Using Depo-Provera

Before starting on Depo-Provera the doctor will need to know if:
  • There is the possibility you might be pregnant
  • You have liver or heart problems, seizures, diabetes, asthma
  • You suffer from migraine headaches or depression
  • You are using any medication (including birth control pills, the patch, or have an IUD)
  • You have allergies
  • You experience or have experienced abnormal vaginal bleeding
  • You have lumps, swelling or tenderness in your breasts
  • You have any medical conditions/illnesses

When do I start Depo-Provera?

You should get your first injection within the first five days of starting your period in order for it to be immediately effective for birth control, unless:

  • You are currently using birth control pills. You can start with the first Depo-Provera injection anytime in the cycle. Continue with your pills until your current pack is finished.
  • You are currently using an IUD. You can start with the first Depo-Provera injection anytime in the cycle. Do not have the IUD removed for at least 2 weeks.

If the injection is not given at the beginning of your period then a pregnancy test should be done and a back-up method of contraception used for 7 days following the shot.

How do I continue on Depo-Provera?

  • You need to return for another shot every 11 to 12 weeks and no later than 13 weeks.
  • The shot slowly wears off over time, so you can't count on being protected against pregnancy longer than 12 weeks after the last shot.

How do I manage common side effects associated with Depo-Provera?

Menstrual changes

Most women notice changes in their periods. During the first year of use, periods are usually irregular, and spotty bleeding may occur between periods. Some women also notice heavier or longer bleeding during their periods, but this rarely causes serious medical problems. After 6 to 12 months of use, most women have periods less often, and many stop having periods altogether. This change is not permanent. Your periods will return after you stop using Depo-Provera.

Pregnancy symptoms

Side effects similar to the symptoms of an early pregnancy occur in many women after the first few injections, but then usually go away. Some women notice acne, sore breasts, nausea, fatigue, and abdominal discomfort. Occasionally, some women experience a spotty darkening of the skin, usually on the face.

Weight changes

One of the effects of the hormone may be an increase in appetite. As a result, about two-thirds of the women who use it gain weight. However, 20% lose weight, and 10% have no change. The average weight gain is 5½ lbs. (2½ kg) by the end of the first year and 8 lbs. (3½ kg) by the end of the second year. Eating a low-fat diet and exercising regularly helps.

Mental depression

This side effect can be worse in women who've had depression before, although the cause isn't clear. Depression related to Depo-Provera usually goes away after the medication has worn off.

Other reactions

Other side effects that may or may not be caused by Depo-Provera have been reported: headaches, dizziness, nervousness, some loss of scalp hair, some increase in body hair, and either an increase or decrease in sex drive.

Be sure to report any new or unusual problems to your doctor or nurse right away. Be especially on the lookout for prolonged, heavy vaginal bleeding; unusual swelling or pain in your legs; severe chest pain; shortness of breath; coughing up of blood; bad headaches; blurred vision; a lump in your breast, or prolonged pain at the injection site. If any of these happen, see a doctor immediately.

What are other considerations with use of Depo-Provera?

Depo-Provera and pregnancy

Once you stop using Depo-Provera, it can take you an average of 9 to 10 months after the last shot to get pregnant. After 2 years, pregnancy rates are the same in women who used Depo-Provera as is in women who used the Pill or an IUD. Women who want children in the near future should keep this in mind when deciding to use Depo-Provera.

Depo-Provera and breast milk

Can be used by nursing mothers as soon as their milk flow is well established because it doesn't affect the amount or quality of the milk.

Depo-Provera and cancer

Research has shown recently that Depo-Provera helps prevent cancer of the lining of the uterus (endometrium) and ovaries. The risk of breast cancer is very small.

Possible thinning of bones

Studies have shown that women who used Depo-Provera for a long time had a slight decrease in the calcium in their bones, which can contribute to the development of a condition called osteoporosis. For all women, the best way to prevent osteoporosis is to exercise, get enough calcium (1000 mg/day), and not smoke. For information, visit HealthLink BC or call 8-1-1 for free and ask for a dietician.

Lack of protection against sexually transmitted infections

While Depo-Provera is a highly effective, convenient method of birth control, it doesn't protect against STIs such as gonorrhoea, Chlamydia, or HIV (the virus that causes AIDS). Use a latex condom every time you have sex in order to protect yourself against these infections.

Reviewed by Danielle Chard, RN, BSc Nursing, Director of Clinical Services