Depa-Provera Contraception

Last updated 20.09.12

 

Definition

-  Long acting intramuscular injectible depo progesterone hormonal contraceptive

 

Features

-  3 monthly (12 weekly) IMI 150mg Medroxyprogesterone Acetate (Progesterone)

-  Every 10 weeks if on anticonvulsants

-  Ovulation suppression

-  Reversible but effect may last up to 1 yr+ --> infertility

-  Implanon has reduced use of Depo-Provera

 

Indications

-  Contraception

-  Endometriosis

-  Carcinoma: recurrent or metastatic breast or renal Ca

 

Contraindications/Precautions

-  DVT, PE

-  Thrombophlebitis

-  Stroke

-  Severely deranged liver function

-  Undiagnosed vaginal bleeding

-  Undiagnosed breast pathology

-  Severe uncontrolled HTN

-  Breast Ca (unless by oncologist)

-  Anticonvulsants make less effective

 

Side Effects

-  May cause irregular bleeding

-  Usually for first few months

-  1/3 pts amenorrhoea

-  1/3 pts regular period w reduced bleed

-  1/3 pts totally irregular period

-  Consider 0.005 – 0.1mg Ethinyl Estradiol PO daily for 7-21 days for 1-2 cycles (not longer)

-  Upto 5% pts

-  Bloating, abdomial discomfort

-  Dizziness, nervousness, fatigue

-  Headache

-  May aggravate depression due to high progesterone

-  Fluid retention/weight gain

-  Avg 3kg after 2yrs (esp if overweight already)

-  Bone mineral loss with long term use (>2 yrs)

-  Reversible

-  Consider alternative contraceptive if high risk of osteoporosis

-  Possbile reduction of

-  Endometrial, ovarian ca

-  Acute episodes of PID

-  Recurrent vulvovaginal candidiasis

-  Endometriosis

 

Dose

-  Contraception: 150mg 3 monthly IMI

-  Endometriosis: 50mg weekly IMI for 6/12

-  Breast Ca: 500mg daily IMI for 4/52+

 

Procedure for Contraception

-  Timings

-  Initiating with normal cycle

-  Day 1-5 of cycle to ensure not preganant

-  Postpartum

-  Bottle feeding: prior to day 21 post partum

-  Breast feeding: after 4/52 post partum

-  Subsequent dosings

-  Within 12 weeks of last dose

-  If >13 weeks after last dose must do pregnancy test prior

-  IM injection

-  Shake vial to evenly distribute solution

-  Typically 150m/ml therefore 1ml administered

-  21 or 23G needle

-  Gluteal or deltoid muscles

-  +/- 1 week cover with alternative contraception

 

 

 

References

 

RANZCOG College Statement C-Gyn 4, July 2012

Contraception: Your Questions Answered, John Guillebrand

Depa-Ralovera Product Information Guide, August 2011