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The Injection

(Depo-Provera)

the injection

What is "the Injection"?

Depo-Provera is a progestin-only injectable form of birth control given by your health care provider every 3 months. It is injected into either your upper arm or buttocks. The next injection should be scheduled in 12 weeks-this gives you a week or two of flexibility if you are unable to keep that appointment.

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How does the Injection work?

It prevents pregnancy by stopping ovulation (the release of an egg from the ovary). It thickens the mucus around the cervix preventing sperm from entering the cervix and alters the lining of the womb to inhibit implantation of the pregnancy.

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How effective is the Injection?

Depo-Provera is more than 99% effective. Of every 1,000 women who use this method, 3 will become pregnant during first year of use. This is one of the most effective forms of birth control.

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Am I a good candidate for the Injection?

Depo-Provera is worth considering if you want long-term contraception without following a daily routine. Since protection is maintained from a injection every 3 months, it allows for sexual spontaneity. It may also be a good choice for you if you cannot remember take a pill everyday or if you cannot use birth control containing estrogen (i.e. you are over 35 and a smoker or have a history of blood clots.) It is also a good choice if you do NOT plan to become pregnant in the near future and want a reliable form of birth control other than the pill. The injection does not protect from sexually transmitted diseases particularly HIV. If this is a concern you should use a condom as well.

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Are there any reasons why I shouldn't use the Injection?

Most women who need birth control can use Depo-Provera, regardless of age.* A woman should not use the injection if she has history of:
  • Active liver disease
  • Current or past history of breast cancer
  • Unexplained vaginal bleeding

* The final decision is between you and your doctor.

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What are the common side effects of the Injection?

  • Irregular bleeding
  • Almost all women who use Depo-Provera will experience changes in their period, including irregular or unpredictable bleeding or spotting, and occasionally heavy or continuous bleeding. This tends to subside the longer you use this method. After a year of use, one-half of women will stop having a period altogether. This is an expected side effect from the injection and is NOT a medical problem. The constant release of hormone in your body from the injection prevents the lining of the uterus from building up; therefore, there is nothing to bleed off each month. If the irregular bleeding is interfering with your lifestyle, talk to your health care provider. This condition can be treated by either taking a short course of estrogen (i.e. taking the birth control pill) or medications such as Motrin or Advil to regulate your cycle for a few months until the irregular bleeding resolves.
  • Weight gain
  • Depo-Provera has been shown to be associated with weight gain. As much as 3 to 5 lbs. in the first year of use. This is most likely due to increased appetite from the progestin. If you watch what you eat and exercise regularly you can offset this weight gain.
  • Delay in the return of your period
  • Although the injection does NOT cause infertility, it may take 12 to18 months from your last injection for your normal menstrual function to return (the average is 10 months). Thus, if you are considering pregnancy in the near future you may want to consider an alternative method of birth control.
  • No immediate discontinuation
  • Unlike, the pill or mini pill, the hormone given as an injection can take several months to clear from your body. Thus, you may be "stuck" with some of the other side effects such as irregular bleeding, weight gain, etc. for several months.
  • Reversible loss of bone mass
  • Women who use Depo-Provera for a long period of time may have lower density than non-users. This will reverse after stopping the Depo-Provera and has not been shown to cause osteoporosis or associated fractures. Women over 40 who continue this method for greater than 2 years would benefit from having their bone density checked.
  • Mood changes
  • Some women experience mood changes on the injection-depression, irritability, and change in sex drive. These are infrequent side effects.

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What are the benefits of the Injection?

  • Easy to use--all you have to remember is to go to your health care provider for a injection 4 times a year
  • Extremely reliable--this form of birth control has one of the lowest failure rates
  • Confidential--no one other than your health care provider needs to know you are using it decreases menstrual cramps and blood loss--after 1 year of use 50% of women will no longer get their period
  • Reversible--although expect a delay in the return of your period of 10 months on average

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When can I start taking the Injection?

We will only give you the Depo-Provera within 5 days of the start of your menstrual period. This ensures that you are NOT pregnant when you receive the injection and it will be effective immediately. Before you get each injection, we will check that you have a negative urine pregnancy test.

Another time to start this method is after the end of a pregnancy; either at the time of termination of pregnancy or within 5 days postpartum if NOT breastfeeding. If you plan to breastfeed, Depo-Provera is a safe method of birth control, but we recommend waiting until 6 weeks postpartum when the milk supply is fully established. If you initiate Depo-Provera after the birth of a child, keep in mind the delay in return of your menstrual cycle. If you are planning to have another baby within the next year or so, you may want to select a different form of birth control.

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What If I am late for my next Injection?

If you are late for your Depo-Provera, we want to make sure that you are NOT pregnant. However, now we need to do a blood pregnancy test to make sure you are not pregnant. This is much more sensitive test than a urine test. The blood test usually takes one day for results. If negative, you could return the next day for your injection but you should use condoms as a backup method for the next two weeks.

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Are there some warning signs I should look out for once I start the Injection?

Call your doctor if you have any of the following problems:
  • Repeated, very painful headaches
  • Heavy bleeding (soaking more than one menstrual pad per hour)
  • Depression
  • Pus, prolonged pain, or bleeding at injection site severe lower abdominal pain

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