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Medroxyprogesterone acetate intramuscular


Suspension for injection containing medroxyprogesterone acetate.

Drugs List

  • DEPO-PROVERA 150mg/1ml suspension for injection pre-filled syringe
  • DEPO-PROVERA 150mg/1ml suspension for injection vial
  • medroxyprogesterone 150mg/1ml suspension for injection pre-filled syringe
  • medroxyprogesterone 150mg/1ml suspension for injection vial
  • Therapeutic Indications


    Contraception - injectable

    Parenteral progestogen-only contraceptive.

    Medroxyprogesterone acetate injection is long term contraceptive suitable for use in women who have been made fully aware of the potential for menstrual disturbance and the potential delay to full fertility after treatment.

    It may be used for short term contraception for:
    Partners of men undergoing vasectomy until the vasectomy becomes effective
    After vaccination against rubella (to prevent pregnancy during the period that the virus is active)
    Women awaiting sterilisation



    First injection
    Intramuscular injection
    150mg to be injected during the first five days of a normal menstrual cycle. No additional contraception is necessary.

    Post partum
    If not breast feeding, the first injection should be given within 5 days to increase assurance that the patient is not pregnant. However, women given medroxyprogesterone acetate immediately after delivery or termination may experience prolonged or heavy bleeding.

    If breast feeding, delay the first injection until six weeks post partum when the infant's enzyme system is better developed. If intercourse has already occurred, exclude pregnancy before treatment.

    Further doses
    Intramuscular injection
    These should be given at 12 week intervals as required for long term contraception.
    Subsequent doses should be no later than 12 weeks and 5 days (89 days) after the last injection. If the interval is greater, pregnancy should be excluded before the next injection and additional contraceptive measures (e.g. barrier methods) used for 14 days after this subsequent injection.

    Partners of men undergoing vasectomy may require a second injection of 150mg intramuscularly after 12 weeks if the partner's sperm count has not fallen to zero.


    Aged 12 to 18 years
    May be used, but only after other methods of contraception are discussed and deemed unsuitable.

    Additional Dosage Information

    Switching from other methods of contraception
    When switching from other contraception methods, medroxyprogesterone injection should be given in a manner that ensures continuous contraceptive coverage based upon the mechanism of action of both methods, (e.g. patient switching from oral contraceptives should have their first injection of medroxyprogesterone within 7 days after their last active pill).


    The 150mg/ml injection is to be given by deep intramuscular injection.

    Care should be taken to ensure that the injection is administered into muscle tissue. The gluteus maximus is the preferred administration site, although other muscle tissue such as the deltoid may also be injected.

    The sterile aqueous suspension should be vigorously shaken just before use to ensure uniform dispersion.


    Breast cancer
    Female genital cancer
    History of severe hepatic disorder
    Hormone dependent neoplasm
    Severe hepatic disorder
    Undiagnosed gynaecological haemorrhage

    Precautions and Warnings

    Children under 18 years
    Major risk factors for decreased bone mineral content
    Severe headache
    Cardiovascular disorder
    Diabetes mellitus
    Disorder of lipid metabolism
    Hepatic disorder
    History of acute visual disturbances
    History of endogenous depression
    History of migraine
    Recent trophoblastic disorder
    Thromboembolic disorder

    May decrease glucose tolerance in patients with diabetes mellitus
    Assess family medical history prior to commencing treatment
    Ensure adequate vitamin D and calcium supplementation
    Exclude breast cancer before treatment
    Pre-treatment medical history and clinical examination
    Exclude pregnancy prior to initiation of treatment
    Abnormal and/or irregular bleeding should be investigated
    Full clinical assessment should be made at 2 years in all patients
    If visual disturbances occur, perform ophthalmic evaluation
    Investigate development of severe headaches or migraine
    May cause prolonged and heavy bleeding during the puerperium
    Monitor patients with a history of depression and/or suicide attempts
    Advise patient to report any new or worsening depression/suicidal ideation
    May cause loss of bone mineral density
    May cause weight gain
    May affect results of some laboratory tests
    Discontinue if cerebrovascular disorders occur
    Discontinue if pulmonary embolism occurs
    Discontinue if retinal thrombosis occurs
    Advise patient of slight increased risk of breast cancer
    Changes in menstrual bleeding patterns should be expected
    Treatment does not protect against risk of sexually transmitted disease

    If abnormal bleeding persists or is severe, rule out the possibility of organic pathology. Excessive bleeding can be controlled by the co-administration of oestrogen either in the form of a low dose (30 micrograms oestrogen) combined contraceptive pill or oestrogen replacement therapy such as conjugated equine oestrogen (0.625 to 1.25mg daily). Oestrogen therapy may need to be repeated for 1 to 2 cycles. Long term oestrogen therapy is not recommended.

