How often should the Depo (medroxyprogesterone acetate) shot be administered?

Depo-Provera (Medroxyprogesterone Acetate) Administration Schedule

The Depo-Provera (medroxyprogesterone acetate) shot should be administered every 13 weeks (3 months), with a grace period allowing administration up to 15 weeks after the previous injection to maintain contraceptive effectiveness. 1, 2, 3

Administration Protocol

• Standard dosing: 150 mg administered by deep intramuscular injection in the gluteal or deltoid muscle every 13 weeks 3
• Alternative option: 104 mg subcutaneous injection every 13 weeks 1
• Timing window: While 13 weeks is the recommended interval, injections can be given up to 15 weeks after the previous dose without compromising contraceptive effectiveness 2, 1
• First injection timing:
  • Must be given ONLY during the first 5 days of a normal menstrual period
  • OR within the first 5 days postpartum if not breastfeeding
  • OR at the sixth postpartum week if exclusively breastfeeding 3

Efficacy Considerations

• Typical use failure rate is approximately 6%, while perfect use failure rate is less than 1% 1
• Effectiveness depends strictly on adherence to the dosage schedule 3
• If the interval between injections exceeds 13 weeks (but remains under 15 weeks), contraceptive effectiveness is maintained 2
• If the interval exceeds 15 weeks, pregnancy status must be confirmed before administering the next dose 3

Important Clinical Considerations

• Menstrual changes: Nearly all users experience menstrual irregularities initially, but bleeding patterns typically improve with continued use 1, 2
• Bone health: Daily intake of 1300 mg calcium and 600 IU vitamin D, regular weight-bearing exercise, and smoking cessation are recommended to mitigate potential reductions in bone mineral density 1, 2
• Weight monitoring: Weight gain is common, with early weight gain (within first 6 months) being a strong predictor of future excessive weight gain 1, 4
• Return to fertility: After discontinuation, return to fertility is typically delayed 9-18 months while the endometrial lining returns to its pre-DMPA state and ovulatory function returns 2, 1

Common Pitfalls to Avoid

1. Missing the injection window: Exceeding the 15-week window may compromise contraceptive effectiveness
2. Inadequate counseling: Patients should be informed about expected menstrual changes to improve continuation rates
3. Overlooking bone health: Regular monitoring and supplementation are important for long-term users
4. Forgetting STI protection: DMPA provides no protection against sexually transmitted infections

Regular follow-up every 3 months is recommended to assess side effects, manage any concerns, and ensure timely administration of the next dose 1.