Birth Control Options for Women - Injected Contraception

Depo-Provera is not given to women with the following conditions:

Liver disease.
Unexplained vaginal bleeding.
Pregnancy.
Women who are breastfeeding for the first six weeks after delivery.
Women at risk for osteoporosis.

Because of the long lag time between ending treatments and restoration of fertility, Depo-Provera is not recommended for women who are thinking of becoming pregnant within two years.

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Advantages of Injected Progestins

The advantages of Depo-Provera are as follows:

Progesterone injections provide highly effective reversible protection against pregnancy without placing heavy demands on the user's time or memory.
They also may protect against uterine and ovarian cancer and do not pose any risk for breast cancer.
DMPA is also useful for painful periods, heavy bleeding (including heavy bleeding caused by fibroids), premenstrual syndrome, and endometriosis.
Depo-Provera does not appear to cause weight gain as other hormonal agents may.

Disadvantages and Complications of Injected Progestins

Disadvantages are as follows:

Side effects of any progestin-containing contraceptive. For example, about 60% of users gain weight during long-term use. For these and other reasons, 70% of users stop the injections within a year.
Most users of Depo-Provera stop menstruating altogether after a year. Women who eventually want to have children should be aware that Depo-Provera can cause persistent infertility for up to 22 months after the last injection, although the average is 10 months. This is significantly longer than restoration of fertility after the removal of the Norplant implant.
Long-term (more than 2 years) use of Depo-Provera can cause loss of bone density. In November 2004, the FDA added a ?black box? warning to the Depo-Provera label advising of this risk. The warning notes that the decline in bone density increases with duration of use and may not be completely reversible even after the drug is discontinued. Based on this information, the FDA recommends that Depo-Provera should not be used for longer than two years unless other birth control methods are inadequate. A 2005 study of young women (age 14 to 18 years) found that adolescents who stop taking Depo-Provera do regain bone density.
The injections do not provide protection against sexually transmitted diseases. According to a 2004 study, women who take Depo-Provera have three times the risk of acquiring chlamydia and gonorrhea as women who do not use a hormonal contraceptive. The reason for this increased risk is unclear. The same study found that oral contraceptive use, in comparison to non-hormonal contraceptives, was not associated with increased risk.
Depo-Provera has been associated with a higher incidence of depression, although it is unclear whether the contraception was really the cause.
Of some concern was a 2002 study that found changes in the arteries of long-time users, suggesting a risk for future heart disease. More research is warranted.