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Injectable Progestogen Contraceptive / Hormone Treatment Pregnancy: Contraindicated in confirmed pregnancy. Inadvertent DMPA in pregnancy: no teratogenicity demonstrated but advise specialist review.

Medroxyprogesterone Acetate (DMPA)

Brand names: Depo-Provera (150mg/mL IM), Sayana Press (104mg/0.65mL SC)

Adult dose

Dose: Contraception (Depo-Provera): 150mg deep IM injection every 12 weeks. Contraception (Sayana Press SC): 104mg SC injection every 13 weeks. Endometriosis: 150mg IM every 12 weeks. Heavy menstrual bleeding: 150mg IM every 12 weeks.
Route: Deep intramuscular injection (Depo-Provera) or subcutaneous (Sayana Press)
Frequency: Every 12 weeks (Depo-Provera) or 13 weeks (Sayana Press)
Max: 150mg per 12-week injection (IM); 104mg per 13-week injection (SC)
Highly effective contraceptive (>99%) when given on time. Fertility may be delayed by 6–12 months after stopping (return of fertility can take up to 18 months). Not first-line in adolescents or women wanting rapid return to fertility. Sayana Press SC can be self-administered at home after training.

Paediatric dose

Route: IM / SC
Frequency: Every 12–13 weeks
Max: 150mg per injection
FSRH: caution in adolescents — bone density concern with long-term use. UKMEC 2 for adolescents <18 years (benefits generally outweigh risks). Seek specialist advice for long-term use in adolescents.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Avoid in severe hepatic disease or liver tumours.

Clinical pearls

  • DMPA is the only hormonal contraceptive not affected by enzyme-inducing drugs — preferred for women on antiepileptics (carbamazepine, phenytoin), rifampicin, or antiretrovirals
  • Bone density: DEXA not required routinely; BMD recovers after stopping. Caution in adolescents (peak bone mass period) and women approaching menopause
  • Amenorrhoea: 70% of women have no periods after 1 year of DMPA — counsel this as a benefit (not a problem) to improve adherence
  • Return of fertility: advise women who want pregnancy within 12 months to use a different method — median delay to conception is 10 months post-last injection

Contraindications

  • Current breast cancer (UKMEC 4)
  • Active severe liver disease
  • Unexplained vaginal bleeding
  • Planning pregnancy within 1 year (delayed fertility return)
  • Osteoporosis or major osteoporosis risk factors with long-term use (caution — UKMEC 2/3)

Side effects

  • Irregular bleeding / amenorrhoea (very common)
  • Weight gain (average 2–3kg over 2 years)
  • Bone mineral density reduction (reversible on stopping — usually returns to baseline within 2–3 years)
  • Mood disturbance / depression
  • Delayed return of fertility
  • Headache
  • Decreased libido

Interactions

  • Enzyme-inducing drugs: DMPA efficacy NOT affected (no hepatic first-pass) — safe to use with enzyme inducers; this is a key advantage over oral contraceptives
  • Aminoglutethimide — may reduce DMPA serum levels

Monitoring

  • Weight (every 6–12 months)
  • Blood pressure
  • Review at each injection — update risk assessment
  • BMD: consider DEXA if >2 years use in adolescents or high osteoporosis risk

Reference: BNFc; BNF 90; FSRH DMPA Guideline 2020; UKMEC 2016. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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