What is the proper usage and dosage of Medroxyprogesterone (Depo-Provera)?

Medroxyprogesterone (Depo-Provera): Proper Usage and Dosage

Medroxyprogesterone acetate injectable suspension (Depo-Provera) should be administered as a 150 mg intramuscular injection every 3 months (13 weeks), with the option for self-administered subcutaneous DMPA-SC (104 mg) as an additional approach to deliver injectable contraception. 1, 2, 3

Administration Protocol

Initial Injection

• Must be given ONLY during the first 5 days of a normal menstrual period or within the first 5 days post-partum to ensure the patient is not pregnant 2
• For post-partum mothers who exclusively breastfeed, administer during or after the sixth post-partum week 2
• Can be administered in the gluteal or deltoid muscle using strict aseptic technique 2
• Vial should be vigorously shaken just before use to ensure uniform suspension 2

Follow-up Injections

• Administer every 13 weeks (3 months) 2, 3
• Can be given up to 2 weeks late (15 weeks from previous injection) without requiring additional contraceptive protection 3
• If more than 15 weeks have passed since the last injection, pregnancy must be ruled out before administering the next dose 2, 3
• Injection sites should be rotated with each administration 2

Self-Administration Option

• Self-administered subcutaneous DMPA-SC (104 mg) is now recommended as an additional approach to deliver injectable contraception 3
• Requires proper instruction on self-injection technique and sharps disposal 3
• Note: Self-administration is considered "off-label" per FDA labeling 3
• Has higher continuation rates compared with provider-administered DMPA 3

Patient Selection

Appropriate Candidates

• Women seeking long-acting, reversible contraception 1
• Lactating women 1
• Women with contraindications to estrogen-containing contraceptives 1
• Most women with chronic illnesses 1

Contraindications

• Active thrombophlebitis or current/history of thromboembolic disorders 2
• Cerebral vascular disease 2
• Known or suspected breast malignancy 2
• Significant liver disease 2
• Undiagnosed vaginal bleeding 2
• Known hypersensitivity to medroxyprogesterone acetate 2
• Pregnancy 2

Important Considerations and Monitoring

Bone Mineral Density

• Associated with significant loss of bone mineral density (BMD) 2, 4
• Not recommended for long-term use (>2 years) unless other birth control methods are considered inadequate 2
• Recommend adequate calcium (1300 mg/day) and vitamin D (600 IU/day) intake 1
• Encourage regular weight-bearing exercise and smoking cessation 1
• BMD typically recovers after discontinuation 4

Side Effects Management

• Nearly all users experience menstrual irregularities initially 1
• Bleeding patterns typically improve over time; amenorrhea develops in many long-term users 1
• Weight gain is common; monitor at 6 months as this predicts future excessive weight gain 1
• Pre-use counseling about potential side effects is crucial to improve continuation rates 1

Common Pitfalls to Avoid

1. Inadequate pre-injection pregnancy screening: Always verify the patient is not pregnant before first injection 2
2. Missing the injection window: Ensure injections are given within the 13-15 week timeframe 3, 2
3. Improper injection technique: Assess body habitus to determine appropriate needle length, especially for gluteal injections 2
4. Insufficient counseling: Thoroughly discuss menstrual changes and other side effects to improve adherence 1
5. Ignoring bone health concerns: Recommend calcium/vitamin D supplementation and weight-bearing exercise 1, 2
6. Overlooking weight gain: Monitor weight at 6 months to identify patients who may need alternative contraception 1

By following these guidelines, medroxyprogesterone acetate can be an effective contraceptive option with a typical failure rate of 6% when administered correctly 1.