DMPA – Depo medroxyprogesterone acetate (Depo Provera®, Depo Ralovera®)

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DMPA is a hormonal contraceptive given by injection every three months.

What is DMPA?

DMPA contains a progestogen. This is similar to the hormone progesterone, which is naturally produced by the female body. DMPA is given by injection into a muscle every 12 weeks and is slowly absorbed into the blood stream to prevent pregnancy. Depo-Provera ® and Depo-Ralovera ® are the brand names of DMPA available in Australia.

How does DMPA work?

DMPA works by:

preventing ovulation (egg release from the ovary)
thickening of the mucus of the cervix so that sperm cannot enter the uterus (womb)
changing the lining of the uterus, making it unsuitable for pregnancy

How effective is DMPA?

DMPA is up to 99% effective. This means that of 100 women using DMPA consistently over a year, it is possible that 1 woman may become pregnant.

What are the advantages of DMPA as a method of contraception?

highly effective
long acting
does not require daily pill taking
inexpensive

What are the disadvantages of DMPA as a method of contraception?

the injection is long acting and if side effects occur they may last up to 3 months (it is not possible to reverse the effects of an injection once it is given)
possible delay in return to fertility; on average, the delay is about 9 months from when the last DMPA injection is given. Studies have shown that more than 80% of women trying to conceive were pregnant within 1 year of stopping DMPA and within 2 years, 90% were pregnant. This compares with women who have not used DMPA, where 90% are pregnant within 1 year.
does not protect against sexually transmitted infections (STIs)
is associated with a loss of bone mass while using the method. Research indicates:
- this loss is largely reversible once DMPA use finishes
- for women in their teenage years or early twenties, this loss is occurring at a time when bone mass should be increasing and could possibly increase the risk of osteoporosis and bone fractures later in life
- that diet and exercise are other important influences on bone mass in young women
- that there is no evidence of an increase in fractures in women who have used DMPA

Studies are continuing on the long term effects of a loss of bone density associated with use of DMPA.

What are the possible health benefits of DMPA?

many women will have no periods or minimal bleeding only, with reduced discomfort or pain
reduces chance of iron deficiency anaemia, endometriosis and cancer of the uterus
reduces premenstrual symptoms (PMS)

What are the possible side effects or complications of DMPA?

Side effects of DMPA may include:

all women will experience changes in bleeding patterns including:
- most commonly, periods stop completely after the first or second injections
- irregular or spot bleeding
- prolonged bleeding (this is usually light, however can cause inconvenience to women) heavy bleeding (occasionally requiring treatment)
small weight gain in some women
headaches
acne
change in sexual interest
mood changes

Is DMPA suitable for all women?

Most women can safely use DMPA.

DMPA is PARTICULARLY SUITABLE for women who:

are unable to take oestrogen
prefer a long acting contraceptive method

DMPA MAY NOT BE SUITABLE for women who have:

liver disease, cardiovascular disease
diabetes
depression
not reached their adult bone mass (under 25 years of age)
difficulty with intra muscular injections
plans to become pregnant within 6-12 months
difficulty in tolerating changes in their periods (refer to possible side effects)

DMPA is NOT SUITABLE for women who have:

an allergy to DMPA
breast cancer
some other forms of cancer
low bone density

What do I need to know about starting DMPA?

Starting DMPA for the first time requires an assessment by a doctor and a prescription.

This allows the doctor to assess your medical history and suitability for this method and ensure that arrangements for the first injection are made at the right time of your menstrual cycle. It also enables you to ask any questions that you may have about DMPA and be certain that it is the most suitable method for you.

The first injection of DMPA is usually given during the first five days of the menstrual period to ensure the woman is not pregnant. In some cases condoms will need to be used for seven days after the first injection. It is very important that there is no chance of an early pregnancy at the time of injection as this may delay the diagnosis of pregnancy.

What do I need to know about the ongoing use of DMPA?

Follow-up DMPA injections are given every 12 weeks to continue protection against pregnancy. To renew your DMPA prescription you will need to see a doctor for review at least once a year.

Review of risks for loss of bone density (osteoporosis) should take place regularly while using DMPA, particularly for younger women and if using for more than 2 years.

Where is DMPA available?

DMPA is available on prescription and can be obtained from Family Planning Queensland (FPQ) clinics or your general practitioner (GP).

www.fpq.com.au
Phone: 07 3250 0240

Disclaimer

Family Planning Queensland (FPQ) has taken every care to ensure that the information contained in this publication is accurate and up-to-date at the time of being published. As information and knowledge is constantly changing, readers are strongly advised to confirm that the information complies with present research, legislation and policy guidelines.FPQ accepts no responsibility for difficulties that may arise as a result of an individual acting on the advice and recommendations it contains.