Your First Year of Depo-Provera Use

Uses of Depo-Provera

Depo-Provera prevents pregnancy in three ways:

• It prevents ovulation, so there is no egg available for sperm to fertilize.
• It thickens your cervical mucus—this makes it harder for sperm to swim.
• The progestin in Depo-Provera can also thin out or prevent the uterine tissue that builds each month. This makes it difficult for a fertilized egg to implant into the uterine wall since there is not enough lining there to receive it.

Depo-Provera shots can also help treat the pain associated with endometriosis.

To have pregnancy protection for a full year, it is important to schedule your Depo-Provera or Depo-subQ Provera 104 shots approximately every 12 weeks. Over the course of one year, you should receive four depo shots.

Side Effects

Your body may go through changes as it adjusts to the progestin in Depo-Provera. To increase your success with depo, it may be helpful to know what to expect during the first year of use.

Before you begin your first depo shot, it is important that you are aware of the possible bleeding side effects that may occur while using Depo-Provera. Unfortunately, there is no way to know ahead of time if these side effects will occur or how long they will last.

Research suggests that women who know ahead of time about the potential for either irregular (spotting) bleeding or prolonged, continuous bleeding are more likely to continue using Depo-Provera.

Many women are willing to go through the initial bleeding in exchange for the chance of not having to have a period anymore.

First Depo Shot (Months 1-3)

If you receive your first depo shot during one of the first five days of your period, then Depo-Provera will begin to work immediately (meaning, you are protected against getting pregnant). With perfect use, Depo-Provera is 99.7% effective (97% with typical use).

Depo will also provide you with continuous pregnancy protection if you have switched from another hormonal method and received your first depo shot within the last seven days of using that method (such as combination birth control pills, NuvaRing, or the Ortho-Evra patch).

Generally speaking, it takes about three months for your body to adjust to Depo-Provera. Similar to other hormonal birth control methods, your body needs this time to get used to the hormone (progestin) in Depo.

Expected Side Effects

As your body is adjusting to Depo-Provera, it is likely that you will experience irregular bleeding (spotting) or prolonged bleeding (like a continuous period). This symptom is considered completely normal.

Other Depo side effects that you may experience include skin reactions, weight gain, and pain (associated with the actual injection).

Less common side effects include: change in sex drive, depression, nervousness, dizziness, nausea, change in appetite, headaches, skin rash or spotty darkening of the skin, sore breasts, hair loss, or increased hair on the face or body.

As your body adjusts to the progestin, these side effects should lessen and go away. For some women, these side effects may continue until the Depo shot wears off (11 to 14 weeks).

Making Next Appointment

It is recommended that you make an appointment for your next scheduled Depo shot during the same healthcare provider’s visit that you receive your first shot:

• If you are using the original Depo-Provera shot, make your appointment for your second injection within 11 to 13 weeks.
• If you are using Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

Second Depo Shot (Months 4-6)

After your second Depo-Provera shot or Depo-subQ 104 injection, your body will still be adjusting to the progestin hormone. By now, you have probably been happy with the convenience of not having to think about birth control.

If you are satisfied with your decision (or are still unsure but want to continue using Depo-Provera), it is time for your second Depo-Provera shot.

During months four through six, it is still considered normal if you are experiencing sporadic bleeding. Most women who use Depo-Provera report that their irregular spotting tends to lessen with each shot. In fact, by the end of month six, 39% of women usually have had their periods stop completely.

Weight Gain

At this point, you may or may not notice changes to your weight. Weight gain is a common side effect. Use this healthcare provider’s visit to discuss a possible exercise and diet plan with your healthcare provider. If you eat sensibly and exercise often, you can help reduce the changes in your weight that may stem from using Depo-Provera.

Preventing Bone Loss

Depo-Provera has a black box warning that advises women that continued depo use may cause bone mineral density loss. Because of this, this depo shot appointment is also a good time to ask your healthcare provider about recommendations for maintaining adequate calcium intake.

Here are some common suggestions for getting enough calcium to prevent losing bone mineral density when using Depo-Provera:

• Calcium supplements and vitamin D
• Getting enough calcium in your diet in ways including eating lots of vegetables
• Exercise to prevent osteoporosis including weight-bearing and muscle-strengthening exercises that may help in countering any potential calcium loss to your bones

Your healthcare provider may also suggest that you stop smoking (if you are a smoker) and to limit or cut out any alcohol consumption.

Making Next Appointment

You should also make an appointment for your next scheduled depo shot during the same healthcare provider’s visit that you receive your second shot.

• If you are using the Depo-Provera shot, make your appointment for your third injection within 11 to 13 weeks.
• If you are using Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

This will ensure that your pregnancy protection continues.

Third Depo Shot (Months 7-9)

By the time you are ready for your third Depo-Provera shot or Depo-subQ Provera 104 injection, there is a good chance that your irregular bleeding and periods have stopped because your body has adjusted to the progestin in this method.

At this point, it is important to be maintaining a healthy lifestyle to help counteract any weight gain or calcium loss associated with Depo-Provera. Keep taking your calcium supplements if your healthcare provider had recommended their use.

Exercise

You should also be exercising. Your routine should including weight-bearing exercises that will help to keep your bones strong. Plus, a regular, heart-healthy exercise that will help burn off extra calories:

• Weight-bearing exercise can include walking, hiking, or running.
• Heart-healthy forms of exercise can include bicycling, yoga, or swimming.

Making Next Appointment

To make sure that your pregnancy protection continues, schedule an appointment for your next depo shot during the same healthcare provider’s visit that you receive your third shot:

• If you are using Depo-Provera, make your appointment for your fourth injection within 11 to 13 weeks.
• If you are using Depo-subQ Provera 104, your next shot should be in 12 to 14 weeks.

Fourth Depo Shot (Months 10 to 12)

At this point, you are probably enjoying the hassle-free nature of this birth control method. As long as you have been receiving your Depo-Provera injections on time, you have had continuous pregnancy protection. From this point on, you should be continuing with an exercise and diet plan to help maintain good bone health and weight.

You may also be experiencing the added benefit of not having your period anymore. If your period has not completely stopped by the end of the first year, don't fret. With continued Depo-Provera use, it will most likely stop within the following months.

Making Next Appointment

After using Depo-Provera for a year, you will most likely need to schedule your annual gynecological exam. You can arrange to receive your fourth depo shot during this appointment.

This is a good time to discuss with your healthcare provider whether or not to continue with your depo shots. If you choose to stay on Depo-Provera, make an appointment for your next scheduled injection (11-14 weeks).

Final Considerations

It is super important that you receive your Depo-Provera shot on time, every time. If you miss your Depo-Provera shot or if more than 13 weeks have gone by since your last injection (14 weeks if using Depo-subQ Provera 104), be sure to use a backup method of birth control, such as condoms, female condoms, or the sponge.

Restoring Fertility

If you want to become pregnant, you should stop your Depo-Provera shots one year before the time you plan to begin trying to get pregnant. It takes several months to regain fertility and begin ovulating after receiving your last Depo-Provera shot, and an average of nine to 10 months (sometimes more than a year) to conceive.

Two-Year Limit

A 2004 FDA advisory recommended that women stop using Depo-Provera or Depo-subQ Provera 104 after two years of continued use due to the potential for bone density loss.

You should continue with your depo shots (for more than two years) only after weighing the benefits vs. risks of continued use, and you and your healthcare provider have determined that there this is the birth control method for you to be using.