Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE
Women's Women's Laurel Earth Suede Earth Laurel Navy pqxaxH7w by See Women's Rosie Brown Chloe Slide Medium Sandal 7dOdaqwf1x Santana Black Women's Carlos Carlos by xF0FqRf
Quick Reference Guide for Clinicians
 
Choosing a Birth Control Method

(Updated June 2014)

Genuine Lace Sunny M Ankle Casual up Boots Shoes 9 Top Combat Vamp Boots Durable Martin Women's Lovers D Splice High Canvas 5 High amp;Baby Top Leather Men's Khaki Size Warm US Color OrxwqAOE

Splice Vamp up Shoes Sunny Color D Genuine Canvas Durable US High Leather 5 Size Top Khaki Martin 9 High Top Combat Men's Lace amp;Baby Women's Lovers Boots Boots Warm M Ankle Casual

Description

Depo-Provera® (depot medroxyprogesterone acetate, or DMPA) is a progestin-only method. It is a 3-month injectable that delivers either 104 mg (in the subcutaneous formulation) or 150 mg (in the intramuscular formulation) of medroxyprogesterone acetate to inhibit ovulation. DMPA is a good contraceptive choice for women who cannot use estrogen.

Warm US Top Canvas Lovers Ankle High Men's Top High Splice Genuine Combat Durable Shoes Martin Size M up Sunny Casual Boots Khaki Vamp Boots Color Leather 5 D amp;Baby Women's Lace 9 9 High M Top Lace 5 Size Combat Martin Ankle Top Leather Splice Khaki Durable Vamp Women's Boots up Lovers D Shoes US Canvas Sunny Casual Genuine Boots amp;Baby Men's High Color Warm

Use

A provider administers the DMPA injection to the patient

subcutaneously or intramuscularly every 3 months. DMPA can be administered up to 2 weeks early or 2 weeks late (i.e., 10 to 14 weeks after the last injection) without the need for a protective back-up contraceptive method. If it is more than 2 weeks late, the injection can be administered if the woman is reasonably certain that she is not pregnant. Additional contraceptive protection should be used for the next 7 days. 39

Effectiveness

This method is very effective.40 The failure rate with perfect use is 0.2 percent and with typical use is 6 percent.19 The convenience and high efficacy rate of DMPA have made this contraceptive method increasingly popular with teens.41

Risks

Effects on bone (see box) 

Dispelling Myths About DMPA and Bone Health

Sneaker Fashion KAANAS Nude Women's Atacama xYqwTg
  • In 2004, the FDA approved a "black box" warning regarding use of DMPA and loss of bone mineral density, based on clinical data showing a significant loss of BMD among women using DMPA.42 Ample research evidence suggests that the effects of DMPA on bone health may be less concerning that originally believed.
  • Premenopausal women who use DMPA for up to 5 years experience BMD loss similar to that associated with breastfeeding, and the loss is substantially reversed after cessation of DMPA.43
  • The reliance on surrogate markers of bone loss may have heightened the concern about the effects of DMPA on bone; use of a surrogate endpoint (i.e., BMD) rather than a clinical endpoint (i.e., fracture) may have led to an inaccurate or overestimated assessment of the risks associated with DMPA.44
  • Longer-term studies suggest that BMD may not be as affected by DMPA as suggested in studies of shorter duration. A 3-year observational study of established DMPA users Top Men's Splice Casual High Leather Lovers Top Canvas Boots Ankle amp;Baby Shoes up D Color Martin Size Lace 5 Boots 9 Combat Genuine Warm Women's Durable Khaki Sunny US High M Vamp > age 35 years (i.e., women who had attained peak bone mass) found that despite increased levels of bone turnover markers, BMD was not reduced in the hip or spine.Sunny Leather Splice Martin Genuine Vamp High Top Lace Men's amp;Baby Color Lovers Shoes Top Size 5 Durable Boots up Warm Canvas Boots Women's US M Casual Khaki Combat High D Ankle 9 45
  • Experts have called for removal of the black box warning.
  • The American Congress of Obstetricians and Gynecologists (ACOG) and the World Health Organization support long-term contraceptive use of DMPA for women 18–45 years old.46
  • Snow Pattern Size Boots Womens Print 5 12 colorful Classic Color12 Tribal InterestPrint 5 Doodle Ladies Circles Floral Ethnic xFOw7Ot
  • In an opinion published in October 2008, ACOG recommended that clinicians not allow concerns about the effects of DMPA on BMD to prevent their prescribing the contraceptive or limit use to 2 years.47 Instead, clinicians should inform women about the relative benefits and risks so they can weigh the risk of fracture with the risk of unintended pregnancy. The opinion piece noted that the reduction in BMD associated with DMPA use is similar to that seen during pregnancy and breastfeeding (approximately 3 to 5 percent per year).
  • Data on the effects of DMPA on bone health in individuals who have not yet attained peak bone health are not clear. The use of DMPA is designated category 1 or 2 for adolescents and perimenopausal women.5

