Pros and Cons of the Depo-Provera Shot

The Depo-Provera birth control shot has advantages and disadvantages compared to other types of birth control. While it's convenient and effective, for example, the Depo shot also carries the risk of side effects like irregular bleeding and bone loss.

This article looks at some of the pros and cons of using Depo-Provera. It also discusses some other things you might want to consider before you try this form of birth control.

Advantages of Depo-Provera

Compared to other birth control methods, Depo-Provera is appealing to many women for a number of reasons.

• It's very effective: Depo-Provera is between 94% and 99% effective. With typical use, only three out of every 100 women who use Depo-Provera will become pregnant.
• You only need four injections a year: After that, you don't need to think about birth control for months.
• It makes periods lighter: Depo-Provera can make your periods very light and may even stop them altogether after a few injections.
• It doesn't interfere with sex: Depo-Provera allows for spontaneity unlike, say, condoms.
• 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: It can be a good alternative if you cannot tolerate estrogen or use combination contraceptives.
• You can use it after giving birth and while nursing: Women who are breastfeeding or are six-weeks postpartum can safely use Depo-Provera.

Disadvantages of Depo Provera

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.

Some disadvantages of Depo-Provera are described below.

Of note, Depo-SubQ Provera 104 (the formulation that is injected under the skin) may lead to fewer hormone-related side effects than the original Depo formulation, which is injected into a muscle. This is because Depo-SubQ Provera 104 contains 31% less progestin.

Shots Must Be On Time

You must have a shot four times a year to maintain Depo-Provera’s high effectiveness rate.

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

The Food and Drug Administration (FDA) issued a black box warning advising women that Depo-Provera can cause severe bone density loss.

Due to this, it's recommended that you don't use Depo-Provera or Depo-SubQ Provera 104 for more than two years. Adolescent girls should not use the Depo shot at all because of this risk.

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

Weight gain has been associated with use of the Depo shot. Some studies show that women gain an average of 5.4 pounds in the first year of use and 8.1 pounds by the end of the second year.

Mild Pain

Some women report mild pain associated with the Depo injection.

Side Effects

Over the first year of Depo shots, you may notice a few changes as your body adjusts.

Some potential side effects include:

• Changes in sex drive
• Change in appetite
• Hair loss
• Increased hair on the face or body

In a few women, it may cause:

• Depression
• Nervousness
• Dizziness
• Nausea
• Headaches
• Skin rash
• Spotty darkening of the skin
• Sore breasts

Additional Considerations

If you're currently using another hormonal method, you can ask about switching to Depo-Provera.

If given the OK by your healthcare provider, 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 women with:

• 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.

The Depo-Provera shot costs around between $50 and $150 per shot, for a total of around $200 to $600 a year.

Summary

Like other forms of birth control, Depo-Provera has pros and cons. Depo-Provera is a very effective form of birth control, and people who use it don't have to remember to take a daily pill. Some people also experience very light or even absent periods while using Depo-Provera.

Some of Depo-Provera's disadvantages include weight gain, irregular bleeding, and bone loss. It may also take some time for you to regain your fertility after you stop using this form of birth control.