INJECTION OF DEPO MEDROXYPROGESTERONE ACETATE (DMPA; DEPO-PROVERA) FOR CONTRACEPTION
Before you start taking DMPA, be sure you understand the benefits and possible problems of using DMPA. This information sheet also lists the danger signs you should watch for. If you have any questions, we will be happy to talk about them with you.
You will get written information on the use, effectiveness, and medically recognized benefits and risks of the available birth control methods and devices as well as the FDA-approved DMPA information provided by the DMPA manufacturer. You should read these and ask questions about anything you do not understand.
DMPA is a man-made hormone like the hormone progesterone, which is normally made by a woman’s body. After you have received DMPA, the hormone effects last for about 12 weeks. DMPA works by keeping eggs from being released from the ovaries, and by making the mucus from the cervix (the opening into the uterus) thick, so that it is hard for sperm to get through it.
DMPA provides highly effective pregnancy protection if you get the injections on time. For every 100 women who use DMPA, there will be about three pregnancies per year. DMPA prevents pregnancy immediately if it is injected within the first 5 days after your period begins.
If you stop DMPA because you want to get pregnant, it can take an average of 9-10 months of unprotected intercourse before pregnancy occurs and possibly up to a year or more. However, some women get pregnant right away after stopping DMPA, so if you do not want to become pregnant, you must begin another method of birth control.
The advantages of using DMPA are:
- It prevents pregnancy very well.
- It lasts for 12 weeks.
- There is no medicine to take every day.
- There is nothing to do right before sex to make it work.
- Helps prevent cancer of the lining of the uterus.
You must not use DMPA if you are pregnant or think you might be pregnant, or if you have any of the following:
- Abnormal bleeding from the vagina that has not been evaluated.
- Known or suspected cancer of the breast.
- Use of a drug (aminoglutethamide) for the treatment of Cushing’s syndrome.
Some past and/or present health conditions may increase your medical risk or make DMPA use inadvisable. In these cases, DMPA may not be the best birth control method for you to choose. You should tell the clinician if you smoke or take any medicines or if you have now, or have had before, any of the following:
- Diabetes, high blood pressure, or other cardiovascular disease risk factors.
- Severe depression.
- Recent history of liver disease (such as hepatitis) or liver function tests that are not normal, or liver tumors.
Most women using DMPA experience a change in menstrual periods, including bleeding more days than usual, spotting between periods, no periods, or more than one of these changes. These changes are common, particularly in the first 12 months of use. After 12 months of use, about half of women using DMPA experience a lack of menstrual periods. It may take several months for periods to return after stopping the injections.
Call the office if you miss a period after having periods every month on DMPA. An unusual period may be a sign of pregnancy.
DMPA use may be associated with reversible (temporary) bone thinning. It is important that you get regular exercise and take extra calcium, either through your diet or by added calcium supplements, to protect your bones.
Some women may also have the following other side effects with DMPA:
- Change of appetite/ weight gain
- Sore breasts
- Nausea/ abdominal discomfort
- Nervousness/ dizziness
- Skin rash or spotty darkening of the skin
- Hair loss, or increased hair on face or body
- Increased or decreased sex drive
If you experience any of these side effects, there is no way to neutralize or reverse the DMPA, and the side effects may continue, and may need evaluation and/or treatment, until the DMPA shot wears off.
The danger signs to watch for (and report to your medical provider) are:
- Lump in your breast
- Yellowing of the skin or eyes
- Severe depression
- Severe pain in the stomach or abdomen
- Unusually heavy or prolonged bleeding from the vagina
The area where DMPA was injected might be sore or bruised for a day or two. You must return for a check-up and another injection every 12 weeks. If you wait longer than 12 weeks for another injection, the DMPA will not be as effective in preventing pregnancy.
Using DMPA does not protect against certain sexually transmitted infections. Severe infection could cause sterility. If you or your partners have other sexual partners, you also should use latex condoms to prevent infections, along with using DMPA to prevent pregnancy.
Regular physical examinations for routine health care and for screening for sexually transmitted infections and cancer are strongly recommended.