Recommended Dose for Depot Provera (Medroxyprogesterone Acetate)
The recommended dose for Depot Provera is 150 mg administered by deep intramuscular (IM) injection every 3 months (13 weeks) in the gluteal or deltoid muscle. 1
Dosing Specifics
- The 1 mL vial of medroxyprogesterone acetate injectable suspension should be vigorously shaken just before use to ensure uniform suspension 1
- Injection should be administered using strict aseptic technique, rotating injection sites with each administration 1
- The injection can be given up to 2 weeks late (15 weeks from the last injection) without requiring additional contraceptive protection 2
- Dosage does not need to be adjusted based on body weight 1
Administration Timing
- First injection should be given ONLY during the first 5 days of a normal menstrual period or within the first 5 days post-partum 1
- For post-partum mothers who exclusively breastfeed, administer during or after the sixth post-partum week 1
- If the interval between injections exceeds 13 weeks, pregnancy should be ruled out before administering the next dose 1
Formulation Options
Intramuscular (IM) Formulation
- Standard formulation: 150 mg/mL administered intramuscularly 1
- Body habitus should be assessed prior to each injection to determine if a longer needle is necessary, particularly for gluteal IM injection 1
Subcutaneous (SC) Formulation
- Lower-dose formulation: 104 mg/0.65 mL administered subcutaneously 3
- Self-administration of DMPA-SC is now recommended as an additional approach to deliver injectable contraception 2
- Self-administered DMPA-SC has been shown to have higher continuation rates compared with provider-administered DMPA 2
Duration Considerations
- FDA warning: Use for longer than 2 years is not recommended unless other birth control methods are considered inadequate due to impact on bone mineral density (BMD) 1
- However, ACOG does not recommend limiting use to 2 years as the benefits of preventing unwanted pregnancy generally outweigh the risks of bone density loss 4
- For patients using DMPA beyond 2 years, counseling about measures to promote skeletal health is recommended, including daily intake of 1300 mg calcium and 600 IU vitamin D, regular weight-bearing exercise, and smoking cessation 4
Efficacy and Side Effects
- Depo Provera has a failure rate of less than 1% in clinical studies 5
- Common side effects include menstrual irregularities (with amenorrhea in 57% of women after one year), weight gain, headache, nervousness, abdominal pain, dizziness, and asthenia 5, 6
- Return to fertility may be delayed for 9-18 months after discontinuation 4, 7
Important Contraindications
- Active thrombophlebitis or history of thromboembolic disorders or cerebral vascular disease 1
- Known or suspected breast malignancy 1
- Hypersensitivity to medroxyprogesterone acetate or any ingredients 1
- Significant liver disease 1
- Undiagnosed vaginal bleeding 1
Clinical Pearls
- Efficacy depends on adherence to the dosage schedule 1
- When switching from oral contraceptives, the 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 1
- Pre-use counseling about menstrual changes is essential to improve continuation rates 6
- Weight gain status at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use 4