular bleeding throughout their time on the shot. According to the most recent guidelines, management of bleeding irregularities while using contraception should prioritize patient goals and preferences 1.

Some key points to consider when managing bleeding irregularities in patients using Depo-Provera include:

• Providing reassurance and advising patients that they may contact their provider at any time to discuss bleeding irregularities or other side effects
• Exploring treatment options, such as NSAIDs, hormonal treatment, or antifibrinolytic agents, if the patient desires treatment
• Considering underlying health conditions that may be contributing to bleeding irregularities, such as interactions with other medications or new pathologic uterine conditions.

It's essential to note that the most recent guidelines prioritize patient-centered care and shared decision-making 1. By taking a patient-centered approach and providing individualized care, healthcare providers can help patients manage bleeding irregularities and improve their overall quality of life while using Depo-Provera.

From the FDA Drug Label

The following side effects have been reported with the use of medroxyprogesterone acetate tablets alone: ... breakthrough bleeding spotting (minor vaginal bleeding) ... irregular vaginal bleeding or spotting The FDA drug label states that breakthrough bleeding, spotting (minor vaginal bleeding), and irregular vaginal bleeding or spotting are possible side effects of medroxyprogesterone acetate tablets.

• Vaginal bleeding is a common side effect of medroxyprogesterone acetate tablets, and it is recommended to see a healthcare provider right away if vaginal bleeding occurs while taking the medication 2. It is essential to note that the medication label advises users to report any side effects that bother them or do not go away to their healthcare provider. The label also recommends regular check-ups with a healthcare provider to discuss the dose and treatment plan 2. Medroxyprogesterone acetate tablets may be given in dosages of 5 or 10 mg daily for 5 to 10 days to induce an optimum secretory transformation of an endometrium that has been adequately primed with either endogenous or exogenous estrogen 2.

From the Research

Vaginal Bleeding on Depo-Provera

• Vaginal bleeding is a common side effect of hormonal contraception, including Depo-Provera (medroxyprogesterone acetate) 3.
• Abnormal uterine bleeding is a major cause for the discontinuation of hormonal contraception, including Depo-Provera 3.
• Studies have shown that vaginal bleeding patterns in women using Depo-Provera can be irregular, with some women experiencing amenorrhea (no bleeding) and others experiencing prolonged or irregular bleeding 4, 5, 6.

Factors Affecting Vaginal Bleeding on Depo-Provera

• The duration of Depo-Provera use can affect vaginal bleeding patterns, with some women experiencing more regular bleeding over time 4, 6.
• Body mass index (BMI) can also affect vaginal bleeding patterns in women using Depo-Provera, with higher BMIs associated with more irregular bleeding 4.
• Prior use of oral contraceptive pills (OCPs) can affect vaginal bleeding patterns in women starting Depo-Provera, with some studies suggesting that prior OCP use can reduce the duration of bleeding 5.

Management of Vaginal Bleeding on Depo-Provera

• Counseling and reassurance are often adequate for managing vaginal bleeding in women using Depo-Provera, especially during the first few months of use 3.
• Supplemental estrogen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage vaginal bleeding in some cases 3, 7.
• Switching to a different contraceptive method, such as a combined estrogen-progestin injectable, may be an option for women who experience unacceptable vaginal bleeding on Depo-Provera 4, 6.