Contraindications for Depo-Provera
Depo-Provera (medroxyprogesterone acetate) is absolutely contraindicated in patients with active thrombophlebitis, current or history of thromboembolic disorders, cerebral vascular disease, known or suspected breast malignancy, known hypersensitivity to the medication or its ingredients, significant liver disease, and undiagnosed vaginal bleeding. 1
Absolute Contraindications
The FDA drug label clearly defines the following as absolute contraindications:
Thromboembolic conditions: Active thrombophlebitis, current or history of thromboembolic disorders, or cerebral vascular disease 1
Breast malignancy: Known or suspected malignancy of breast 1
Hypersensitivity: Known hypersensitivity to medroxyprogesterone acetate or any of its ingredients 1
Liver disease: Significant liver disease 1
Undiagnosed vaginal bleeding: Any undiagnosed vaginal bleeding 1
Additional Important Contraindications from Clinical Guidelines
Beyond the FDA-labeled absolute contraindications, NCCN guidelines identify additional clinical scenarios where medroxyprogesterone should be carefully considered or avoided:
History of stroke or myocardial infarction: These cardiovascular events are listed as contraindications in the context of progestin-based therapy 2
Pulmonary embolism or deep vein thrombosis: History of these thromboembolic events contraindicates use 2
Active smoking: Smoking is identified as a contraindication, particularly when combined with other risk factors 2
Neurofibromas or meningiomas: Depo-Provera should generally be avoided in individuals with a history of these tumors due to evidence suggesting it may stimulate tumor growth, particularly with high-dose depot injections 3
Critical Clinical Considerations
Pregnancy must be excluded before administration: The first injection should be given only during the first 5 days of a normal menstrual period or within the first 5 days postpartum 1
In exclusively breastfeeding postpartum mothers, administer during or after the sixth postpartum week 1
If the interval between injections exceeds 13 weeks, pregnancy must be ruled out before the next dose 1
Long-term use limitations: Use for longer than 2 years is not recommended unless other birth control methods are considered inadequate, due to significant bone mineral density loss 1
Common Pitfall to Avoid
Do not assume all progestin-based contraceptives carry equal contraindications—depot formulations like Depo-Provera appear to pose greater risks for certain conditions (such as neuro tumors) compared to oral contraceptives or IUDs 3. The high-dose depot formulation is specifically problematic for patients with progesterone receptor-positive tumors 3.