AlternativeDepo-Provera / Sayana Press
Depot medroxyprogesterone acetate (DMPA)
Progestogen-only injectable contraceptive
12-weekly injection — highest amenorrhoea rates, reversible BMD loss.
IM (150 mg)SC (104 mg — self-administered)
First-line for
- Contraception when adherence poor
- Endometriosis-related dysmenorrhoea (adjunct)
Mechanism
High-dose progestogen suppresses LH surge → anovulation; also endometrial atrophy + mucus thickening.
"Depo dips bone"
- Anovulation for 12+ weeks
- Reversible BMD loss — review after 2 y
- Return of fertility delayed up to 12 months
Dosing
- IM
- 150 mg deep IM every 12 weeks (grace 14 wk)
- SC
- 104 mg SC anterior thigh/abdomen every 13 weeks
Contraindications
- AbsoluteCurrent breast cancer
- CautionAge < 18 or > 45 (BMD)
- CautionMultiple osteoporosis risks
Side effects
- Irregular bleeding then amenorrhoea (~50% at 1 y)
- Weight gain (~2 kg/y)
- Mood change
- Delayed fertility return
- ↓ BMD
Fetal & maternal notes
- • Extensive safety data; inadvertent early-pregnancy exposure not linked to malformations
Key interactions
Enzyme inducers
OKEfficacy NOT reduced (depot avoids first-pass)
Clinical pearls
- 💡 Preferred POC when enzyme inducers used
- 💡 Discuss BMD if > 2 years use
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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