Questions and Answers
What is the dose of Depo-Provera injected in the thigh or abdomen?
What is the mechanism of action (MOA) of Depo-Provera?
Prevents pregnancy by suppressing ovulation through inhibition of LH and FSH surge, thickening cervical mucous, slowing tubal mobility, and thinning endometrium.
What is the duration of action of Depo-Provera?
May inhibit ovulation up to 14 weeks.
What are some advantages of using Depo-Provera?
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What are some disadvantages of Depo-Provera?
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What are some common side effects of Depo-Provera?
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Depo-Provera has a black box warning for increased risk of bone mineral density loss.
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What is the expected return to fertility after stopping Depo-Provera?
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When is the preferred start time for Depo-Provera injections?
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What should be done when switching from non-hormonal methods to Depo-Provera?
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What are the recommendations for initiation of Depo-Provera in postpartum women?
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Study Notes
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.
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Description
Test your knowledge on Depo-Provera (DMPA) with these flashcards. Learn key terms such as dose, mechanism of action, and duration of action. Perfect for anyone studying pharmacology or contraception methods.
