What is Depo-Provera?

Depo-Provera (medroxyprogesterone acetate) is a drug very similar to progesterone, a hormone normally produced by the ovaries every month as part of the menstrual cycle. Depo-Provera is an injectable form of this medicine that prevents pregnancy for up to 3 months with each injection ("shot").

How does it work?

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg from the ovary). If an egg is not released, pregnancy is unlikely. Depo-Provera is given as 1 shot in the buttock or upper arm. The first shot should be given within 5 days after the beginning of a normal menstrual period, and shots should be repeated every 3 months.

Is it effective?

Depo-Provera is as effective as tubal ligation (having your tubes tied) and more effective at preventing pregnancy than several other methods, including birth control pills, condoms and diaphragms. It does not, however, protect against sexually transmitted diseases such as AIDS.

Is the effect permanent?

No. Depo-Provera only works for about 3 months. The shot must be repeated every 3 months to prevent pregnancy. After a woman stops using Depo-Provera, her normal ovarian function returns after a short time.

Are there side effects?

Most women have some changes in their menstrual periods while using Depo-Provera, including irregular and unpredictable bleeding or spotting, an increase or decrease in menstrual bleeding, or no bleeding at all. After 1 year of use, about 2 of 3 women have no bleeding at all. The absence of periods is not harmful, and periods usually return to normal after Depo-Provera is stopped. If unusually heavy or continuous bleeding occurs, you should see your doctor. Other possible side effects include weight gain, headaches, nervousness, abdominal discomfort, dizziness and weakness or fatigue.

Can I use it if I am breast feeding?

Depo-Provera can be used safely in women who are breast feeding you can receive an injection after your baby is 6 weeks old. The hormones will not hurt your baby. If you are not going to breastfeed your baby, you can have an injection right after your delivery. Long-term studies of babies whose mothers used Depo-Provera while breast feeding found no bad effects.

Who should not use Depo-Provera?

Women who have any of the following should not use Depo-Provera: liver disease, a history of blood clots (phlebitis) or stroke, vaginal bleeding without a known reason, cancer of the breast or reproductive organs, known or suspected pregnancy or allergy to the medication in Depo-Provera.

To use this method, women receive an injection every 13 weeks. Each injection contains progestin, a hormone much like the hormone a woman produces during the last 2 weeks of each monthly cycle. This hormone stops the woman from passing an egg. It also thickens the mucus in the cervix, making it difficult for the sperm to enter the uterus. The hormone is absorbed slowly from the body and lasts for 13 weeks.

Among typical couples who use Depo-Provera, about three in 1,000 will experience an accidental pregnancy in the first year. To have similar protection from pregnancy, you must get your shots on time. Your risk of pregnancy may increase if you are late for your next scheduled injection. Check out the chart above to see how this birth control method compares with other methods.

When Do I Get My First Shot?
Most health care providers give the first shot when a woman is having her period or within five days of the start of her period. This protects you from pregnancy as soon as you receive your first injection. It also ensures that you are not pregnant when you receive your shot. If you have recently had a baby and are breastfeeding, your provider can give you a shot six weeks or longer after your delivery.

How Soon Does It Start Working?
If you receive the shot within five days of the start of your period, you are protected as soon as you receive the shot. If you receive the shot at a different time in your menstrual cycle, you should ask your healthcare provider if you should use a back-up birth control method. In general, most healthcare providers recommend using a back-up method or not having sex for one to two weeks after receiving the shot

What Should I Expect at First?
Irregular bleeding is common at first. But, over time, the amount of irregular bleeding decreases. Weight gain is also a common side effect. These side effects are not dangerous and do not mean you are pregnant.

How Often Do I Need It?
You will visit your hospital or clinic for a shot every 13 weeks, which is about every three months. If you need to, you can have your birth control shot up to 2 to 4 weeks early.

If you are late for a shot, your protection against pregnancy is decreased. However, there is some flexibility. In general, if you return two weeks late for your next shot, you are still considered to be protected against pregnancy. If you wait longer, you should use a back-up method of birth control until you receive your shot. If it has been longer than two weeks, your provider may recommend a pregnancy test when you return for your next shot.

Where Is the Shot Given?
You receive the shot in your arm or in your buttocks. You should not rub the site where the shot was given, because this might cause your body to absorb the hormone faster than it is supposed to.

