What is Depo Provera?
Depo Provera Medroxyprogesterone Acetate (DMPA) is a form of birth control measure used by women worldwide, popularly known as DMPA or Depo Provera (commercial name of MPA). Depo Provera is a long-acting reversible contraceptive method (LARC) discovered by syntax and Upjohn Company in 1956. It was first introduced on 18 June 1959 by Upjohn in the United States under the brand name Provera. DMPA is widely used by private practitioners in India since early 1990. In April 2016, the drug technical Advisory Board of India has recommended that DMPA shall be included in the basket of contraceptives in family planning program.
It is highly effective contraceptive. It is more effective than the oral contraceptive pill because you only need to remember to have the injection every 12 weeks, instead of taking a pill every day. It is a highly effective contraceptive method. With a standard regimen the first year effectiveness is 99.7% when the drug is used correctly; however the effectiveness decreases in typical use. The perfect use failure rate of 0.3% is lower in comparison to 0.5% of female sterilization, 0.8% of IUCD and 3% of combined oral contraceptives (WHO: Family Planning: AGlobal Handbook for Providers).
How does it work?
DMPA contains active agent medroxyprogesterone acetate, which is an artificial form of naturally occurring female sex hormone progesterone. It acts as contraceptive in below mentioned ways:
- Prevents eggs from being released from the ovaries which is known as ovulation. By preventing it from entering womb, succession of fertilisation of egg is challenging and less likely to happen.
- It increases the thickness of the mucus which stimulates naturally in neck of the womb and creates difficulty for sperm to cross from vagina into the womb.
So in short it causes changes in the cervical mucus and uterine lining to make it difficult for sperm to reach the uterus and makes it harder to make the egg fertile.
Where is it injected?
DMPA is injected into the muscle, on woman’s preference the sterilised needle is inserted either deep into the hip which is ventrogluteal muscle or the upper arm which is deltoid muscle or the buttocks which are gluteal muscle, upper outer portion. It is guided not to massage the injected area.
Composition of MPA-
Intramuscular : MPA-IM: One dose = one vial of 150 mg/1 ml
Subcutaneous : MPA-SC: One dose =104 mg/0.65 ml
When can it be taken?
DMPA can be taken during any day of the menstrual cycle. It can also be taken after the menstrual cycle if there is no chance of pregnancy (for an example, if there had been no intercourse since the last period). It is highly advisable to use it during the menstrual cycle.
Who can use DMPA?
Almost every women in her fertile period can use it but mostly it’s not advisable as a first choice for women under 18 years of age or women over 45 years because of its effect on bone density. DMPA can also be used by women who want to avoid pregnancy for three month/ short term basis for partners of men having a vasectomy or no scalpel vasectomy to provide protection until the sterilisation of men gets effective.
It’s not suggestive and needs doctor’s consultation to take it in following conditions:
- Women who have heart of liver disease
- Women who has breast cancer
- Pregnant women
- Women who have vaginal issues
Can it be used by Breastfeeding mothers?
- DMPA can be taken postpartum only after 6 weeks/ 42 days which is highly advised by doctors.
- If not performing breastfeeding then it can be started immediate or preferably after 5 days postpartum
- Reversible and Convenient, requires only four shots per year
- Effective mode of birth control measure and highly effective contraceptive
- Repeat dose every 3months unlike routine contraceptive methods like condoms and pills or weekly contraception like transdermal patch which needs to be changed weekly from 1st day of menstrual cycle.
- Decreased risk of strokes as it does not contain estrogen
- Decreased risk of iron deficiency/ anemia
- Amenorrhoea is very common is DMPA. Changes in menstrual flow which can be absence of bleeding or excess of bleeding
- Effect on bones
- Delayed return of fertility
- Can lead to cardiac or liver disease
- The occurrence of acne
- It can cause birth defects if taken by pregnant women
- It can activate weight loss or gain
- It can increase or create symptoms of depression, irritability or hypersensitivity reactions in some women
- Increases the risk of breast cancer
- No contraceptive method other than CONDOM gives protection against sexually transmitted diseases. Not even DMPA.
- Amenorrhoea: An abnormal absence of menstruation while the woman is in her reproductive age. Amenorrhoea can be normal and healthy during pregnancy. It also occurs in many women while they are breastfeeding. There are two types of Amenorrhoea: Primary and Secondary. In primary Amenorrhoea menstruation does not start during puberty and in secondary Amenorrhoea a woman’s period’s start, but then they cease to occur. Secondary amenorrhea is sometimes defined as an absence of menstruation for at least 6 months in a woman who previously had normal periods.
- It’s important to know that after the dose of DMPA is stopped, women might take 8-9 months or more to return to their regular cycle. Because of which, it might take time to become pregnant after a DMPA injection.
- LARC are contraceptive methods that provides effective birth control measure for a defined period without demanding continuous user action. They include injections, implants, intrauterine devices, transdermal patch also known as Orthro Evra patch, vaginal rings and pills). More over in India only IUD, DMPA and pills are used extensively.
- An intramuscular injection is a technique used to deliver a medication deep into the muscles where as A subcutaneous injection is a shot given into the fat layer between the skin and muscle. Subcutaneous injections are used to give small amounts and certain kinds of medicine.
- Intramuscular injection is absorbed faster than subcutaneous injection. This is because muscle tissue has a greater blood supply than the tissue just under the skin. Muscle tissue can also hold a larger volume of medication than subcutaneous
Note- DMPA shall always been taken after its advised by doctor. The side effects varies from person to person.
The article has been written after in depth research on DMPA, taken feedback from DMPA users and also after consulting few obstetricians & gynaecologists.
Dr. Asha Kochhar– Senior Specialist,Quality Assurance at a leading iNGO and a retired CMS
Dr. Shikha Srivastava– Senior Adviser – Medical Services & Training at a leading iNGO
Dr. Samina Asif– Obstetrician and Gynaecologist
***In our next article we will give you clear incites on DMPA usage by public sector in India.
Reference Manual for Injectable contraceptive (DMPA) by Family Planning Division, Ministry of Health and Family Welfare, Government of India
Minutes of the 70th Meeting of Drugs Technical Advisory Board held on 18th August, 2015 atCDSCO, HQ, FDA Bhawan, Kotla road, NEW DELHI- http://www.cdsco.nic.in/writereaddata/70th%20DTAB%20minutes.pdf