What is the recommended frequency for Depo-Provera (medroxyprogesterone) injections?

Depo-Provera (Medroxyprogesterone Acetate) Injection Frequency

The recommended frequency for Depo-Provera injections is every 3 months (13 weeks), with a grace period allowing administration up to 15 weeks from the previous injection without requiring additional contraceptive protection. 1, 2, 3

Standard Administration Schedule

• Standard dose: 150 mg administered by deep intramuscular (IM) injection in the gluteal or deltoid muscle 1, 3
• Alternative: 104 mg subcutaneous (SC) injection every 13 weeks 2
• Timing window: Must be given within 13-15 weeks of previous injection to maintain contraceptive effectiveness 1, 2
• If more than 15 weeks have elapsed since the last injection, pregnancy must be ruled out before administering the next dose 3

Initial Injection Timing

For first-time users, Depo-Provera should be administered:

• During the first 5 days of a normal menstrual period 3
• Within the first 5 days postpartum for non-breastfeeding women 3
• At or after the sixth postpartum week for women who exclusively breastfeed 3

Self-Administration Option

The CDC recommends that self-administered subcutaneous DMPA-SC (104 mg) should be made available as an additional approach to deliver injectable contraception 1. This option:

• Improves contraceptive access and increases reproductive autonomy
• Follows the same 13-week (with up to 15-week grace period) injection schedule as provider-administered DMPA
• Requires proper patient education on self-injection technique and sharps disposal

Clinical Considerations

Efficacy

• Typical use failure rate: approximately 6%
• Perfect use failure rate: less than 1% 2
• Efficacy depends strictly on adherence to the dosage schedule 3

Duration of Use

• Not recommended for long-term use (>2 years) unless other birth control methods are considered inadequate due to bone mineral density concerns 3
• Regular monitoring is recommended to assess bone health, especially in adolescents 2

Side Effects Management

• Menstrual irregularities are common initially but typically improve over time 1, 2
• Weight gain may occur, with early weight gain (>5% at 6 months) predicting more significant future weight gain 1
• To mitigate bone mineral density loss, recommend daily intake of 1300 mg calcium and 600 IU vitamin D, regular weight-bearing exercise, and smoking cessation 2

Common Pitfalls to Avoid

1. Missing the injection window: Ensure patients understand the importance of returning within 13-15 weeks for their next injection
2. Inadequate counseling: Thorough pre-use counseling about expected menstrual changes reduces discontinuation rates
3. Overlooking bone health: Monitor bone health, especially in adolescents and those using the method long-term
4. Forgetting STI protection: Remind patients that Depo-Provera provides contraception but not STI protection

Depo-Provera offers a convenient, highly effective contraceptive option that requires minimal user adherence beyond remembering quarterly appointments, making it particularly suitable for those who struggle with daily contraceptive methods.