    The most important risk factor for breast cancer is the age women discontinue the injectable progestogen; the older the age at stopping the more breast cancers are diagnosed. Duration of use is less important and the excess risk gradually disappears during the 10 years after stopping injectable progestogen use such that after 10 years there appears to be no excess.
    The possible increase in risk of breast cancer should be discussed with the user and weighed against the benefits of injectable progestogen.

    Perform a general medical and gynaecological examination before therapy and at appropriate intervals thereafter.

    Women must be made fully aware of the potential for menstrual disturbances and other side effects and the potential delay to full fertility after treatment. Patients should be warned that the contraceptive effect of the injection cannot be immediately reversed.

    The CSM has advised that:

    in adolescents, medroxyprogesterone acetate be used only when other methods of contraception are inappropriate,
    in all women, the benefits of using medroxyprogesterone acetate beyond 2 years should be evaluated against the risks,
    in women with risk factors for osteoporosis an alternative method of contraception instead of medroxyprogesterone acetate should be considered.

    Pregnancy and Lactation


    Medroxyprogesterone acetate is contraindicated during pregnancy.

    The manufacturer recommends that pregnancy should be excluded before the initial injection and if the administration of any subsequent injection is delayed beyond the manufacturers recommended period.

    Accidental pregnancy occurring 1 to 2 months after medroxyprogesterone injection are associated with an increased risk of low birth weight and a subsequent increased risk of neonatal death.

    Children exposed in utero showed no adverse effects on their health, including physical, intellectual, sexual or social development.

    Use with caution immediately after childbirth or termination. Following administration of medroxyprogesterone in the immediate puerperium, prolonged and heavy bleeding may occur.


    Use Medroxyprogesterone acetate with caution during breastfeeding.

    The manufacturer states that medroxyprogesterone acetates and/or its metabolites are secreted in breast milk but there is no evidence to suggest that this presents any hazard to the infant. Infants exposed to medroxyprogesterone via breast milk have shown no adverse effects on their development or behaviour.

    If given to breast feeding women, it is recommended that the first injection is not administered until the infant is 6 weeks old.


    Advise patient to report signs of mood changes and depressive symptoms.

    Advise patient treatment may cause weight gain.

    Advise patient that treatment does not protect against sexually transmitted disease.

    Women must be made fully aware of the potential for menstrual disturbances and other side effects and the potential delay to full fertility after treatment. Patients should be warned that the contraceptive effect of the injection cannot be immediately reversed.

    Full counselling necessary (supported by the manufacturer's approved literature) to warn patients of likelihood of menstrual disturbance and the potential delay in return to full fertility (normally within 12-18 months).

    The possible increase in risk of breast cancer should be discussed with the user and weighed against the benefits of injectable progestogen.

    Side Effects

    "Spotting" bleeding
    Abdominal distension
    Abdominal pain
    Abscess formation (injection site)
    Alterations in hepatic enzymes
    Anaphylactoid reaction
    Axillary swelling
    Blood dyscrasias
    Breast nodules (benign)
    Breast pain
    Changes in breast size
    Chest pain
    Decrease in bone mineral density
    Decreased glucose tolerance
    Deep vein thrombosis (DVT)
    Disturbances of appetite
    Emotional lability
    Endometrial hyperplasia
    Facial palsy
    Fluid retention
    Gastro-intestinal disturbances
    Genitourinary infections
    Hot flushes
    Hypersensitivity reactions
    Impaired fertility
    Increased risk of breast cancer
    Leg cramps
    Limb pain
    Local pain (injection site)
    Menstrual disturbances
    Mood changes
    Muscle cramps
    Nipple discomfort
    Ovarian cysts
    Pelvic pain
    Premenstrual-like syndrome
    Prolonged bleeding
    Pulmonary embolism
    Rectal bleeding
    Reduced libido
    Sensation of pregnancy
    Suppression of lactation post-partum
    Vaginal cysts
    Vaginal discharge
    Vaginal dryness
    Varicose veins
    Weight changes

    Effects on Laboratory Tests

    The following laboratory tests may be affected by the use of medroxyprogesterone acetate:

    Gonadotrophin levels (decreased)
    Plasma progesterone levels (decreased)
    Urinary pregnanediol levels (decreased)
    Plasma oestrogen levels (decreased)
    Plasma cortisol levels (decreased)
    Glucose tolerance test
    Metyrapone test
    Liver function tests (may increase)
    Thyroid function tests (protein bound iodine levels may increase and T3 uptake levels may decrease)
    Coagulation test values for prothrombin (Factor II), and Factors VII, VIII, IX and X may increase.

    Physicians should be aware that pathologists should be informed of the patient's use of medroxyprogesterone if endometrial or endocervical tissue is submitted for examination.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: November 2020

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Depo-Provera 150mg/ml Injection sterile suspension for injection. Pfizer Ltd. Revised March 2020.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Medroxyprogesterone Acetate Last revised: 31 October 2018
    Last accessed: 09 November 2020

    The Norwegian Porphyria Centre (NAPOS).
    Available at:
    Last accessed: 09 November 2020

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