Key Considerations for Depo Provera (Medroxyprogesterone Acetate) Injections
Depo Provera should be administered every 3 months (13 weeks) with injections allowed up to 2 weeks late (15 weeks from last injection) without requiring additional contraceptive protection, and both provider-administered and self-administered subcutaneous formulations are recommended options for injectable contraception. 1
Administration Guidelines
- The standard dose is 150 mg administered every 3 months (13 weeks) by deep intramuscular injection in the gluteal or deltoid muscle, using strict aseptic technique and rotating injection sites 2
- The injection vial should be vigorously shaken just before use to ensure uniform suspension 2
- Body habitus should be assessed prior to each injection to determine if a longer needle is necessary, particularly for gluteal intramuscular injections 2
- Self-administered subcutaneous DMPA-SC is now recommended as an additional approach that can improve contraceptive access and increase reproductive autonomy 1
- First injection timing is critical:
- Should be given ONLY during the first 5 days of a normal menstrual period or within the first 5 days post-partum 2
- For postpartum mothers who exclusively breastfeed, administer during or after the sixth postpartum week 2
- If switching from oral contraceptives, give the first injection on the day after the last active tablet or at the latest, on the day following the final inactive tablet 2
Efficacy and Benefits
- Failure rate is less than 1% when administered on schedule 3
- Provides discrete, convenient, and low-maintenance contraception 4
- Ideal for patients with contraindications to estrogen use 4
- Self-administered DMPA-SC has shown higher continuation rates compared to provider-administered DMPA 5
Side Effects and Management
Menstrual Changes
- Nearly all patients experience menstrual irregularities initially, which typically improve over time 6
- Amenorrhea becomes common, reported by 57% of women by the end of a year of treatment 3
- For spotting or light bleeding, NSAIDs for 5-7 days may be considered 1
Bone Health Concerns
- FDA black box warning: DMPA reduces serum estrogen levels and is associated with significant loss of bone mineral density (BMD) 2
- Not recommended as a long-term (longer than 2 years) birth control method unless other options are considered inadequate 2
- For patients using DMPA beyond 2 years, recommend:
Weight Gain
- Common side effect with long-term use 6
- Weight gain status at 6 months is a strong predictor of future excessive weight gain 6
- Patients showing early weight gain (>5% at 6 months) may experience significant increases in BMI with continued use 6
Return to Fertility
- May be delayed for 9-18 months after discontinuation 5, 6
- This delay occurs while the endometrial lining returns to pre-DMPA state and ovulatory function returns 6
Other Side Effects
- Headache, breast tenderness, nervousness, abdominal pain, dizziness, and asthenia 3
- Changes in libido and hair loss may occur with continued use 6
Contraindications
- Active thrombophlebitis or history of thromboembolic disorders 2
- Cerebral vascular disease 2
- Known or suspected breast malignancy 2
- Significant liver disease 2
- Undiagnosed vaginal bleeding 2
- Known hypersensitivity to medroxyprogesterone acetate or any other ingredients 2
Implementation Considerations
- Critical elements for self-administration include:
- Pre-use counseling about potential side effects, especially menstrual changes, is essential to improve continuation rates 7
- Patients should be encouraged to contact a healthcare provider to discuss side effects, change methods, or address injection concerns 1