Depo-Provera (medroxyprogesterone acetate or DMPA) is a form of birth control. It is an injection, or shot, that contains progestin. This is a natural hormone that your ovaries produce each month as part of your menstrual cycle.

How does it work?

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg by your ovaries). It thickens your cervical mucus, which makes it hard for sperm to reach and fertilize an egg. It also thins your uterine lining, which makes it hard for a fertilized egg to implant, or attach, to your uterus.

How is it administered?

Your doctor will give you the injection in either in your upper arm or buttock. It is given into  your muscle (intramuscular).

Depo-Provera works for about 3 months at a time. To prevent pregnancy, you have to get 1 shot from your doctor 4 times a year, about 12 to 14 weeks apart. If you get it in the first 7 days of your cycle, it works right away. If you don’t, you’ll need to use another form of birth control for 1 week. Your doctor will confirm you are not pregnant before giving you the injection.

What is the effect of DMPA on periods?

Most women who use Depo-Provera have changes in their menstrual periods. These may include:

  • bleeding or spotting between menstrual periods
  • an increase or decrease in menstrual bleeding or no menstrual bleeding at all

About half of women who use Depo-Provera stop having periods after 1 year. This is not harmful. Menstrual bleeding usually returns to normal when you stop using Depo-Provera. It may take about 9 to 10 months to get pregnant after your last shot.

What are the advantages?

  • Convenient, requires only four shots per year
  • Discreet
  • Very effective
  • Reversible
  • Very light or no periods beneficial in conditions like iron deficiency anemia,excessive bleeding,cramping during periods. May be a desired lifestyle change; can also decrease the risk of dysfunctional menstrual bleeding in women who are overweight.
  • Lack of estrogen in DMPA makes it appropriate for smokers older than age 35, postpartum, breastfeeding women, and others who have contraindications to estrogen.

What are the disadvantages?

  • Requires visit to clinician for quarterly injection.
  • Initial irregular bleeding
  • Weight gain may occur in some women due to increased appetite, particularly those who are sedentary or overweight when they begin DMPA.
  • Short term reversible bone mineral density loss.
  • Delayed return to fertility: the median time to conception for those who do conceive is 10 months after the last injection, much longer than with other hormonal methods.
  • No protection against STIs.

 What are the possible side effects?

  • weight gain
  • headaches
  • nervousness
  • abdominal pain
  • dizziness
  • weakness or fatigue
  • osteoporosis (loss of bone density)
  • blood clots

Contact your doctor right away if you have abnormally heavy or nonstop bleeding.

Also To renew your DMPA prescription you will need to see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) will take place at this visit.

Injectable contraceptive is a good option for you if you choose to use contraception methods at a leisure and to avoid daily usage of pills or insertion of IUDs.Discuss with your doctor if DMPA is a good choice for you keeping in mind the risks and benefits.

Acknowledgements

https://www.ncbi.nlm.nih.gov/books/NBK51044/

https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/injectables.html

https://www.uptodate.com/contents/depot-medroxyprogesterone-acetate-for-contraception

-Dr Prerna Gaur

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