Depo-Provera, aka the birth control shot, is an injectable form of progestin-based birth control you take every 13 weeks to prevent pregnancy. It's also used to help ease endometriosis pain. It's safe to use while breastfeeding, although it can temporarily affect bone density and may cause weight gain and unusual bleeding or spotting.
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The birth control shot is an injection of synthetic progesterone (progestin) that's given to women every 13 weeks (around three months) to prevent pregnancy. It's also approved to help manage pain from endometriosis.
The shot that's available in the United States is a form of progestin known as DMPA, which stands for depot medroxyprogesterone acetate. The most common version goes by the name Depo-Provera, and it's injected into the muscle of your buttock or upper arm.
Advertisement | page continues belowAnother version, called Depo-Provera Subcutaneous - 104 (or Depo-subQ Provera 104), contains a lower dose of the same type of progestin, and it's injected into the tissue just under the skin. (Some women can give themselves this shot at home.) It's just as effective as Depo-Provera, but it may be a bit more expensive since it's not available generically (and Depo-Provera is).
Yes – but they're not all available in the U.S. Only Depo-Provera (and its generic forms) and Depo-Provera Subcutaneous - 104 are the only shots approved by the U.S. Food and Drug Administration (FDA).
Outside of the U.S., there are two other main types of injectable birth control: Noristerat (norethisterone enanthate) and combined injectable contraceptives (CICs). (They, along with Depo-Provera, are on the World Health Organization's list of essential medicines.) Noristerat is a type of progestin-only birth control shot, like Depo-Provera. CICs, meanwhile, contain progestin and synthetic estrogen to prevent pregnancy. One form, Lunelle, was temporarily available in the U.S., but was voluntarily recalled in 2002 due to concerns about efficacy.
Depo-Provera contains a long-acting form of progestin that works primarily by suppressing ovulation, so your ovaries don't release an egg. What's more, in the unlikely event that you do ovulate, the progestin causes your cervical mucus to thicken, making it hard for sperm to get through the cervix and reach your fallopian tubes to fertilize the egg. Progestin also causes the lining of your uterus to thin, making it less likely that a fertilized egg will implant there.
The most common side effects of the shot are unpredictable periods and vaginal bleeding or spotting, particularly during the first year of use. This usually gets better with time. By the end of the first year, only one in 10 women continue to have irregular bleeding. And half of all people on the shot stop getting periods altogether.
Some women may gain weight while on the shot. The average weight gain is about 5 pounds during the first year of use, although one small study found women could gain as much as 14 kilograms (30 pounds). Multiple studies show that the shot is the only form of birth control shown to cause weight gain when looking at a large population of women.
The shot can also cause you to lose calcium stored in your bones, resulting in reduced bone density while you're using it. The longer you use the shot, the higher your risk. For this reason, the FDA recommends that the shot is not used for more than two years unless a person cannot use other contraceptive options. However, because this loss of bone calcium in women using birth control shots is reversible (bone growth starts again when you stop using the shot), medical organizations such as the American College of Obstetricians and Gynecologists (ACOG) don't suggest restricting the length of time the birth control shot is used.
Advertisement | page continues belowHeadaches are another side effect of the shot for some women. Less common side effects include a change in sex drive, vaginal dryness, hair loss or an increase in facial or body hair, acne, nausea, and dizziness. Some women notice an increase in depression or anxiety on the shot.
Finally, while a couple of studies suggest a possible link between DMPA and breast cancer risk , other older studies found no correlation. Generally, organizations like ACOG say that the potential risk of cancer associated with progestin-only birth control (like Depo-Provera) is unclear but warrants more study.
Serious problems are rare, but call your practitioner immediately if you have any of the following:
And, of course, call your caregiver if you think you might be pregnant.
Advertisement | page continues belowAs with any medication, there are definitely some advantages and disadvantages of the birth control shot that are well worth considering.
In general, the birth control shot appeals to some women who want a highly effective method of contraception but don't want (or can't use) an IUD or implant, can't take estrogen, or have trouble remembering to take pills. It's also a very good temporary method for women who are waiting to get sterilized or whose partner has just had a vasectomy.
