WHAT IS DEPO-PROVERA^®?
Depo-Provera^® is a long-acting hormonal form of birth control.  It contains medroxyprogesterone acetate (DMPA), which is similar to the natural progesterone produced by the ovaries during the second half of the menstrual cycle.  It is given by injection (shot) in the buttock or upper arm muscle. Injections must be received on a regular basis every 12-13 weeks.

HOW EFFECTIVE IS IT?
Depo-Provera^® is one of the most effective methods of hormonal birth control available.  When injections are received every 12-13 weeks, the effectiveness rate is over 99%.  This means that the average annual pregnancy rate is less than one per 100 women.  This effectiveness rate with typical use is equal to that of tubal ligation (female sterilization) and even more effective than birth control pills or the IUD (intrauterine device).

HOW DOES IT WORK?
Depo-Provera^® works because it prevents the release of an egg from the ovary; thus there is nothing to be fertilized by the sperm and a pregnancy cannot occur.  Cervical mucus is thickened and it also thins the lining of the uterus, which would make the uterus less hospitable to a fertilized egg should ovulation occur.

WHAT ARE THE SIDE EFFECTS AND RISKS OF USING DEPO-PROVERA^®?
Depo-Provera^®, like all other medications, has many potential side effects.  Each woman's response to the medication will differ, depending on her own body chemistry.  It is impossible to predict who will or will not experience a certain effect.  It is important to remember that once the medication is injected, side effects cannot be neutralized or reversed. Side effects include:

Bone Density - Women who use Depo-Provera^® may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible. It is unknown if use of Depo-Provera® during adolescence or early adulthood, a critical period of bone development, will reduce peak bone mass and increase the risk of osteoporotic fracture in later life. Depo-Provera^® should be used as a long-term birth control method (e.g., longer than two years) only if other birth control methods are inadequate.

Smoking may further decrease the levels of calcium stored in the bone.  It is very important that a woman's diet contain adequate calcium intake (1200-1500 mg per day). Although there are no studies addressing whether or not calcium and vitamin D may lessen bone marrow density (BMD) loss in women using Depo-Provera^®?, all patients should have adequate calcium and vitamin D intake. Calcium supplements may be used if one cannot attain the recommended dietary intake.

Menstrual Changes - This is the most common side effect experienced.  The amount of bleeding may vary from irregular or unpredictable spotting and light bleeding to no bleeding at all.  With increasing duration of use, frequency and length of bleeding episodes usually decrease.  In clinical studies, 55% of the women reported no menstrual bleeding after one year of use.  Occasionally a woman will experience daily bleeding or bleeding may be heavier than a usual period, and this should be reported to the health care clinician.  This side effect is related to the effect of the DMPA on the ovaries and uterine lining.

Depression - Depo-Provera^® may cause moodiness and feelings of depression.  This may be worse in women who have had depression in the past and may make it more difficult to treat active depression.  If a woman is on antidepressant medications, she should discuss this carefully with all of her health care providers.

Weight Gain - Depo-Provera^® users may experience an increased appetite.  The average weight gain is approximately five pounds in the first year and eight pounds after two years of use.  A healthy diet and regular exercise will help decrease weight gain.

Other side effects that may occur include increased headaches, decreased sex drive, breast tenderness, acne, abdominal/pelvic cramps, bloating, hair loss or slow hair growth, vaginal dryness, fatigue and insomnia.  If you experience any of these side effects or others that you think may be related to the Depo-Provera^®, you should contact your health care clinician.

WHAT ABOUT THE ABILITY TO BECOME PREGNANT AT A LATER TIME?
These effects on the ovaries and uterus are reversible and regular menstrual cycles usually return 3-10 months after the last injection.  Pregnancy will generally occur within 12-18 months after discontinuing DMPA injections.  The length of time DMPA is used for contraception has no effect on how long it takes to become pregnant.  It is recommended that injections be discontinued one year before a pregnancy is desired.  This recommended time period allows the menstrual cycles to return to a predictable pattern, which helps determine the pregnancy due date. DMPA will not cause birth defects even if a pregnancy occurs while actively on or immediately after discontinuing the medication.

WHAT ARE THE BENEFITS OF DEPO-PROVERA^®?

