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?

very effective method of contraception when used correctly and consistently
long acting
does not require daily pill taking
inexpensive

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

DMPA changes bleeding/period patterns. These changes are a result of the hormonal effect to the lining of the uterus. It is not possible to predict which changes will occur, but they can include:

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 (rare)
does not protect against sexually transmitted infections (STIs)
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 is comparable with women who have not used DMPA, where 90% are pregnant within 1 year.

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 caused by heavy periods
can be used to manage painful periods, endometriosis or premenstrual symptoms (PMS)
reduces the risk of cancer of the uterus

What are the possible side effects of DMPA?

DMPA has few side effects. However, side effectsmay include:

small weight gain in some women
headaches
acne
change in sexual interest
mood changes
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)

What are the possible risks associated with DMPA?

DMPA use is associated with a slight 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 normally is increasing
that diet and exercise are other important influences on bone mass in young women
that there is no evidence of an increase infractures in women who have used DMPA
Studies are continuing on the long term effects of a loss of bone density associated with use ofDMPA.

Is DMPA suitable for all women?

Most women can safely use DMPA. Your doctor will review the suitability of the method with you prior to commencing use. In assessing your suitability, consideration is given to a number of important factors. If you have:

(or have had) breast cancer
liver disease
heart disease, high blood pressure, blood clotting disorders or stroke
diabetes
low bone density
unexplained vaginal bleeding (this should be investigated before using DMPA)

The doctor will also review any other medications you are currently taking. If your general health changes, the suitability of this method should be reassessed.

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 assessment enables you to ask any questions you may have 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 a 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 lead to a delay in the diagnosis of a 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. If you go beyond 12 weeks from your last injection you may be at risk of pregnancy. If you aren't certain what to do, seek further advice as soon as possible, particularly if you think you may need Emergency Contraception.

To renew your DMPA prescription you will need to see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) should take place at this visit.

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.