a. A 1-mL crystalline suspension of 150 mg of depot medroxyprogesterone acetate (DMPA) injected
intramuscularly into deltoid or gluteus maximus muscle every 11–13 weeks
: Perfect use failure rate: 0.3%; typical use failure rate: 3%
c. Start methods
i. Preferred start: First 5 days of menses. No backup needed
ii. Alternative start: Any time in cycle if not pregnant. Use backup for 7 days.
iii. Postpartum: May give injection before hospital discharge
iv. Breastfeeding: May start immediately or wait 4–6 weeks
v. Switching methods: Any time patient not known to be pregnant. Use backup
d. Adverse effects
i. Progestin related (see above)
ii. Progressive significant weight gain
iii. Severe depression (rare)
iv. Black box warning—Loss of bone, women who used DMPA for at least 5 years have
significantly reduced BMD of lumbar spine and femoral neck, particularly after 15 years of
use and if initiated before age 20
(a) The effect is almost completely reversible, even after 4 years or more of DMPA use.
(b) All women placed on DMPA should be taking sufficient calcium and
e. Missed doses—Greater than 13 weeks between injections
f. Patient counseling
i. Do not massage area for a few hours where shot was given.
ii. Expect irregular bleeding/spotting in beginning but decreases over time.
iii. Take calcium if not achieving 1000–1200 mg/day through diet.
iv. Return in 11–13 weeks for next injection. Use backup if ever more than 13 weeks
v. If ever changing from DMPA to another method, start method when next injection is due.
vi. May have delayed return to fertility for up to 18 months. Use with caution in women 35 years
or older who express interest in future conception.
3. Depot subcutaneously—Subcutaneous injection of 104 mg of DMPA, information similar to above
but, in addition, has FDA indication for endometriosis
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