When can I administer Depot Provera (medroxyprogesterone acetate)?

When to Administer Depot Provera (Medroxyprogesterone Acetate)

Depot Provera can be administered at any time during the menstrual cycle if it is reasonably certain that the woman is not pregnant, with appropriate backup contraception for 7 days if not started within the first 5 days of menstruation. 1

Timing of First Injection Based on Situation

During Regular Menstrual Cycle

• First 5 days of menstrual cycle: Can start without need for backup contraception 2
• After day 5 of menstrual cycle: Can start but needs 7 days of backup contraception 1

Amenorrhea (Not Postpartum)

• Can start at any time if reasonably certain the woman is not pregnant
• Requires 7 days of backup contraception 1

Postpartum (Breastfeeding)

• Can be given at any time, including immediately postpartum
• No backup needed if:
  • Less than 6 months postpartum
  • Amenorrheic
  • Fully or nearly fully breastfeeding (≥85% of feeds are breastfeeds)
• Otherwise, backup contraception needed for 7 days if ≥21 days postpartum 1

Postpartum (Not Breastfeeding)

• Can be given at any time, including immediately postpartum
• If ≥21 days postpartum: needs 7 days of backup contraception 1

Post-Abortion

• Can be given within 7 days of abortion, including immediately
• Backup contraception needed for 7 days unless given at time of surgical abortion 1

Switching from Another Method

• Can be given immediately
• Backup contraception needed if >7 days since menstrual bleeding started
• Special considerations for switching from IUD (see below) 1

Administration Guidelines

Injection Technique

• Intramuscular (IM): 150 mg deep IM injection in gluteal or deltoid muscle 2
• Subcutaneous (SC): 104 mg SC injection, can be self-administered 1
• Vial should be vigorously shaken before use 2
• Rotate injection sites with each administration 2

Dosing Schedule

• Administer every 13 weeks (3 months)
• Can be given up to 15 weeks (2 weeks late) without requiring additional contraception 1
• If more than 15 weeks since last injection, rule out pregnancy before administering 2

Special Considerations

Switching from IUD

If switching from an IUD and the woman has had intercourse since the start of her current cycle and it has been >5 days since menstrual bleeding started, consider one of these options:

1. Keep IUD in place for at least 7 days after Depot Provera injection
2. Abstain from sex or use barrier method for 7 days before IUD removal
3. Use emergency contraception at time of IUD removal 1

Bone Health

• Not recommended for long-term use (>2 years) unless other methods are inadequate due to bone mineral density loss 2
• Consider calcium (1300 mg/day) and vitamin D (600 IU/day) supplementation 3

Self-Administration Option

• Self-administered subcutaneous DMPA-SC is now available as an additional approach
• Same eligibility criteria and timing recommendations apply as for provider-administered DMPA 1

Common Pitfalls to Avoid

1. Inadequate counseling: Menstrual changes (irregular bleeding, eventual amenorrhea) are common and a major reason for discontinuation 4
2. Forgetting to rule out pregnancy: Always ensure the patient is not pregnant before first injection 2
3. Missing the injection window: Effectiveness depends on adherence to the 13-15 week schedule 2
4. Ignoring bone health: Consider calcium and vitamin D supplementation, especially for long-term users 3, 2
5. Not discussing return to fertility: Return to ovulation may be delayed for several months after discontinuation 5

By following these guidelines, Depot Provera can be administered safely and effectively as a contraceptive method with a very low failure rate of less than 1% with perfect use 1, 6.