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Understanding the Use and Effects of Depo-Provera Pills
Introduction to Depo-Provera Contraceptive
Depo-Provera, also known as medroxyprogesterone acetate, is a long-acting injectable contraceptive that has been widely used for over a decade in the United States and globally for around 40 years. It is administered intramuscularly at a dose of 150 mg every three months and is known for its high efficacy in preventing pregnancy by inhibiting ovulation and altering cervical mucus to block sperm penetration5 9.
Clinical Profiles and User Demographics
A study examining adolescents who chose Depo-Provera compared to other contraceptive methods found that a significant number of Depo-Provera users had previous pregnancies or a history of using birth control. This group also had a higher prevalence of genital infections, particularly with Chlamydia trachomatis, compared to those using other methods like Norplant or oral contraceptive pills (OCP)1.
Side Effects and Management
Menstrual Irregularities and Weight Gain
Depo-Provera is associated with several side effects, including menstrual irregularities and weight gain. Menstrual disturbances are common, with many users experiencing amenorrhea (absence of menstruation) by the end of six months of therapy1 7. A study investigating the supplementation of vitamin C and vitamin B6 found no significant effect on preventing these menstrual irregularities or weight changes, suggesting that these side effects are inherent to Depo-Provera use2.
Metabolic Effects
Depo-Provera has been shown to affect glucose tolerance and insulin response, although these changes are generally less pronounced than those observed with combined oral contraceptives. Lipid levels remain largely unchanged with Depo-Provera use3. Additionally, users of Depo-Provera have been found to have higher serum levels of phosphorus and magnesium compared to those using non-chemical contraceptives4.
Long-Term Safety and Return to Fertility
Long-term use of Depo-Provera has been scrutinized for potential health risks, including cardiovascular events, breast and gynecologic malignancies, and osteopenia. However, extensive clinical experience has established its safety, with no significant long-term hazards identified10. The return to ovulation after discontinuing Depo-Provera typically occurs within 30 weeks, with a high cumulative rate of return to fertility at 12 months6.
Patient Satisfaction and Compliance
Despite the side effects, many users report high satisfaction with Depo-Provera due to its convenience and the lack of daily compliance required. In a study, a significant majority of users expressed satisfaction and indicated they would recommend Depo-Provera to others2. However, compliance with follow-up appointments can vary, with higher rates observed among Depo-Provera users compared to those using Norplant or OCP1.
Conclusion
Depo-Provera remains a highly effective and convenient contraceptive option for many women, particularly those who prefer a non-daily method. While it is associated with certain side effects such as menstrual irregularities and potential weight gain, its long-term safety profile is well-established. Proper patient counseling and follow-up are essential to manage side effects and ensure continued satisfaction with this contraceptive method.
Sources and full results
Most relevant research papers on this topic
A prospective study of adolescents who choose among levonorgestrel implant (Norplant), medroxyprogesterone acetate (Depo-Provera), or the combined oral contraceptive pill as contraception.
Adolescents with previous pregnancies or birth control use are more likely to choose implant or injection contraception, with common medical symptoms and sexually transmitted diseases before therapy initiation.
Observational Study
Highly CitedSupplementation with vitamin C and/or vitamin B(6) in the prevention of Depo-Provera side effects in adolescents.
Vitamin C and vitamin B6 supplementation in adolescents does not significantly reduce menstrual irregularities or weight gain associated with Depo-Provera use.
RCTA comparative study of the metabolic effects of injectable and oral contraceptives.
Injectable and oral contraceptives impair glucose tolerance, with the combination pill showing more changes, while lipid levels remain unchanged.
Serum levels of phosphorus, magnesium, and calcium in women utilizing combination oral or long-acting injectable progestational contraceptives.
Oral contraceptive users have lower phosphorus and calcium levels, while Depo-Provera users have higher levels, but these effects do not persist over time.
RCT
Large Human TrialDepo-Provera: an injectable contraceptive.
Depo-Provera is an effective long-acting injectable contraceptive, but its safety and long-term fertility control are questionable, and it should be used as a last resort.
Pharmacokinetics, ovulation suppression and return to ovulation following a lower dose subcutaneous formulation of Depo-Provera.
The lower-dose subcutaneous formulation of Depo-Provera effectively suppresses ovulation for more than 13 weeks and has a 97.4% cumulative rate of return to ovulation at 12 months, making it more convenient and tolerable.
RCTHighly CitedDepo Provera. Position paper on clinical use, effectiveness and side effects.
Depo Provera is a highly effective contraceptive with low failure rates, providing a simple, effective alternative for women who cannot use the combined oral contraceptive pill due to blood pressure or thrombosis concerns.
Depo-Provera (Injectable Contraceptive)—A Review
Depo-Provera effectively prevents ovulation and has other contraceptive effects by affecting cervical mucus, endometrium, and oviducts.
Literature ReviewDepo-Provera in adolescents: effects of early second injection or prior oral contraception.
Early second Depo-Provera injection does not alter menstrual abnormalities and predisposes to greater weight gain, while prior oral contraceptive use reduces bleeding duration without changing weight gain rate.
Non-RCTDepot-medroxyprogesterone acetate injection (Depo-Provera): a highly effective contraceptive option with proven long-term safety.
Depot-medroxyprogesterone acetate (Depo-Provera) is a highly effective, long-term hormonal contraceptive with proven long-term safety, including reduced risk of cardiovascular events, breast and gynecologic malignancy, and osteopenia.
Highly Cited