Unlike certain other types of hormonal birth control (like the Pill), you can get the birth control shot immediately after birth, whether or not you're breastfeeding. The progestin in the shot may be transmitted in small amounts to the mother's milk, but this hasn't been found to hurt the quality or quantity of breast milk.
The birth control shot has other benefits beyond preventing pregnancy. Most significantly, it can be used to help manage pelvic pain from endometriosis. It may also reduce the risk of pelvic inflammatory disease and uterine cancer, as well as reduce uterine fibroid bleeding.
However, it's not a good method for women who plan to start trying to conceive in the coming year or so because it may take a while for fertility to return after your last shot – around 10 months on average.
Advertisement | page continues belowWhile there's less maintenance on the shot than the Pill or patch method, you still have to remember to get a shot from your healthcare provider every 13 weeks. (In some cases, Depo-Provera Subcutaneous-104 can be self-administered at home with the permission of your doctor, but you still have to remember to do it on time.) Missing shots or getting them late can affect how well the shot protects you from pregnancy. If you have a super busy schedule or don't have reliable access to your doctor (say, limited transportation options), this might not be the right birth control method for you.
Certain people should also avoid the birth control shot. If you have lupus, a history of heart disease, breast cancer, or stroke, or liver disease, you should talk to your doctor about an alternative form of contraception that's safer for you. Opens a new window
You should also be aware that the shot provides no protection from HIV and other sexually transmitted infections (STIs). So, if you're not in a monogamous relationship, be sure to use condoms every time you have sex.
Finally, it should be noted that the shot is…well, a shot, and may be painful. Depo-Provera and its generic forms are injected fairly deep into your skin, which can hurt. (Depo-Provera Subcutaneous-104 has a smaller needle and doesn't go as deep into the skin, so may be slightly less painful.) But if you're squeamish about needles or not a fan of getting shots regularly, this isn't the right birth control method for you.
The shot is fairly effective at preventing pregnancy. With typical use, six in 100 women on the shot get pregnant in the first year. With perfect use – meaning that you never miss a shot and always get them exactly on schedule – fewer than one in 100 women get pregnant in the first year.
Advertisement | page continues belowYes, if you don't get your shots on time or if you skip a shot. As mentioned above, there is a failure rate of 6 percent with typical use of the birth control shot.
That said, it may take around 10 months or more once you stop the injections to get pregnant as it's the only method of non-permanent birth control that has been shown to delay return to fertility. If you know that you'll want to try to conceive in the next year or so, choose a different method of contraception that's more immediately reversible.
You risk pregnancy if you get your shot more than two weeks late. If it's been more than 15 weeks since your last birth control injection, you'll need to abstain from sex or use a backup method of contraception until you get the next shot and for seven days afterward.
Note: If you were overdue for the shot and had unprotected sex during that time or within seven days after getting it, using emergency contraception will help prevent pregnancy. It can be used up to 120 hours (five days) after unprotected sex, but the sooner you take it the more likely it is to be effective. So if you have some on hand, take it right away. Otherwise, head to a pharmacy or your doctor's office.
If you and your doctor decide that the birth control shot is right for you, you can get it pretty much any time you'd like. If you get the shot within three weeks of giving birth, or during the first seven days of your period, you don't need to use a backup method. If you start at any other time, you'll need to use a backup method, such as condoms, for at least the first 7 days. (The exception: If you're breastfeeding, less than 6 months postpartum, and still don't have your period, you don't need a backup method.)
Advertisement | page continues belowIt's a good idea to make your next appointment in 12 weeks. That way, if you have to postpone it for some reason, you'll still have another week to get the shot on time. If you're going to be away when you're due for the shot, you can get it a little earlier.
Thanks to the Affordable Care Act, most private (and all government marketplace) insurance plans must cover at least one form of every type of FDA-approved prescription contraceptive method with no cost to you. There are some exceptions to this rule – say, you work for a church or religiously-affiliated hospital – but in most cases there are still workarounds to ensure you're covered.
If you don't have insurance and are paying out of pocket, you can expect to spend up to $150 per injection, plus the cost of the office visit. Family planning clinics, such as Planned Parenthood, are generally less expensive and may have sliding fee scales.
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