As summer is drawing to a close and we settle down into routines for the fall, don’t forget to take your birth control! If you are not on any contraception, now is a good time to re-evaluate your options. In prior months, we explored the intrauterine device and implants as choices for long term birth control. There is another option that is not reversible, but it does not require daily pills or barrier methods, and that is the injectable hormone, Depo Provera.
- What exactly is Depo Provera?
Depo Provera is a progesterone injectable medication that contains Depot medroxyprogesterone acetate (DMPA), and has a dosing schedule of four times a year or one injection every three months. It is more convenient than the pills, patch, or ring as it lasts for a longer period of time. It has been used by one in five adolescents or adult women in the United States who are sexually active.
- What is the mechanism of action of this medication?
The primary mechanism of action is the suppression of ovulation. The progesterone prevents the pituitary gland from secreting its hormones that stimulate ovulation. Without ovulation occurring, pregnancies cannot happen. There is only one version of this medication in the United States.
- How long does it work, how effective is it, and what are its advantages?
Depo Provera is only effective for 3 months and has an efficacy that is better than birth control pills, but less effective than the intrauterine device or implant. The injection is not considered reversible, and it lasts for a relatively shorter time span than the intrauterine device or implant. The injection is intramuscular and usually placed in the buttocks area. Convenience is one factor that draws people to this method, as it does not require too long of a commitment, but enough coverage so that an individual does not need to remember on a daily or weekly basis to take their birth control.
- What are the disadvantages of this method?
Long term use of the Depo Provera medication has been shown to decrease the bone mineral density, which refers to the amount of mineral matter per volume of bones, and directly correlates with bone strength. There are many factors to bone strength, including diet, exercise, age, and lifestyle factors. Depo medroxyprogesterone acetate inhibits pituitary hormones, which in turn leaves to anovulation and decreased production of estrogen, which is associated with a decrease in bone mass. However, this decreased bone mineral density is limited and reversible, and it is recommended that women either take estrogen supplementation or take breaks when on the Depo Provera regimen. In addition, the longer-lasting medication can cause disruptions in the menstrual cycle leading to irregular bleeding patterns, and possibly other hormonal side effects such as weight gain. In addition, the injections are to be administered by a health care provider, which leads to additional visits to the doctor every year.
- Compared to the intrauterine device (IUD) and the Nexplanon Implant, which one would you say is a better option for the modern woman?
This is a subjective call, and it comes down to what one would prefer. The IUD and Nexplanon require that an actual medical device is placed inside a person’s body. Depo Provera is an injectable medication that lasts only three months, which is a shorter time commitment. All of these options can lead to irregular menstruation. The IUD has the least hormonal side effects as it is localized inside the uterus. The injectable hormones can lead additionally to a transient loss of bone mineral density. It is easier to get approved by insurance for the Depo Provera than for the longer-acting devices, as it costs less. The loss of bone strength is temporary and completely reversible and those interested in the injectables should still consider it.
With everything, please consult a physician if you are interested and do not attempt to insert, remove, or inject any medication on your own.
Sources:
- ACOG Committee Opinion 602, June 2014 (Reaffirmed 2017). Depot Medroxyprogesterone Acetate and Bone Effects.
Jennifer E. Cho, MD, FACOG