What If I Miss a Period?
It is common to miss periods or have other irregular bleeding with Depo-Provera. After a year or so, about half of women using this method have no period at all. This is not dangerous. It does not mean that you have reached menopause or are sterile. It is unlikely that you are pregnant. However, if you are late for your shot and miss a period, you may want to take a pregnancy test.

Where Do I Get It?
You can get Depo-Provera injections from your doctor, nurse practitioner, nurse midwife, health department, or family planning clinic.

When Should I Call My Healthcare Provider?
Call your healthcare provider if you have sharp chest pain, if you cough blood, if you have a severe headache, if you have severe vomiting, if your leg or arm becomes suddenly or severely numb, if you have sudden or severe dizziness, if you have severe pain in your calf, if you have heavy vaginal bleeding, if you have severe pain in your lower abdomen, or if you have pain, pus, or bleeding at the injection site. Also call if your skin tone becomes yellow, or if you think you might be pregnant.

Lose Less Blood
Women using this method lose less blood during their period and have fewer menstrual cramps. After a year, some women may stop having periods completely. Losing less blood can help prevent anemia due to iron-deficiency.

Privacy
This is a private method of birth control. No one needs to know you are using this method.

No Reported Increase in Cancer Risk
This method is considered very safe. There is no reported increase in risk for breast cancer or risk for cancer of the uterus.

Prevents Some Cancers and Some Gynecological Problems
Depo-Provera may prevent problems such as uterine fibroids. It also has a protective effect against endometrial cancer and possibly a protective effect against ovarian cancer.

No Estrogen
Depo-Provera injections do not contain estrogen. Estrogen can cause certain complications, such as an increase in the risk of heart problems and risk of stroke.

Relatively Long Return to Fertility
This method does not permanently change your ability to become pregnant. However, after your last shot it may be a number of months before your periods return to normal and you are able to become pregnant. In women who stop using this method to become pregnant, 50 percent can become pregnant within 10 months after their last injection, 68 percent can become pregnant within 12 months after their last injection, and 93 percent can become pregnant within 18 months after their last injection.

Visit Healthcare Provider Four Times a Year
You have to return to the providers office every 13 weeks, or about every 3 months, for your injection.

No STD Protection
Depo-Provera does not protect you from sexually transmitted diseases, including HIV/AIDS or other infections. Use a condom if you may be at risk.

Requires Injections
The protection is delivered through injections, which some people do not like.

Irregular Periods
Depo-Provera injections can lead to very irregular periods. 70 percent of women who use this method have irregular bleeding in the first year, and 10 percent have irregular bleeding thereafter. Irregular refers to spotting and bleeding between periods. Rarely, women may have heavy bleeding. As you continue to get injections, the bleeding and spotting between periods will decrease. Many women stop having periods altogether. After one year, 55 percent of women have no bleeding; after two years, 68 percent of women have no bleeding. If your bleeding pattern bothers you, your doctor may be able to provide you with medications that make you have a more regular bleeding pattern.

Breast Tenderness
Some women report breast tenderness when using this method. Breast tenderness may be painful, but it is not considered to be dangerous. Breast tenderness is reported in less than 5 percent of women using this method.

Weight Gain
Some women gain weight with this method. On average, women may gain about 2 to 4 pounds per year. To avoid weight gain, watch your calories and get plenty of exercise.

Possible Bone Loss
Depo-Provera may cause a slight loss in bone density, although this is not certain. This could increase your risk of bone fractures. To protect your bones from this bone loss, called osteoporosis, get regular exercise and consider taking extra calcium. This effect is temporary and disappears after you stop taking the birth control shot.

Other Side Effects
Up to 17 percent of women report headaches as a side effect. Premenstrual symptoms may improve or become worse. Fewer than 5 percent of women report depression or decreased sex drive. Other reported side effects include dizziness, abdominal pain, nausea, acne, anxiety, leg cramps, bloating, swelling of hands or feet, backache, depression, hair loss or excessive hair growth, and joint pain. Make sure you read the package insert for full prescribing information.

Allergy
While it is rare, some women are allergic to Depo-Provera.

Cancer Risk
There is no increased overall risk for ovarian, breast, uterine, cervical, or liver cancer with this method of birth control. However, there is a slight increased risk of breast cancer in women under 35 who had their first exposure to the hormone in the last four to five years.

Other Risks
This method is considered very safe, but there are some risks. The hormone used in the shot may affect your bodys ability to metabolize cholesterol. This can increase your risk of heart disease. Also, hormone-based methods of birth control may increase your risk of blood clots or stroke. There are other risks listed in the package insert that you should read carefully.