Sexual Health Birth Control Prescription Options What You Need to Know About Depo-Provera By Dawn Stacey, PhD, LMHC Dawn Stacey, PhD, LMHC LinkedIn Twitter Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience. Learn about our editorial process Updated on October 18, 2020 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Anita Sadaty, MD Medically reviewed by Anita Sadaty, MD Facebook LinkedIn Twitter Anita Sadaty, MD, is board-certified in obstetrics-gynecology. She is a clinical assistant professor at Hofstra Northwell School of Medicine and founder of Redefining Health Medical. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Formulations Advantages Disadvantages Side Effects Considerations Appropriate Use Other Uses Cost Depo-Provera is a reversible method of prescription birth control. Also known as DMPA, Depo shot, Depo, or the birth control shot, this progestin-only contraceptive prevents pregnancy for up to three months with each shot. B. Boissonnet / Getty Images Depo-Provera slowly releases a progestin known as medroxyprogesterone acetate which must be taken every 13 weeks. It works by preventing ovulation and thickening the cervical mucus. This prevents sperm from entering the fallopian tubes and fertilizing an egg that may have been ovulated. Depo-Provera is between 94% and 99% effective. With typical use, three out of every 100 women who use Depo-Provera will become pregnant. Formulations There are two versions of Depo-Provera. Each provides the same level of pregnancy protection. Depo-Provera Injection The original Depo-Provera formula must be injected into a muscle, either the buttock or upper arm. You must have a shot four times a year (every 13 weeks) to maintain Depo-Provera’s high effectiveness rate. One shot contains 150 milligrams (mg) of medroxyprogesterone acetate. If you get your first Depo shot within the first five days of your period, it will provide immediate pregnancy protection. If you start treatment at any other time in your cycle, you should use a backup method, such as condoms, for at least seven days. Depo-SubQ Provera 104 Injection This version contains 31% less hormone than the original Depo shot at 104 mg of medroxyprogesterone acetate. Because it has a lower dose of progestin, it may lead to fewer progestin-related side effects. The subQ stands for subcutaneous, meaning that the shot is injected under the skin, not into a muscle. It requires a smaller needle and is delivered into the thigh or abdomen four times a year (every 12 to 14 weeks). You can easily switch from Depo-Provera to Depo-subQ Provera 104 at your next scheduled injection. If you do this, you will have immediate pregnancy protection. Advantages Compared to other birth control methods, Depo-Provera is appealing to many women for a number of reasons. It's a highly effective and reversible prescription birth control option. You don't have the hassle of a daily birth control method like the pill. You only have to get Depo-Provera injections four times a year, then you don't need to think about birth control for months. Depo-Provera may make your periods very light and may stop them altogether after a few injections. Depo-Provera doesn't interfere with having sex, so it allows for spontaneity. It's a private and discreet contraceptive choice. Nobody has to know that you use Depo-Provera because there are no wrappers or pill compacts. Depo does not contain estrogen, so it can be a good alternative if you cannot tolerate estrogen or use combination contraceptives. Women who are breastfeeding or are six-weeks postpartum can safely use Depo-Provera. Disadvantages It's common for birth control to have disadvantages. Depo-Provera is no different, and it's important to know both the pros and the cons before you make a decision. Among the other disadvantages: Scheduling is Important You must remember to make your injection appointment every 12 weeks. If it's been more than 13 weeks since your last shot (or 14 weeks since your last Depo-subQ 104 shot), use a backup birth control method so you don't get pregnant. Bone Density Loss Due to this known side effect, it's recommended that you don't use Depo Provera or Depo-subQ Provera 104 for more than two years. Bleeding Issues Many women stop using Depo-Provera during the first year due to spotting, irregular bleeding, and/or continuous bleeding. This side effect is especially common during the first three months. Skin Reactions In a small number of cases, women have experienced reactions in the area where they received the Depo shot. The skin around the injection may also get dry, dimpled, or feel lumpy. Delayed Return of Fertility You need to stop Depo injections one year before you want to get pregnant. After your last shot, it takes an average of nine to 10 months (and sometimes more than a year), to begin ovulating and regain fertility. Weight Gain Some studies show that women gain an average of 5.4 pounds the first year and 8.1 pounds by the end of the second year. Mild Pain Some women report mild pain associated with the Depo injection. The U.S. Food and Drug Administration (FDA) issued a black box warning advising women that Depo-Provera can cause severe bone density loss. Because of this, Depo-Provera is avoided in adolescent girls. There's no way to predict who will get side effects or any way to stop them once they occur. While the symptoms usually resolve once the treatment is stopped, it may take you 12 to 14 weeks for them to go away completely. Less Common Side Effects Over the first year of Depo shots, you may notice a few changes as your body adjusts. Some of the less common side effects include: Changes in sex driveChange in appetiteHair lossIncreased hair on the face or body In a few women, it may cause: DepressionNervousnessDizzinessNauseaHeadachesSkin rashSpotty darkening of the skinSore breasts Additional Considerations If you're currently using another hormonal method, you can switch to Depo-Provera. You should receive your first Depo shot within seven days after discontinuing your current method—meaning within seven days after taking your last active combination birth control pill, removing your Ortho Evra Patch, or taking out your NuvaRing. Appropriate Use Depo-Provera can be a safe birth control option for most healthy women. It's important that you discuss your complete medical history with your healthcare provider before receiving an injection. Depo-Provera is not recommended for adolescent girls or for women who any of the following: Breast cancer Thrombophlebitis, a history of thromboembolic disorders, or cerebral vascular disease Risk factors for osteoporosis (bone disease, excessive alcohol or smoking, a family history of osteoporosis, anorexia, or use of steroid drugs) Significant liver disease Undiagnosed vaginal bleeding A desire to become pregnant within the next year Non-Contraceptive Uses While Depo-subQ Provera 104 is recognized as a safe and effective form of long-term birth control, it has other uses that are distinct from original Depo-Provera. Depo-subQ Provera 104 is also approved for the treatment of endometriosis pain. Research has shown that it's just as effective as leuprolide but with fewer vasomotor symptoms (like hot flashes and sweats) and less bone density loss. The efficacy of the drug extends to alleviating pelvic pain and tenderness, dysmenorrhea (menstrual cramps), painful intercourse, and the hardening and thickening of endometrial tissue. Both Depo-Provera versions can also help lower your uterine cancer risk. Cost of Treatment Under the Affordable Care Act, most insurance plans must cover healthcare provider visits related to birth control and the shot itself is free under most plans. Medicaid may cover the cost as well. Any changes to the Affordable Care Act may affect whether insurance plans cover contraception. Check with your insurance plan to see what your coverage and costs may be. If you don't have coverage, you'll need to pay out-of-pocket for the medical exam and the injection. Your cost may be as much as $250 for the first visit and as much as $150 for further visits. The cost of a Depo-Provera injection can range from $50 to $95. This translates to a total cost of roughly $220 to $650 per year, on top of office visits. You may incur additional costs if you are more than two weeks late for your next scheduled shot because your healthcare provider may require a pregnancy test before giving you an injection, so you'll need to pay for that as well. A Word From Verywell Since it was first approved by the FDA, Depo-Provera has been a popular option for birth control. Whether it's right for you depends on various factors. Many women have found that a couple of years of regular injections makes managing birth control easier. Speak with your healthcare provider to see if it's a good fit and be sure to ask any questions you have along the way. Pros and Cons of the NuvaRing Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 11 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. Cleveland Clinic. Depo-Provera. U.S. Centers for Disease Control and Prevention: Morbility and Mortality Weekly Report. U.S. selected practice recommendations for contraceptive use. U.S. Food and Drug Administration: FDA AccessData. Physicial information: Depo-Provera contraceptive injection. Pharmacia. Depo-Provera contraceptive injection. Pfizer Pharmaceuticals. Depo-SubQ Provera 104. Zeman S, Havlík P, Zemanová J, Němec D. Status of bone mineral density after the long-standing application of contraception Depo-Provera. Ceska Gynekol. 2013;78(1):116-24. Cromer BA, Scholes D, Berenson A, Cundy T, Clark MK, Kaunitz AM. Depot mardoxyprogesterone acetate and bone mineral density in adolescents--The Black Box Warning: A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health. 2006 39(2):296-301. doi:10.1016/j.jadohealth.2006.03.011 American Academy of Family Physicians. How to switch birth control methods. Am Fam Physician. 2011;83(5):575-576. Quaas AM, Weedin EA, Hansen KR. On-label and off-label rug use in the treatment of endometriosis. Fertility and Sterility. 2015;103(3):612-625. doi:10.1016/j.fertnstert.2015.01.006 Lu KH, Loose DS, Yates MS, et al. Prospective multicenter randomized intermediate biomarker study of oral contraceptive versus Depo-Provera for prevention of endometrial cancer in women with Lynch syndrome. Cancer Prev Res (Phila). 2013;6(8):774-81. doi:10.1158/1940-6207.CAPR-13-0020 Bonnema RA, McNamara MC, Spencer AL. Contraception choices in women with underlying medical conditions. Am Fam Physician. 2010 Sep 15;82(6):621-628. Additional Reading Bonnema R, McNamara M, Spencer A. Contraception choices in women with underlying medical conditions. Am Fam Physician. 2010;82(6):621-628. Centers for Disease Control and Prevention. U.S. selected practice recommendations for contraceptive use. Cromer BA, Scholes D, Berenson A, et al. Depot medroxyprogesterone acetate and bone mineral density in adolescents—the black box warning: a position paper of the Society for Adolescent Medicine. J Adolesc Health. 2006;39(2):296-301. doi:10.1016/j.jadohealth.2006.03.011 Quaas AM, Weedin EA, Hansen KR. On-label and off-label drug use in the treatment of endometriosis. Fertil Steril. 2015;103(3):612-25. doi:10.1016/j.fertnstert.2015.01.006