Recommended Dosing for Depo-Provera (Medroxyprogesterone Acetate) Injection
The recommended dose for Depo-Provera is 150 mg administered by deep intramuscular injection every 3 months (13 weeks) in the gluteal or deltoid muscle. 1
Administration Options
- Intramuscular (IM) injection: 150 mg every 13 weeks
- Subcutaneous (SC) injection: 104 mg every 13 weeks
- Self-administration option available for subcutaneous form
- Self-administered DMPA-SC has shown higher continuation rates compared to provider-administered DMPA 2
Administration Timing
Initial Injection
- Must be given ONLY during one of these timeframes:
- First 5 days of a normal menstrual period
- First 5 days postpartum if not breastfeeding
- Sixth postpartum week if exclusively breastfeeding 1
Subsequent Injections
- Every 13 weeks (3 months)
- Can be given up to 15 weeks from the last injection without requiring additional contraceptive protection 2, 1
- If interval exceeds 13 weeks, pregnancy should be ruled out before administering 1
Preparation and Administration Technique
- Vial or prefilled syringe should be vigorously shaken just before use to ensure uniform suspension 1
- Administer as deep IM injection in gluteal or deltoid muscle 1
Efficacy
- Highly effective contraceptive with failure rate less than 1% with perfect use
- Typical use failure rate approximately 6% 2
- Efficacy depends on adherence to the recommended dosage schedule 1
Follow-up
- No routine follow-up is required beyond scheduled injections every 13 weeks
- Patients should contact healthcare providers if they experience side effects, want to change contraceptive methods, or have questions about re-injection 2, 3
Important Considerations
Bone Health
- FDA recommends adequate calcium (1300 mg/day) and vitamin D (600 IU/day) intake
- Regular weight-bearing exercise and smoking cessation are recommended to support bone health 2
Return to Fertility
- Median time for return to ovulation after discontinuation is approximately 30 weeks
- 97.4% cumulative rate of return to ovulation at 12 months 4
Common Side Effects
- Menstrual irregularities (nearly all users experience this initially)
- Bleeding patterns typically improve over time, with amenorrhea developing in many long-term users
- Weight gain (weight gain at 6 months is a strong predictor of future excessive weight gain) 2
Pitfalls to Avoid
- Missing the injection window (ensure injections are given within the 13-15 week timeframe)
- Failing to shake the vial/syringe vigorously before administration
- Overlooking bone health considerations
- Forgetting that Depo-Provera provides contraception but not STI protection 2
The Centers for Disease Control and Prevention (CDC) recommends that self-administered subcutaneous DMPA should be made available as an additional approach to deliver injectable contraception, which can improve access and increase reproductive autonomy 3.