Most Common Side Effect of Depo-Provera
Menstrual irregularities are the most common side effect of Depo-Provera, experienced by nearly all users initially, with irregular bleeding, spotting, and amenorrhea being the predominant patterns. 1, 2
Menstrual Changes
- Menstrual irregularities occur in approximately 92.6% of Depo-Provera users, making this the most frequently reported side effect 3
- The FDA drug label confirms that change in normal menstrual cycle is "the side effect reported most frequently by women who use medroxyprogesterone acetate injectable suspension for birth control" 2
- During the first year, users experience irregular or unpredictable bleeding, spotting, increased or decreased menstrual bleeding, or complete absence of bleeding 2
- Amenorrhea becomes increasingly common with continued use: 55-57% of women report no menstrual bleeding after one year, and 68% after two years 2, 4
- These menstrual changes are generally not harmful but significantly affect patient satisfaction and continuation rates 1
Other Common Side Effects
Beyond menstrual irregularities, the following side effects occur frequently:
Weight Gain
- Weight gain is the second most common side effect, reported by approximately two-thirds of users 2
- Average weight gain is about 5 pounds during the first year and 8 pounds over two years of use 2
- Weight gain status at 6 months strongly predicts future excessive weight gain with ongoing use 1
Additional Frequent Side Effects
- Headache, abdominal pain or discomfort, nervousness, dizziness, and weakness are commonly reported 2, 4
- Non-menstrual side effects collectively occur in 67.6% of users 3
Clinical Implications for Discontinuation
- The 12-month discontinuation rate for Depo-Provera is approximately 49%, with menstrual side effects accounting for 23.1% of discontinuations and non-menstrual side effects (primarily weight gain and headaches) accounting for 35.6% 3
- Among adolescents, 26% discontinue due to menstrual irregularities and 18% due to weight gain 5
- 70% of those discontinuing due to irregular bleeding do so after only one injection, highlighting the importance of early counseling 5
Management Recommendations
- Counsel all patients before initiation that menstrual irregularities are expected and typically improve over time, as this improves continuation rates 1
- For persistent irregular bleeding, NSAIDs for 5-7 days can be offered as treatment 6
- Reassure patients that amenorrhea with regular injections every 3 months is common and does not indicate pregnancy 2
- If bleeding persists or becomes unacceptable despite treatment, offer counseling on alternative contraceptive methods 6