Spotting and Bleeding With Depo-Provera

One major drawback of Depo-Provera is the continuous or irregular bleeding (spotting) that can sometimes occur during the first year. While this typically occurs during the first few months, it can persist for up to a year or longer for some people. Learn more about this side effect and what you can do if it persists.

Close up of a person loading a syringe
TEK IMAGE / Getty Images

Depo-Provera is an injectable form of birth control which uses a synthetic form of progesterone to prevent pregnancy for up to 14 weeks. Depo-Provera is discreet and convenient. It is 99% effective when used correctly. However, with typical use, it is only about 94% effective, as some people may forget to get their shots on time.

As a progestin-only contraceptive, it is also a great choice if you are unable to use estrogen-based contraception.

Spotting and Bleeding Symptoms

When it comes to birth control, bleeding remains the number one reason why women discontinue contraception.

With a drug like Depo-Provera, vaginal bleeding is not only a common side effect but one that's expected to occur in about 25% of users in the first year.

There is no way to predict who will experience these side effects or how severe they might be. For most people, symptoms of bleeding will resolve within a year. On the off chance they don’t, a person may be faced with the choice of either abandoning treatment with Depo-Provera or pushing through.

If you begin spotting or bleeding after your first Depo-Provera shot, it may seem distressing but it is generally not permanent. According to the drug manufacturer, around 57% of the people on Depo-Provera will cease having periods by the 12th month.

Treatment If Bleeding Continues

For those who continue to have spotting or bleeding, there may be treatments that can help. Most of these are intended only for short-term use and, while effective, come with their own set of side effects and considerations. Among the treatments currently approved for use by the U.S. Food and Drug Administration (FDA) are the following.

Estrogen Supplementation

Estrogen supplementation has been shown to relieve bleeding by promoting the growth of the uterine lining while stabilizing blood vessels and blood clot. Not only does estrogen enhance Depo-Provera’s contraceptive effects, but it can also be delivered by oral tablet, transdermal patch, or intravaginal ring.

Research has shown that while estrogen provides short-term relief, the effects generally return when treatment stops.


Lysteda (tranexamic acid) is a non-hormonal oral medication which received Food and Drug Administration (FDA) approval in 2009 for the treatment of heavy menstrual bleeding.

In one study, 88% of women on Depo-Provera had no vaginal bleeding within one week of treatment compared to 8.2% in the placebo group. After four weeks, a bleeding-free interval of more than 20 days was found in 68% of those treated, and in none of those who took the placebo.

Side effects are relatively mild and include a headache, back pain, stomach ache, sinusitis, muscle and joint pain, migraine, anemia, and fatigue.


Ponstel (mefenamic acid) is a non-steroidal anti-inflammatory drug used for short-term control of spotting and bleeding. It is not considered a long-term solution as prolonged use can increase the risk of high blood pressure, heart attack, and stroke.


If any of these treatments are contraindicated or unavailable, some healthcare providers may prescribe a non-steroidal anti-inflammatory drug like ibuprofen taken three times daily to reduce uterine inflammation and alleviate discomfort.

When to See Your Healthcare Provider

If heavy bleeding occurs while taking Depo-Provera, it's important to remember that the drug may not be the source (or only source) of the condition.

Abnormal bleeding should always warrant a thorough investigation, and all other causes—including uterine fibroids, sexually transmitted infection, and cancer—should be ruled out before a course of treatment is prescribed.

A Word From Verywell

Birth control choices are not always easy. If you are on Depo-Provera and faced with side effects you cannot bear, speak with your healthcare provider about treatments that may allow you to continue or explore alternatives that may be less impactful both in the short and long term.

Before starting treatment, learn as much about the drug as you can, weighing the risks and benefits. Studies show that people who were informed in advance about the risks of birth control were most able to tolerate the side effects and less likely to stop. As always, knowledge is key when making informed choices about contraception.

Frequently Asked Questions

  • How do I stop spotting or bleeding on Depo-Provera?

    Spotting or bleeding usually stops within a year of starting Depo-Provera. Treatments do exist to control the bleeding, although most are intended for short-term use. Some examples include estrogen supplementation, Lysteda (tranexamic acid), Ponstel (mefenamic acid), and ibuprofen.

  • What should I do if I experience heavy bleeding on Depo-Provera?

    If you experience heavy bleeding, see your healthcare provider to determine its cause. Similarly, prolonged bleeding should be discussed with a professional, as it might signal another health issue.

  • If I'm bleeding while on Depo-Provera, could I be pregnant?

    If you're bleeding on Depo-Provera and you receive the shot regularly, the bleeding likely isn't a result of being pregnant. When used correctly, Depo-Provera is a 99%-effective birth control. If someone forgets to get their shot on time, the effectivenes can drop to 94%.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Depo-Provera label.

  2. Marugg L, Atkinson MN, Fernandes A. The five-box method: The "four-box method" for the Catholic physicianLinacre Q. 2014;81(4):363‐371. doi:10.1179/2050854914Y.0000000032

  3. Allen R, Villavicencio J. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates. OAJC. 2016;7:43–52. doi:10.2147/OAJC.S85565

  4. Villavicencio J, Allen RH. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation ratesOpen Access J Contracept. 2016;7:43‐52. doi:10.2147/OAJC.S85565

  5. Planned Parenthood. What are the disadvantages of the birth control shot?

  6. Pfizer Medical Information. DEPO-PROVERA® CI (medroxyprogesterone acetate)

  7. Dempsey A, Roca C, Westhoff C. Vaginal estrogen supplementation during Depo-Provera initiation: a randomized controlled trial. Contraception. 2010;82(3):250-255. doi:10.1016/j.contraception.2010.04.003

  8. Senthong AJ, Taneepanichskul S. The effect of tranexamic acid for treatment irregular uterine bleeding secondary to DMPA useJ Med Assoc Thai. 2009;92(4):461‐465.

  9. Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use. Clin Obstet Gynecol. 2014;57(4):659-73. doi:10.1097/GRF.0000000000000059

Additional Reading

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.