The Shot

The Depo-Provera Shot is a pregnancy preventing hormone injection that lasts for 3 (three) months. The injection has synthetic progesterone and no estrogen. It stops the ovaries from releasing eggs. It also thickens the cervical mucus and changes the uterine lining, so that it’s harder for sperm to enter or survive in the uterus. Depo-Provera is a very private form of birth control: it can’t be seen on the body and requires no home supplies. It does, however, require a clinic appointment every three months. Depo-Provera is 94 to 99.8% effective as birth control. It does not protect against reproductive tract infections, including HIV/AIDS. There are some potential health risks with Depo Provera, so be sure to get all the facts in advance.

Use

Depo-Provera (also called DMPA or depot medroxyprogesterone acetate) is usually given in the arm or hip, delivering a high level of progesterone into the body. The first shot is usually given during or a few days after the start of a menstrual period, but can be given anytime. If the shot is given during your period or right after an abortion, it is effective immediately. Otherwise, it takes 7 days to become effective as birth control. You will need to have another shot in 13 weeks if you decide to continue using it as birth control. Many women find it useful to schedule their next shot slightly earlier than necessary. Then if something prevents them from making their appointment, there will be a window of opportunity to receive their next shot.

If you are more than a week late for your shot, use a backup method of birth control until you can get your next shot. If you are more than a week late and you have had unprotected sex since your shot was due, consider taking a pregnancy test before receiving the next dose.

Your Health

Women with unexplained vaginal bleeding should discuss with their provider whether or not they can use Depo. Usually your provider will want to figure out the cause of your irregular bleeding before starting Depo, because the side effects of Depo may mask any symptoms of a more serious condition.  Women with a known or suspected pregnancy should not use Depo-Provera.

Depo-Provera may not be recommended for women who are planning on becoming pregnant in the near future, because in some cases it may prevent pregnancy for much longer than 3 months.

Women who are concerned about weight gain, have liver disease, gallbladder disease, or a history of depression should study the risks and talk with their health care practitioner about the safety of using Depo.

Health Risks

Studies released in 2004 showed that Depo-Provera is associated with loss of bone density. It also showed that the loss of bone density was greater the longer a woman used Depo. However, later studies showed that the bone loss is reversible when a woman goes off Depo-Provera. No studies have been done to show whether or not using Depo could increase the risk of ostroporosis or broken bones later in life. Women on Depo, like all women, are advised to exercise and take in plenty of calcium. (see article on Building Healthy Bones and factsheet on calcium-containing foods)

Please note that some women have allergic reactions to Depo-Provera.

If a woman becomes pregnant while using Depo-Provera, and continues her pregnancy, there may be an increased risk of premature birth.

The effects of Depo-Provera on breast cancer are still unknown.

Health Benefits

Women on Depo-Provera have a decreased risk of endometrial cancer, ovarian cancer, and pelvic inflammatory disease. They may have less menstrual cramping and pain, fewer periods, and less chance of anemia.

Side Effects

Many women using Depo-Provera gain weight. The average weight gain in some studies was about 5 pounds per year. Some women feel that they have an increase in appetite with Depo.

Irregular, heavy, or no bleeding are common side effects of Depo-Provera. Irregular or prolonged bleeding is more common when a woman first starts using Depo, or when restarting Depo after not using it for awhile. After a year of use, many women stop having periods. Lack of a period becomes increasingly common with longer use.

Other less common side effects of Depo-Provera can include headaches, nervousness, mood changes, bloating, hot flashes, decreased interest in sex, breast tenderness, acne, hair loss, and back ache.

Drug Interactions

Few medications lower the effectiveness of Depo-Provera. Women with Cushing’s syndrome may take medications that interfere with Depo-Provera. If you are taking any medications, tell your clinician. When taking medications that may interfere with Depo-Provera, consider adding a backup method of birth control, like male condom, female condom or spermicide. As with all drugs, it is useful to inform all your medical providers if you are taking Depo Provera.

Future Fertility

Women who want to become pregnant may stop using Depo-Provera at any time. For some women, fertility returns immediately. For others, it may take 6 to18 months or longer for the body’s hormone cycle to go back to normal.

Going Off Depo-Provera

After the last shot, it can take six months or longer for the drug to leave the body. Side effects and irregular periods or spotting may last one year.

Some women endeavor to remove the synthetic hormone from where it is stored in the body’s tissues through detoxifying methods such as drinking plenty of water and raw vegetable juice, eating lots of fresh raw organic vegetables, sweating in a steam room or sauna, and getting lots of exercise and fresh air. There’s also the option of taking herbal formulas or teas that help balance female hormones, or talking with a naturopathic physician or herbalist. The effectiveness of these methods has not been studied.

IF you decide to switch from Depo Provera to another hormonal method like the birth control pill, the vaginal ring, or the contraceptive patch, it is recommended that you start your new method on the date your next Depo injection is due. Use a back-up method of contraception such as male condoms, female condoms, or abstinence for the first seven days of pill use.

Advantages

  • Private.
  • Does not require regular attention.
  • Does not interrupt sex play.
  • Has no estrogen.
  • May decrease risk for ovarian and uterine cancers.
  • Can be used starting six weeks after giving birth.

Disadvantages

  • Causes loss of bone density.
  • Does not protect against sexually transmitted infections, including HIV/AIDS.
  • Requires injections every 3 months.
  • Delays the return to fertility.
  • Could cause irregular bleeding.
  • Leads to weight gain for many women.

Something to Think About

There is no antidote to the Depo-Provera shot. Women who are given Depo-Provera should be well informed about the drug and know that there are other options for birth control. In this country and in other countries, women have been pressured into taking Depo-Provera without knowing what it was. Know your options.

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