How long can I take Depo-Provera (medroxyprogesterone acetate)?

Duration of Depo-Provera (Medroxyprogesterone Acetate) Use

Depo-Provera can be used long-term without a mandatory time limit, with injections administered every 13 weeks (up to 15 weeks). The previous concerns about limiting use to 2 years have been revised as evidence shows substantial recovery of bone mineral density after discontinuation 1, 2.

Administration Guidelines

• Administered as a 150 mg intramuscular injection or 104 mg subcutaneous injection every 3 months (13 weeks)
• Can be given up to 2 weeks late (15 weeks from previous injection) without requiring additional contraceptive protection 2, 3
• Self-administered subcutaneous DMPA-SC is now an approved option, though considered "off-label" per FDA labeling 1

Long-Term Use Considerations

Bone Health

• FDA issued a black box warning in 2004 about decreased bone mineral density (BMD) with DMPA use
• However, studies document substantial recovery of BMD after discontinuation 1
• The American College of Obstetricians and Gynecologists (ACOG) no longer advises limiting DMPA use to 2 years or routinely monitoring bone density 1
• Recommendations for bone health during use:
  • Daily intake of 1300 mg calcium
  • 600 IU of vitamin D daily
  • Regular weight-bearing exercise
  • Avoidance of smoking and alcohol 1, 2

Menstrual Changes

• Nearly all users experience menstrual irregularities initially
• Bleeding patterns typically improve over time
• Amenorrhea becomes common with continued use (57% of women by end of first year) 2, 4
• Pre-use counseling about these changes improves continuation rates

Weight Gain

• Weight gain is a common side effect
• Studies in both adolescents and adults suggest that weight gain at 6 months is a strong predictor of future excessive weight gain 1
• Consider alternative methods for patients with obesity or at risk for weight-related complications

Effectiveness and Benefits

• Highly effective contraceptive with failure rate less than 1% with perfect use and approximately 6% with typical use 1, 3
• Convenient, user-independent method
• Can be used by women who cannot use estrogen-containing contraceptives
• Safe for use in women with HIV, with no evidence of increased infectious complications 1
• No significant interactions with antiretroviral medications 1

Return to Fertility

• Median time for return to ovulation after discontinuation is approximately 30 weeks
• Studies show 97.4% cumulative rate of return to ovulation at 12 months 5

Follow-up Recommendations

• No routine follow-up is required beyond scheduled injections every 13 weeks
• Patients should contact healthcare providers for:
  • Discussion of side effects or problems
  • Desire to change contraceptive method
  • Questions about re-injection 1

While Depo-Provera can be used long-term, the decision to continue should be based on the individual's tolerance of side effects, particularly menstrual changes and weight gain, balanced against the high contraceptive efficacy and convenience of the method.