At what age can Depo-Provera (medroxyprogesterone) be started?

Depo-Provera Use in Adolescents

Depo-Provera (medroxyprogesterone acetate) can be started at any age during adolescence after menarche, with no specific minimum age requirement for initiation. 1

Administration and Effectiveness

• Administered as a 150 mg intramuscular injection or 104 mg subcutaneous injection every 13 weeks (up to 15 weeks)
• Highly effective contraceptive with failure rate of approximately 6% with typical use and 0.2% with perfect use 1
• Convenient for adolescents due to independence from daily adherence requirements
• Can be initiated on the same day as the visit ("quick start") if pregnancy can be reasonably ruled out 1

Benefits for Adolescents

• User-independent method requiring only quarterly visits
• Does not require daily, weekly, or monthly adherence
• Provides improvement in dysmenorrhea
• Protection against iron-deficiency anemia and endometrial cancer
• Safe for use in adolescents with lactation or most chronic illnesses 1
• May provide additional benefits in specific conditions (e.g., raising seizure threshold, decreasing sickle cell crises) 1

Side Effects and Management

Menstrual Changes

• Nearly all users experience menstrual irregularities initially, which typically improve over time 1
• Thorough pre-injection counseling about bleeding changes significantly improves continuation rates 1
• Irregular bleeding is the most common reason for discontinuation (26% of discontinuers) 2

Weight Gain

• Weight gain affects some but not all users
• Studies show that weight gain at 6 months is a strong predictor of future excessive weight gain 1
• About 21% of adolescents experience "early weight gain" (>5% increase at 6 months) 1
• Weight gain was the second most common reason for discontinuation (18%) in adolescent users 2

Bone Health

• DMPA causes reductions in bone mineral density (BMD) 1, 3
• FDA data shows BMD decline in adolescents using DMPA for up to 240 weeks (4.6 years) 3
• Mean decrease in BMD at 240 weeks was more pronounced at total hip (-6.4%) and femoral neck (-5.4%) compared to lumbar spine (-2.1%) 3
• BMD recovery occurs after discontinuation, but may be incomplete in those who used DMPA for more than 2 years 3
• Recommendations for bone health:
  • Daily intake of 1300 mg calcium and 600 IU vitamin D
  • Regular weight-bearing exercise
  • Smoking cessation 1, 4

Continuation Rates and Follow-up

• Continuation rates among adolescents: 71% at 3 months, 48% at 6 months, and 27% at 12 months 2
• About 37% of discontinuers restart DMPA during follow-up 2
• High pregnancy rates (19%) among discontinuers warrant close follow-up after discontinuation 2

Common Pitfalls to Avoid

1. Inadequate pre-injection counseling: Thorough counseling about side effects, especially menstrual changes, improves continuation rates 1
2. Missing follow-up appointments: 23% of discontinuation is due to missed appointments 2
3. Ignoring bone health: Ensure adequate calcium and vitamin D intake, regular weight-bearing exercise, and smoking cessation 1, 4
4. Overlooking early weight gain: Monitor weight at 6 months as a predictor of future weight gain patterns 1
5. Failing to provide STI protection: DMPA does not protect against STIs, so condom use should still be encouraged 1

Return to Fertility

• Return to fertility is typically delayed 9-18 months after discontinuation 1
• For adolescents, this delay is usually not a major deterrent 1

Depo-Provera is an appropriate contraceptive option for adolescents of any age after menarche, with proper counseling about potential side effects and management strategies to improve continuation rates and overall health outcomes.