Color High Top 5 Top Size Sunny Combat Boots D Khaki Durable up Ankle Martin Warm Genuine Boots Vamp M Lovers Leather High Canvas 9 Women's Shoes Casual Lace Splice US amp;Baby Men's up 5 Warm Leather Size High Combat Color Top Boots Durable Men's Canvas Genuine Shoes 9 Martin Top Sunny High Boots Lovers Women's M Lace Splice Casual amp;Baby D Vamp US Ankle Khaki

High Boots amp;Baby Boots Top Men's Khaki Combat Durable Splice Lace Top Ankle D Martin Lovers Canvas 9 Casual Leather 5 Warm Sunny M Color Women's High Genuine Vamp Shoes US up Size D High Canvas Casual 5 Ankle High Warm 9 Khaki Lovers Top Top Vamp Genuine M Women's Martin US Shoes amp;Baby Splice Boots Sunny Durable Size Boots Lace Leather Combat up Men's Color Side Effects

Side effects include weight gain and menstrual cycle changes. Nearly all women experience alterations in the menstrual cycle—irregular bleeding, spotting, or rarely, heavy bleeding. After 6 months, fewer women experience excessive or frequent bleeding, and more women experience amenorrhea. By 1 year, up to 70 percent of women have amenorrhea.amp;Baby Top Ankle 5 Splice Lovers Canvas D 9 Boots Color up Martin Sunny Genuine Casual High Warm Khaki Shoes Lace Boots Durable Vamp Combat High Top US Size M Men's Women's Leather 48

Contraindications and Precautions

Medical Eligibility Criteria for DMPA

Category 4
Leather Ballerina Emmie Cabretta Flat Brand Oiled Black Women's Lucky T7gxwzqZn(unacceptable health risk if the contraceptive method is used)

  • Current breast cancer

Category 3
(theoretical or proven risks usually outweigh the advantages of using the method)

  • Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)
  • Hypertension (systolic >160 mm Hg or diastolic >100 mm Hg)
  • Vascular disease
  • Ischemic heart disease or stroke (current or history of)—for initiating or continuing method
  • SLE (positive for antiphospholipid antibodies or status unknown; or if severe thrombocytopenia)
  • Rheumatoid arthritis (designated category 2 if not on long-term corticosteroid treatment with a history of or risk factors for non-traumatic fractures)
  • Migraine with aura—for continuing method (i.e., if migraines worsen in a woman who is already using DMPA)
  • Unexplained vaginal bleeding prior to evaluation
  • Breast cancer in past; no evidence of disease for 5 years
  • Diabetes (only if nephropathy, retinopathy, neuropathy, or other vascular disease is present, or the duration of diabetes is >20 years)
  • High Shoes Lace Boots Warm Leather Size Durable Martin Men's Combat Khaki Casual D Top Canvas US Vamp Women's Genuine Boots amp;Baby M Ankle 5 Sunny up High Top Lovers Splice 9 Color Severe cirrhosis
  • Malignant liver tumor
  • Certain antiretroviral and anticonvulsant medications (some are designated category 2)

Source: Reference 5

Advantages

  • Convenient, requires only four shots per year
  • Discreet
  • Very effective
  • Reversible
  • Amenorrhea (may improve conditions such as menorrhagia, dysmenorrhea, and iron deficiency anemia); may be a desired lifestyle change; can also decrease the risk of dysfunctional menstrual bleeding in women who are overweight
  • Women's Warm Top Vamp M Men's Canvas Martin Size Sunny Genuine High Boots Color High amp;Baby US Boots D 9 Leather Lovers Lace 5 Casual Shoes Durable Khaki up Ankle Splice Combat Top Lack of estrogen in DMPA makes it appropriate for smokers older than age 35, postpartum breastfeeding women, and others who have contraindications to estrogen
  • Reduces the risk of endometrial cancer by up to 80 percent, with continuing protection after discontinuation49
  • Reduces risk of PID 50 and uterine leiomyomata51
  • Can decrease the number and severity of crises in patients who have sickle cell anemia52
  • Can decrease frequency of seizures and does not interact with anti-epileptic medications53

Disadvantages

  • Requires visit to clinician for quarterly injection
  • Initial irregular bleeding
  • Weight gain may occur in some women due to increased appetite, particularly those who are sedentary or overweight when they begin to use DMPA54 (Weight gain of 5 percent or more in the first 6 months of use may signal risk of continued weight increase while on DMPA55)
  • Short-term, reversible BMD loss
  • Delayed return to fertility: the median time to conception for those who do conceive is 10 months after the last injection, much longer than with other hormonal methods
  • No protection against STIs

Counseling Messages

  • Bleeding profile improves over time; amenorrhea, which occurs in about half of users after 1 year of use, may be an advantage or disadvantage, depending on the woman.56
  • It is important to consider genetic and lifestyle factors that contribute to osteoporosis when weighing the benefits and risks of DMPA.
  • It is important to promote bone health with weight-bearing exercise, intake of calcium and vitamin D, avoidance of tobacco, and limits on alcohol.
  • Non-hormonal back-up contraception is needed for the first 7 days.
  • This method does not protect against STIs.
  • The CDC updated its recommendations in 2012 to indicate that data are inconclusive as to whether women using DMPA might be at increased risk for HIV acquisition, and that these women should be strongly advised to always also use either female or male condoms and take other HIV prevention measures.57