Frequently Asked Questions about Depo Provera

What is Depo Provera?
How does Depo Provera work?
What are the side effects of Depo Provera use?
What is bone mineral density and why is it important to women's health?
What impact does Depo Provera use have on bone health?
What is a "black box" warning and why was it applied to Depo Provera?
What are other possible health effects of Depo Provera?
Why would a woman choose Depo Provera over other methods of contraception?

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What is Depo Provera?
Depo Provera is an injection of synthetic progesterone similar to one of the hormones made by a woman’s ovaries. Approved by the FDA in 1992, Depo Provera is a highly effective, long-acting method of contraception. When used perfectly, it is more than 99% effective at preventing pregnancy. A woman who chooses Depo Provera as her method of contraception returns once every thirteen weeks to a healthcare provider for re-injection.

How does Depo Provera work?
Depo Provera prevents pregnancy by reducing the amount of estrogen a woman’s ovaries make, similar to what happens to women during and after menopause. Like other progestin-only contraceptives (which contain no estrogen), it works to prevent pregnancy by inhibiting ovulation and by altering the environment in the cervix and uterus to make it harder for sperm to travel. Depo Provera does not protect against sexually transmitted infections, including HIV/AIDS.

What are the side effects of Depo Provera use?
Women who use Depo Provera may experience side effects, the incidence and severity of which vary from person to person. In clinical trials, the most frequently reported side effects included menstrual irregularities, abdominal pain or discomfort, weight gain, dizziness, headache, fatigue and nervousness. Some women also experience breast tenderness, depression, and decreased libido. New data shows that Depo Provera use decreases bone mineral density in women and adolescents — an effect that appeared greater the longer the use.

What is bone mineral density and why is it important for women's health?
Bone mineral density is a measurement of the level of calcium in certain bones. A decrease in bone density may make bones more susceptible to fractures later in life. Promoting bone health is particularly important for young women, as the critical years for building bone mass are from pre-adolescence to about age 30. Given that women are four times more likely than men to develop osteoporosis, it is crucial that young women are informed about strategies for building and maintaining bone mass – such as through diet and exercise.

What impact does Depo Provera use have on bone health?
Studies conducted by the product manufacturer, Pfizer, and by researchers at the National Institutes of Health (NIH) found that adult women and teens who used Depo Provera for at least two years were more likely to experience loss of bone density than women using non-hormonal methods. 1 2 The loss of bone density is a risk factor for osteoporotic fractures. However, the evidence also shows that when women stop using Depo Provera, the bone loss is at least partially reversed. In the case of adolescents, the NIH research shows that bone recovery after Depo Provera use is significant, effectively reversing the bone loss. The impact of health interventions such as nutritional supplements or exercise on bone mineral density among Depo Provera users has not been studied.

What is a "black box" warning and why was it applied to Depo Provera?
The "black box" warning is the Food and Drug Administration's (FDA) most stringent caution short of an outright ban. A "black box" warning is designed to inform healthcare providers and consumers about serious and imminent problems associated with use of a drug. Bone mineral density loss is an important concern, but not comparable to the types of side effects typically presented in a "black box" warning — adverse reactions that could cause imminent harm, injury, or death. FDA's recent history of putting politics before science in its handling of reproductive health products and the Bush administration's track record of attacks on family planning cannot help but raise questions about the reasons FDA chose to apply the "black box" warning to Depo Provera.

What are other possible health effects of Depo Provera?
Possible increased risk of sexually transmitted infections. Recent research suggests that women who use Depo Provera have a greater risk for acquiring gonorrhea or chlamydia than women not using hormonal contraception. Therefore, women who know they are at risk for sexually transmitted infections, have multiple sex partners and/or cannot negotiate consistent and correct condom use should consider a different method. For more information on Depo Provera and STIs, click here.

No increased risk of breast cancer. Despite concerns based on animal studies, there is accumulating evidence — including from the World Health Organization — that Depo Provera does not increase women's risk of breast cancer.

Why would a woman choose Depo Provera over other methods of contraception?
Women who are trying to prevent pregnancy choose contraceptive methods for a variety of reasons. While effectiveness and convenience are the primary factors women cite for why they choose their method, many women also face particular situations that require they use a certain type of contraception. Reasons why a woman might choose Depo Provera over another method include:

• Depo Provera is a progestin-only contraceptive method. Many women who want a hormonal contraceptive method experience unmanageable side effects from use of estrogen.
• Depo Provera is highly effective and reliable. There is only a slight difference between effectiveness with perfect (99.7%) and typical use (97%) and since it is an injectable, there is less room for user failure, i.e. missing a Pill or inserting a diaphragm wrong.
• Depo Provera is long-acting. A woman only has to manage her contraception once every three months when she returns for re-injections.
• Women can use Depo Provera discreetly. Since there are no pill packs or barrier methods to store, Depo Provera can be used covertly by women who wish not to disclose contraceptive use to family members or partners.

  

1 FDA Labeling for depo-subQ provera 104, accessed at http://www.fda.gov/cder/foi/label/2004/021583lbl.pdf

2 Scholes D, et al. Change in Bone Mineral Density Among Adolescent Women Using and Discontinuing Depot Medroxyprogesterone Acetate Contraception. Archives in Pediatric and Adolescent Medicine. Vol 59: February 2005.