What is the recommended dosage for Depo-Provera (medroxyprogesterone acetate)?

Recommended Dosage for Depo-Provera (Medroxyprogesterone Acetate)

The recommended dose for Depo-Provera is 150 mg administered by deep intramuscular (IM) injection every 3 months (13 weeks) in the gluteal or deltoid muscle, with a subcutaneous option of 104 mg every 13 weeks. 1, 2

Administration Details

Intramuscular (IM) Administration

• Dose: 150 mg every 3 months (13 weeks)
• Injection site: Deep IM injection in gluteal or deltoid muscle
• Technique:
  • Vial should be vigorously shaken before use to ensure uniform suspension
  • Use strict aseptic technique
  • Rotate injection sites with each administration
  • Assess body habitus prior to injection to determine if a longer needle is necessary, particularly for gluteal injections 2

Subcutaneous Administration

• Dose: 104 mg every 13 weeks
• This lower-dose formulation provides comparable contraceptive efficacy while delivering 30% less medication 3

Timing of Administration

First Injection

• Must be given ONLY during the first 5 days of a normal menstrual period to ensure the patient is not pregnant 2
• For postpartum women:
  • Within the first 5 days postpartum for non-breastfeeding mothers
  • During or after the sixth postpartum week for exclusively breastfeeding mothers 2

Subsequent Injections

• Must be given within the 13-15 week timeframe to maintain contraceptive effectiveness 1
• If interval exceeds 13 weeks, pregnancy must be ruled out before administering the next dose 2

Duration of Use

• Not recommended for long-term use (>2 years) unless other birth control methods are considered inadequate due to impact on bone mineral density 2
• Regular monitoring is recommended to assess:
  • Side effects management
  • Bone health considerations
  • Weight changes 1

Switching from Other Contraceptive Methods

When transitioning from other contraceptives to Depo-Provera:

• For oral contraceptives: First injection should be given on the day after the last active tablet or at the latest, on the day following the final inactive tablet 2
• Ensure continuous contraceptive coverage based on the mechanism of action of both methods 2

Efficacy and Considerations

• Typical use failure rate: approximately 6%
• Perfect use failure rate: less than 1% 1
• Efficacy is not affected by body weight 2
• Ovulation is inhibited for at least 14 weeks after a 150 mg dose 4
• Median time for return to ovulation after discontinuation: approximately 30 weeks, with 97.4% cumulative rate of return to ovulation at 12 months 1, 3

Common Pitfalls to Avoid

1. Missing the injection window: Strictly adhere to the 13-week schedule
2. Inadequate counseling: Thoroughly discuss expected menstrual changes to improve compliance
3. Ignoring bone health: Recommend daily intake of 1300 mg calcium and 600 IU vitamin D, regular weight-bearing exercise, and smoking cessation
4. Overlooking weight gain: Monitor weight changes, as weight gain at 6 months predicts future excessive weight gain
5. Forgetting backup contraception: Use backup method (condoms or abstinence) for at least the first week after starting