How do I stop Depo Provera (medroxyprogesterone acetate) to get pregnant?

How to Stop Depo-Provera to Get Pregnant

Simply stop receiving the injections and wait for fertility to return—no active intervention is needed to "stop" Depo-Provera, as it is not reversible once administered. 1

Understanding the Timeline

The key challenge with Depo-Provera is that once injected, you cannot remove it from your system. The medication must naturally clear over time:

• Median time to conception: Approximately 9 months after the last injection (5.5 months plus the 15-week duration of the injection's effect) 2
• Typical return to fertility: 9-18 months after discontinuation 1
• Detection in serum: MPA can be detected for up to 9 months after a single 150 mg injection in some women 3
• Ovulation resumes: When MPA levels fall below 0.1 ng/mL 3

What Happens After Stopping

Hormonal Recovery Process

• Initial phase: Serum MPA levels plateau at approximately 1.0 ng/mL for about 3 months, then gradually decline 3
• Ovulation inhibition: Progesterone levels remain low (<0.4 ng/mL) for several months following injection 3
• Estradiol recovery: Levels begin to rise about 4 months after a single injection when MPA falls below 0.5 ng/mL 3
• Endometrial recovery: The atrophic endometrium must regenerate to support implantation 3

Fertility Outcomes

Reassuring data shows no long-term fertility impairment:

• No evidence that prolonged use increases delay to conception 2
• Return of fertility among never-pregnant users is similar to ever-pregnant users 2
• Within 2 years of stopping, conception rates are comparable to IUD users 2

Practical Steps to Optimize Conception

1. Stop Scheduling Injections Immediately

• Do not receive your next scheduled injection if you wish to conceive 1
• The injection is given every 13 weeks (up to 15 weeks), so plan accordingly 1

2. Begin Preconception Optimization Now

• Start prenatal vitamins with folic acid immediately—don't wait for fertility to return
• Ensure adequate calcium (1300 mg daily) and vitamin D (600 IU) intake, as DMPA causes reversible bone mineral density reductions 1
• Optimize weight through healthy diet and regular weight-bearing exercise 1
• Stop smoking and limit alcohol 1

3. Expect Menstrual Irregularities

• Irregular bleeding, spotting, or continued amenorrhea is normal during the recovery period 1, 4
• Amenorrhea was present in 57% of users by one year of treatment 5
• Menstrual patterns typically normalize as MPA clears, but this varies greatly between individuals 4

4. Track Ovulation When Menses Return

• Once regular menstrual cycles resume, use ovulation predictor kits or basal body temperature tracking
• Return of menses suggests (but doesn't guarantee) ovulation has resumed

5. Seek Evaluation if Needed

• If amenorrhea persists beyond 18 months after the last injection, further evaluation is warranted as this exceeds expected recovery time 6
• If no conception occurs within 12 months of regular cycles resuming, consider fertility evaluation

Common Pitfalls to Avoid

Do not assume immediate fertility return: The most common misconception is that fertility returns quickly after stopping Depo-Provera. The median delay is 9 months, but some women may take up to 18 months or longer 1, 2

Do not delay preconception care: Begin optimizing your health immediately rather than waiting for fertility to return, as the delay is substantial 1

Do not assume amenorrhea means infertility: While most women remain anovulatory during amenorrhea, ovulation can occasionally occur before regular menses resume 3

Do not panic about the delay: This delay does not indicate permanent infertility—studies show no difference in long-term fertility outcomes between DMPA users and IUD users 2

Special Considerations

If You Need to Conceive Sooner

Unfortunately, there is no way to accelerate MPA clearance from your system. The pharmacokinetics are fixed—the medication is slowly released from muscle tissue over months 3. If rapid fertility is essential, Depo-Provera should not have been chosen initially, as this delayed return to fertility is an inherent characteristic of the method 1.

Bone Health During the Waiting Period

While bone mineral density substantially recovers after discontinuation, continue calcium and vitamin D supplementation during the waiting period 1. The American College of Obstetricians and Gynecologists does not recommend limiting use to 2 years despite FDA warnings, recognizing that BMD recovery occurs 1.