Depo-Provera Flashcards

Dose

• Administered as 150 mg of medroxyprogesterone acetate via intramuscular (IM) injection or 104 mg via subcutaneous (SC) injection in the thigh or abdomen.
• Dosing occurs every 13-14 weeks.

Mechanism of Action (MOA)

• Prevents pregnancy by suppressing ovulation through inhibition of the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) surge.
• Thickens cervical mucus, slows tubal mobility, and thins the endometrium.

Duration of Action

• Can inhibit ovulation for up to 14 weeks.
• A pregnancy test is required for those returning for an injection after 14 weeks.

Advantages

• Leads to decreased menstrual blood loss; 50% of users may experience amenorrhea after 1 year, increasing to 80% after 5 years.
• Reduces menstrual cramps and ovulation pain.
• Efficacy remains high for women on anticonvulsants and may help reduce seizures.
• Decreases frequency of acute sickle cell crises and can be used by breastfeeding mothers.
• Associated with a reduction in endometrial and ovarian cancers.

Disadvantages

• Users may experience irregular bleeding in the initial months, potentially affecting intercourse.
• Amenorrhea may occur but can be concerning if not adequately explained.
• Requires injections, which may provoke needle anxiety.
• Average weight gain of 5.4 lbs in the first year and 16.5 lbs after 5 years.
• Not immediately reversible; may impact glucose and lipid levels negatively.

Side Effects

• Common side effects include dyspareunia, hot flashes, decreased libido, depression, anxiety, PMS symptoms, fatigue, acne, hirsutism, breast tenderness, bloating, hair loss, and other vasomotor symptoms.

Black Box Warning

• Prolonged use may decrease bone mineral density, especially if not followed by recovery time before menopause.
• Recommended calcium supplements (1000-1200 mg) and regular exercise for women on long-term DMPA.

Return to Fertility

• Fertility can take from 12 weeks to over 9 months to return after cessation of DMPA.

Initiation

• Ideal to initiate 7 days before menstruation, but can be started anytime during the cycle.
• If injected at any time, back-up contraception is recommended for 7 days.
• Do not massage the injection site to maintain efficacy.

Switching from Non-Hormonal Methods

• Follow the same initiation protocol as above: preferred start is 7 days before menses, with backup needed if injected anytime during the cycle.

Initiation in Postpartum Women

• Delay injection until lochia has stopped, particularly after significant obstetric blood loss.
• For women at high risk for postpartum depression, wait at least 4-6 weeks before injection.
• Breastfeeding women may start immediately or wait 4-6 weeks, depending on individual circumstances.