From the Guidelines
Depo-Provera can be used for long-term contraception with no mandatory time limit for most women, but its use should be reassessed after 2 years due to concerns about bone mineral density loss. The injection is typically administered every 12-13 weeks (about 3 months), and you can continue receiving it for many years 1. However, healthcare providers often recommend reassessing its use after 2 years due to concerns about bone mineral density loss, which increases the longer you use the medication. This bone loss is usually temporary and gradually recovers after discontinuing the injection 1. Some women may need to stop sooner or can safely use it longer depending on their individual health factors, such as risk for osteoporosis, cardiovascular disease, or other medical conditions.
Key points to consider when using Depo-Provera long-term include:
- Bone mineral density loss, which can increase the risk of osteoporosis 1
- Irregular bleeding, which typically improves with continued use 1
- Weight gain, which can occur in some women, especially if they experience weight gain in the first 6 months of use 1
- The need for regular injections every 12-13 weeks 1
If you're concerned about bone health while using Depo-Provera long-term, your doctor might recommend:
- Calcium and vitamin D supplements to promote skeletal health 1
- Regular weight-bearing exercise to support bone health 1
- Periodic bone density monitoring to assess the risk of osteoporosis 1
When you decide to stop using Depo-Provera, be aware that fertility may take 6-12 months to return as the medication gradually leaves your system. It's essential to discuss your individual situation and any concerns with your healthcare provider to determine the best course of action for your long-term contraception needs.
From the FDA Drug Label
Medroxyprogesterone Acetate Injectable Suspension, USP should be used as a long-term birth control method (e. g. longer than 2 years) only if other birth control methods are inadequate. In a controlled, clinical study, adult women using Medroxyprogesterone Acetate Injectable Suspension, USP for up to 5 years showed spine and hip BMD mean decreases of 5–6%, compared to no significant change in BMD in the control group.
Duration of Use: The FDA recommends that Medroxyprogesterone Acetate Injectable Suspension, USP should not be used for more than 2 years as a long-term birth control method unless other methods are inadequate.
- Key Considerations:
- Use for more than 2 years may lead to significant loss of bone mineral density (BMD)
- BMD loss is of particular concern during adolescence and early adulthood
- The decrease in BMD appears to be at least partially reversible after Medroxyprogesterone Acetate Injectable Suspension, USP is discontinued 2
From the Research
Duration of Depo-Provera Use
- The duration of Depo-Provera use can vary, but studies have shown that long-term use can have effects on bone mineral density (BMD) 3, 4, 5, 6.
- One study found that women who used Depo-Provera for up to 240 weeks (approximately 4.6 years) had significant disparities in baseline characteristics compared to nonusers, which could influence bone accretion rates independent of Depo-Provera exposure 3.
- Another study found that long-term use of Depo-Provera (>2 years) had a significant adverse effect on BMD and induced increased bone turnover 4.
- A cross-sectional study found that 68.1% of long-term Depo-Provera users had low bone mass and 29.8% had osteoporosis, compared to 36.6% and 2.4% of copper intrauterine device (Cu-IUD) users, respectively 5.
- A study on forearm BMD found that women who used Depo-Provera for 13-15 years had significantly lower BMD at the distal and ultra-distal radius compared to Cu-IUD users 6.
Factors Affecting Depo-Provera Use
- Age, body mass index (BMI), and years of use can affect BMD in Depo-Provera users 4, 5, 6.
- A study found that BMD decreased as the number of years of Depo-Provera use increased 5.
- Another study found that BMD was inversely correlated with older age and directly correlated with BMI (kg/m2) 6.
- Physical activity and parity were also found to be significantly greater among Cu-IUD users compared to Depo-Provera users 6.
Safety and Efficacy
- Depo-Provera has been found to be an acceptable and effective contraceptive method, with minimal major adverse reactions 7.
- However, long-term use of Depo-Provera can lead to decreased BMD and increased bone turnover, which may increase the risk of osteoporosis and fractures 4, 5.
- The measurement of lumbar spine BMD and biomarkers of bone turnover may be recommended in women aged above 40 years and who used Depo-Provera for a long duration (2-5 years) 4.