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Depo Provera

Depo Provera  is the only injectable that we have available in NZ. It is a very effective contraceptive as it works by stopping ovulation and is given every 12 weeks into the buttock. However we do have 4 weeks leeway if a woman is late for her injection, as there is evidence of efficacy for a further 4 weeks  ie up to 16 weeks after the last injection.

Like all progestogen only methods ,one of the common side effects is the potential irregular bleeding pattern though this tends to improve with further injections. Women need to have this discussed along with an explanation of why they are likely to not have periods while using  DepoProvera (no lining building up, so none to come away). One of the benefits of DepoProvera is that it can be used if there are estrogen contraindications such as previous DVT. Most pamphlets, and the package insert regarding DepoProvera, talk about other potential side effects such as weight gain and mood changes which we will be looking at this during the week.

Delay in return to fertility needs to be discussed with women who are considering the use of the injection. For some women this is fairly immediate for others it may take longer - occasionally up to 18 months. Within 10 months of the last injection about 50% of women who have stopped it to conceive will be pregnant.

Case Study: Margaret

Margaret has recently been using the diaphragm  for contraception but is now thinking of Depo Provera as her contraceptive method. However she wants more information about 2 issues You might like to have a look at the Faculty of Sexual and Reproductive Healthcare document on injectables for some further info here.

  1. Explain what may happen to her bleeding pattern on the injection
  2. What would you tell her re the risk of breast and endometrial cancer ?

Discuss these issues with each other - if you feel you cannot find the answers, do ask us on the discussion board.


Let's go back to that visit with Margaret.

You are giving her first DepoProvera  injection on Day 5 of the cycle. You see from her previous notes that she has epilepsy which is well controlled on Tegretol. Answer yes or no to each of the following statements:

You have to:

1. tell her that the contraceptive efficacy is immediate?

2. give her future injections more frequently?

Which of the following are true for Depo Provera

3. Increases the risk of endometrial cancer?

4. Should never be given to women with CVD?

5. Works by preventing ovulation?

6. Has immediate return to fertility after stopping?

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