What questions should be asked before administering the Depo (medroxyprogesterone acetate) injection for birth control?

Essential Questions to Ask Before Administering Depo-Provera Injection

Before administering a Depo-Provera (medroxyprogesterone acetate) injection for birth control, healthcare providers should ask specific screening questions to ensure safety and effectiveness, focusing on medical history, pregnancy status, and patient understanding of the method.

Medical History Assessment

• Last menstrual period (LMP): When was your last menstrual period? (Must be given within first 5 days of normal menstrual period to ensure patient is not pregnant) 1
• Pregnancy status: Is there any possibility you could be pregnant? (If uncertain, pregnancy test should be performed) 2
• Previous contraceptive use: What methods have you used in the past and what was your experience with them? 2
• Allergies: Do you have any known allergies to medications? 1
• Current medications: What medications are you currently taking? (Specifically ask about aminoglutethimide which can decrease effectiveness) 1
• Medical conditions: Ask about:
  • Undiagnosed vaginal bleeding
  • History or suspected breast cancer
  • Thromboembolic disorders or cerebrovascular disease
  • Liver dysfunction
  • Diabetes (as glucose tolerance may be affected) 1

Sexual Health Assessment

• Recent sexual activity: When was your last sexual intercourse? 2
• STI risk factors: Do you have multiple partners or new partners? (Remind that Depo does not protect against STIs) 1
• Reproductive life plan: Do you want to have children in the future? If so, when? (Important due to potential delay in return to fertility) 2, 3

Side Effect Discussion and Preparation

• Menstrual changes: Are you aware that most women experience menstrual irregularities with Depo-Provera, including spotting, unpredictable bleeding, or amenorrhea? 1
• Weight concerns: Do you have any concerns about potential weight gain? (Weight gain at 6 months may predict future excessive weight gain) 4
• Bone health: Do you get adequate calcium and vitamin D in your diet? Do you perform regular weight-bearing exercise? 4
• Follow-up plans: Can you return for your next injection in 13 weeks (3 months)? 1

Self-Administration Assessment (if applicable)

• Interest in self-administration: Would you prefer to self-administer the subcutaneous form of Depo-Provera? 2
• Comfort with injection technique: How comfortable are you with learning to give yourself an injection? 2
• Access to follow-up care: Do you have a way to contact healthcare providers if you have questions or concerns about self-administration? 2

Common Pitfalls to Avoid

1. Failing to verify pregnancy status before administration - always confirm LMP or perform pregnancy test if indicated 1
2. Not discussing menstrual changes - inadequate counseling about expected bleeding changes leads to higher discontinuation rates 4
3. Overlooking the importance of timely injections - emphasize that injections must be given every 13 weeks, with a grace period of only 2 weeks 2
4. Forgetting to discuss STI protection - clearly explain that Depo-Provera provides no protection against sexually transmitted infections 1
5. Neglecting bone health considerations - especially important for adolescents and long-term users 4

By thoroughly addressing these questions before administering Depo-Provera, healthcare providers can ensure safe and appropriate use of this contraceptive method while helping patients understand what to expect and how to manage potential side effects.