What is the recommended dosage and administration of Medroxyprogesterone (Depo-Provera)?

Medroxyprogesterone (Depo-Provera) Dosage and Administration

For contraception, the recommended dosage of Depo-Provera is 150 mg administered by deep intramuscular injection every 3 months (13 weeks) in the gluteal or deltoid muscle. 1

Intramuscular (IM) Administration Guidelines

• The 1 mL vial should be vigorously shaken just before use to ensure uniform suspension 1
• Administer using strict aseptic technique, rotating injection sites with each administration 1
• Body habitus should be assessed prior to each injection to determine if a longer needle is necessary, particularly for gluteal IM injection 1
• First injection timing:
  • 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

Important Timing Considerations

• If the time interval between injections exceeds 13 weeks, pregnancy should be ruled out before administering the next dose 1
• Efficacy depends on adherence to the dosage schedule 1
• When switching from other contraceptive methods, Depo-Provera should be given in a manner that ensures continuous contraceptive coverage 1

Duration of Use Considerations

• Not recommended as a long-term birth control method (i.e., longer than 2 years) unless other options are considered inadequate due to bone mineral density concerns 1
• Women using Depo-Provera may lose significant bone mineral density, with greater loss occurring with increasing duration of use 1
• Bone loss may not be completely reversible 1

Self-Administration Option

• Self-administered subcutaneous DMPA-SC is now recommended as an additional approach to deliver injectable contraception 2
• Self-administration has been shown to improve contraceptive continuation rates while maintaining equivalent safety and efficacy to provider administration 2
• Provider-administered DMPA should remain available as an option 2

Special Populations and Alternative Uses

For Hormone Replacement Therapy in Premature Ovarian Insufficiency

• When used as part of hormone replacement therapy (HRT) with estrogen:
  • For sequential regimens: 10 mg daily for 12-14 days per month 2
  • For continuous regimens: 2.5 mg daily 2
  • Begin cyclic progestogens after at least 2 years of estrogen or when breakthrough bleeding occurs 2

For Endometriosis Treatment

• Higher doses have been used for endometriosis treatment:
  • 30-50 mg oral daily for 90 days to 4 months has shown efficacy 3, 4
  • Injectable form (150 mg every 3 months) has also demonstrated effectiveness for pelvic pain associated with endometriosis 5

Contraindications

• Active thrombophlebitis or current/history of thromboembolic disorders or cerebral vascular disease 1
• Known or suspected breast malignancy 1
• Known hypersensitivity to medroxyprogesterone acetate or any ingredients 1
• Significant liver disease 1
• Undiagnosed vaginal bleeding 1

Monitoring and Follow-up

• Monitor for bone mineral density changes, especially in adolescents and young adults 1
• Evaluate treatment effect if used for other conditions (e.g., endometriosis) after 3-6 months 2
• For diabetic patients, monitor carbohydrate metabolism carefully 1

Patient Counseling Points

• Inform patients about potential menstrual irregularities (bleeding or spotting), which occur in 57% of users at 12 months and 32% at 24 months 1
• Advise about possible weight gain (38% gain >10 lbs at 24 months) 1
• Discuss other common side effects: abdominal pain/discomfort (11%), dizziness (6%), headache (17%), nervousness (11%), and decreased libido (6%) 1
• Return to fertility may be delayed for several months after discontinuation 6