• Provides safe, long acting, highly effective contraception without requiring a woman to think about her birth control method on a daily basis or at the time of intercourse.

• Offers convenience and privacy.

• Does not contain estrogen; estrogen is the other hormone found in combination birth control and there are women who, for medical reasons, cannot take medications containing estrogen; has no effect on blood clotting.

• Is reversible.

• Can be used by nursing mothers without impacting milk supply when initiated at least six weeks after nursing begins.

• May decrease pain associated with ovulation, menstruation and endometriosis.

• Decreases risk of endometrial cancer and ovarian cancer.

• Has no demonstrated interactions with antibiotics and most other medications, including anti-seizure medications.

NOTE: DMPA does not provide any protection against sexually transmitted infection (STI), including gonorrhea, chlamydia, genital herpes, genital warts, syphilis, hepatitis, and HIV.  Women are urged to use condoms consistently to decrease risk of STI transmission.

ARE THERE WOMEN WHO SHOULD NOT USE DEPO-PROVERA^®?
Each woman should be evaluated individually. Determining factors include past medical history, family history and findings of a physical exam. A woman should not receive a DMPA injection if she:

• Thinks she might be pregnant.

• Has had vaginal bleeding without a known cause and has not been medically evaluated.

• Is actively receiving treatment for, or has a history of, breast cancer or cancer of cervix, vagina or uterus.

• Has a known allergy to medroxyprogesterone acetate or any of its other ingredients.

It is also important to tell your health care clinician if you have a history of other health problems such as:

• Additional risk factors for osteoporosis including metabolic bone disease, chronic alcohol or tobacco use, anorexia nervosa, a strong family history of osteoporosis, or chronic use of drugs that can reduce bone mass, such as anticonvulsants or corticosteroids

• Blood clots in your legs, lungs or eyes

• Heart attack or stroke

• Migraine headaches

• Depression

• Irregular menstrual periods

• Seizures

• Diabetes

• High blood pressure

• Kidney or liver disease

• Abnormal breast exams

• Asthma

• Regular use of prescription or over-the-counter medications.

PRECAUTIONS YOU SHOULD TAKE:
Always inform all of your health care providers that you are receiving Depo-Provera^®.  Report any of the following symptoms right away:

• Prolonged, heavy vaginal bleeding

• Severe lower abdominal pain

• Chest pain, shortness of breath

• Repeated, very painful headaches

• Unusual swelling or pain in the leg

• Breast lumps

These symptoms need to be evaluated, although they may or may not be related to the use of DMPA.

HOW DO I START USING DEPO-PROVERA^®?
You must have a current physical exam and will need to meet with a health care clinician for screening and instruction.  The first injection must be given during the first five days of your period, or within the first five days after childbirth (unless you are breast-feeding) or termination of pregnancy.  Talk with your clinician about scheduling the first injection if you are currently using a prescribed method of birth control (birth control pills, or IUD). Depo-Provera^® will be an effective method of birth control 24 hours after receiving the injection.

WHEN DO I NEED TO REPEAT MY INJECTION?
When you receive the first injection, you will be given a date 12 weeks later.  That is the date your next injection is due.  If necessary you may receive the injection up to 14 days early or up to seven days late.  However, if you have not received your injection within 13 weeks after the last injection, you must immediately begin using an alternative method of birth control or abstain from intercourse.  Pregnancy testing will be required before you can receive another Depo-Provera^® injection.

To schedule an appointment for a physical exam evaluation for Depo-Provera^® use, or to receive a Depo-Provera^® injection, you may call 928-523-8995.

References:
Depo-Provera^® Contraceptive Injection Patient Information; Pharmacia & UpJohn Company, 1999 Hatcher et, al., Contraceptive Technology. Ardent Media Inc. New York. 2004
Hatcher RA, Zieman M. et, al., A Pocket Guide to Managing Contraception. Tiger, Georgia: Bridging the Gap Foundation 2004

From: McKinley Health Center, University of Illinois at Urbana-Champaign

 

Fronske Health Promotion Office
PO Box 6033
Building 39/NE Lobby
Flagstaff, Arizona 86011

Phone: 928-523-6867
Fax: (928) 523-0420