(Updated June 2014)
Depo-Provera® (depot medroxyprogesterone acetate, or DMPA) is a progestin-only method. It is a 3-month injectable that delivers either 104 mg (in the subcutaneous formulation) or 150 mg (in the intramuscular formulation) of medroxyprogesterone acetate to inhibit ovulation. DMPA is a good contraceptive choice for women who cannot use estrogen.
A provider administers the DMPA injection to the patient
subcutaneously or intramuscularly every 3 months. DMPA can be administered up to 2 weeks early or 2 weeks late (i.e., 10 to 14 weeks after the last injection) without the need for a protective back-up contraceptive method. If it is more than 2 weeks late, the injection can be administered if the woman is reasonably certain that she is not pregnant. Additional contraceptive protection should be used for the next 7 days.39
This method is very effective.40 The failure rate with perfect use is 0.2 percent and with typical use is 6 percent.19 The convenience and high efficacy rate of DMPA have made this contraceptive method increasingly popular with teens.41
Effects on bone (see box)
|Dispelling Myths About DMPA and Bone Health
Side effects include weight gain and menstrual cycle changes. Nearly all women experience alterations in the menstrual cycle—irregular bleeding, spotting, or rarely, heavy bleeding. After 6 months, fewer women experience excessive or frequent bleeding, and more women experience amenorrhea. By 1 year, up to 70 percent of women have amenorrhea.48
Contraindications and Precautions
|Medical Eligibility Criteria for DMPA
(unacceptable health risk if the contraceptive method is used)
(theoretical or proven risks usually outweigh the advantages of using the method)
Source: Reference 5
- Convenient, requires only four shots per year
- Very effective
- Amenorrhea (may improve conditions such as menorrhagia, dysmenorrhea, and iron deficiency anemia); 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
- Reduces the risk of endometrial cancer by up to 80 percent, with continuing protection after discontinuation49
- Reduces risk of PID 50 and uterine leiomyomata51
- Can decrease the number and severity of crises in patients who have sickle cell anemia52
- Can decrease frequency of seizures and does not interact with anti-epileptic medications53
- 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 to use DMPA54 (Weight gain of 5 percent or more in the first 6 months of use may signal risk of continued weight increase while on DMPA55)
- Short-term, reversible BMD 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
- Bleeding profile improves over time; amenorrhea, which occurs in about half of users after 1 year of use, may be an advantage or disadvantage, depending on the woman.56
- It is important to consider genetic and lifestyle factors that contribute to osteoporosis when weighing the benefits and risks of DMPA.
- It is important to promote bone health with weight-bearing exercise, intake of calcium and vitamin D, avoidance of tobacco, and limits on alcohol.
- Non-hormonal back-up contraception is needed for the first 7 days.
- This method does not protect against STIs.
- The CDC updated its recommendations in 2012 to indicate that data are inconclusive as to whether women using DMPA might be at increased risk for HIV acquisition, and that these women should be strongly advised to always also use either female or male condoms and take other HIV prevention measures.57