Injectable contraception (Depo-Provera)

The injectable contraceptive, also known as Depo-Provera®, is given once every 12 weeks (four times a year) as an injection (shot) to prevent pregnancy. Depo-Provera® contains only one female hormone, a progestin. Depo-Provera® is a highly effective form of birth control, 99.7 per cent effective if used as instructed.

How does Depo-Provera work?
Depo-Provera® prevents the ovaries from releasing an egg each month (ovulation). Depo-Provera® also changes the lining of the uterus making it difficult for an egg to attach itself. Finally, Depo-Provera® changes the mucus in the cervix making it harder for sperm to enter the uterus.
Who can use Depo-Provera®?
All women seeking a reliable and reversible method of birth control that requires little attention can use Depo-Provera®. Also, it may be a good option for women who are unable to take estrogen.
How do I use Depo-Provera®?
Depo-Provera® must be injected into the upper arm (deltoid muscle) or the hip (gluteus muscle) by a health care provider (HCP) and noted below:
  • During the first five days of your period
  • During the first five days after stopping the birth control pill, the Evrapatch® or the NuvaRing®
  • During the first five days after an abortion
  • Can be started post partum and does not affect breastfeeding.
  • Any time during the menstrual cycle if pregnancy or the possibility of pregnancy can be ruled out
Backup?
If given within the first five days of your period, Depo-Provera® is effective within the first 24 hours. If given after the first five days of the menstrual cycle, a backup method of birth control such as condoms should be used for the next 7 days.
Late injection
If it has been 14 or more weeks since your last injection (shot), use a backup method of birth control such as condoms until the next Depo-Provera® injection can be given.
What are the advantages or possible side effects of Depo-Provera®?
Advantages
  • Convenient (one every three months)
  • Some women stop having their periods
  • Decreased cramping and menstrual bleeding
  • Reduced risk of endometrial cancer

Reduction of symptoms linked with endometriosis, premenstrual syndrome, and chronic pelvic pain

  • Decreased incidence of seizures
  • Possible reduced risk of pelvic inflammatory disease

Possible side effects

  • Reduction in bone mineral density (bone mass) see below for recovery after stopping
  • Menstrual cycle changes (irregular bleeding)

Hormonal side effects

  • Headache
  • Acne
  • Decreased libido
  • Nausea
  • Breast tenderness
  • Weight gain due to appetite stimulation
  • Mood effects

Remember

Depo-Provera® and Bone Mineral Density

The use of depot medroxyprogesterone acetate (DMPA) is associated with a decrease in bone mineral density. The decrease is most rapid in the first 2 years of use and appears to be largely reversible once DMPA is discontinued.

Note: (I) There is no strong evidence that the use of DMPA causes osteoporosis (II-2) or increase the risk of fracture. (SOGC 2016)

  • Depo-Provera® does not protect you against STBBIs or HIV; use condoms to lower your risk
  • If you experience any side effects, it cannot be reversed until the hormones wear off. Side effects from DMPA will decrease after the hormone is stopped
  • Depo-Provera® does not affect your fertility, but there may be a delay in the return of ovulation. Women who want to become pregnant in the next 1-2 years may consider other birth control options
  • Health care providers should inform patients of the potential effects of DMPA on bone mineral density and counsel them on 'bone health', including calcium and vitamin D supplementation, smoking cessation, weight-bearing exercise, and decreased alcohol and caffeine consumption. (SOGC 2016 (III-A))
  • For additional information or assistance contact the province wide Aids and Sexual Health Infoline at Toll free: 1 (800) 668-2437
  • For more information on Depo-Provera®, please consult sexandu.ca.

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