Brand name:

Depo-Provera

Why is Depo-Provera prescribed?

Depo-Provera Contraceptive Injection is given in the buttock or upper arm to prevent pregnancy. It is more than 99 percent effective; your chances of becoming pregnant during the first year of use are less than 1 in 100. The injection is given every 3 months (13 weeks) by your doctor. Depo-Provera works by preventing the release of hormones called gonadotropins from the pituitary gland in the brain. Without these hormones, the monthly release of an egg from the ovary cannot occur. If no egg is released, pregnancy is impossible. Depo-Provera also causes changes in the lining of the uterus that make pregnancy less likely even if an egg is released.

In higher doses, Depo-Provera is also used in the treatment of certain cancers including cancer of the endometrium (lining of the uterus) and kidney cancer.

Most important fact about Depo-Provera

Because Depo-Provera is a long-acting form of birth control, it will take a while for the effects of your last injection to wear off. In medical studies, only 68 percent of women became pregnant within 12 months after stopping Depo-Provera. However, within 18 months, 93 percent had become pregnant. If you think you will want to get pregnant shortly after you stop using birth control, Depo-Provera may not be the ideal method for you. The amount of time you use Depo-Provera does not affect the delay in becoming pregnant when you stop.

How should you take Depo-Provera?

Depo-Provera is given by a doctor. To make sure you are not pregnant when you receive your first injection, it is given only during the first 5 days after your menstrual period, when it is very unlikely that you could be pregnant. If you are breastfeeding, Depo-Provera is given 6 weeks after childbirth to reduce the infant's exposure to the drug through breast milk. If you are not breastfeeding, it is given within 5 days of childbirth.

Depo-Provera must be taken every 3 months (13 weeks), on schedule. Although the birth-control effects of the drug generally take time to wear off, there is still a possibility of becoming pregnant right away if you miss your scheduled injection.

--If you miss a dose...

If you allow more than 13 weeks to elapse before your next injection, your doctor will do a test to make sure you are not pregnant before giving you another injection.

--Storage instructions...

Depo-Provera is always given at a doctor's office or clinic, never at home.

Depo-Provera side effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Depo-Provera.

By far, the most common side effect of Depo-Provera is unpredictable menstrual bleeding. In fact, most women have some change in their menstrual pattern. For example, when first taking Depo-Provera, it is common to have spotting between menstrual periods, or an increase or decrease in the amount of bleeding when menstrual periods occur. With continued use, many women stop having their menstrual periods altogether.

By 12 months (or four injections), 55 percent of women report not having periods, and by 24 months, 68 percent no longer have periods. Going without a menstrual period is not an indication that something is wrong, however.

• Side effects may include:
  Abdominal pain or discomfort, dizziness, headache, nervousness, unpredictable menstrual bleeding, weakness or fatigue, weight gain or loss

Why should Depo-Provera not be prescribed?

You should not use Depo-Provera if you know or suspect you are pregnant, or if you have unusual vaginal bleeding that has not been diagnosed by a doctor.

Also avoid Depo-Provera if you know or suspect you have breast cancer, or if you have liver disease.

Do not use this method of birth control if you have thrombophlebitis (inflammation of a vein with development of a blood clot), or have ever had any blood-clotting disorders, such as a stroke, or disease of the blood vessels in the brain.

You should not take Depo-Provera if you have ever had an allergic reaction to it or to any of its ingredients.

Special warnings about Depo-Provera

Call your doctor immediately if any of these problems occur after an injection of Depo-Provera: sharp chest pain, coughing of blood, sudden shortness of breath, sudden severe headache or vomiting, dizziness or fainting, problems with your eyesight or speech, weakness or numbness in an arm or leg, severe pain or swelling in the calf, unusually heavy vaginal bleeding, severe pain or tenderness in the lower abdominal area, migraine headache, or persistent pain, pus, or bleeding at the injection site.

Studies indicate that using Depo-Provera may make you more prone to osteoporosis, or brittle bone disease. The rate at which bone loss occurs is greatest during the early years of Depo-Provera use, and the risk decreases to normal over time.

Studies of women who have used Depo-Provera for a long time have found virtually no increased risk of cancers of the breast, ovaries, liver, or cervix (mouth of the uterus). Some studies do show a slight increased risk of breast cancer in women younger than 35 years old who have taken Depo-Provera for a short time, but the increase is about three additional cases of breast cancer per 10,000 women. At the same time, Depo-Provera helps reduce the chance of cancer of the endometrium, or lining of the uterus.

Depo-Provera may cause fluid retention, so if you have conditions that may be worsened by fluid retention, such as epilepsy, migraine headaches, asthma, heart disease, or kidney disease, make sure the doctor is aware of it.

Depo-Provera tends to alter levels of blood sugar, so diabetic women need to be carefully observed by their doctors when taking Depo-Provera.

If you develop jaundice (a yellowing of the skin and whites of the eyes caused by liver disease), you probably should not receive Depo-Provera again.

Most women gain weight while they are using Depo-Provera.

While it is an excellent birth control method, Depo-Provera does not protect you against AIDS or other sexually transmitted diseases. If you are concerned about AIDS or other STDs, be sure your partner uses a condom during intercourse (or, for absolute safety, abstain from sex).

Before you start using Depo-Provera, be sure to tell your doctor if you or anyone in your family has ever had breast cancer; if you have ever had any problems with your breasts; if your menstrual periods have ever been irregular or spotty; if you have kidney disease, high blood pressure, migraine headaches, asthma, epilepsy, or a history of depression; if you or anyone in your family has or has had diabetes; or if you are taking any prescription or over-the-counter drugs.

Possible food and drug interactions when taking Depo-Provera

If Depo-Provera is taken with aminoglutethimide (Cytadren), a drug used to treat a disorder of the adrenal glands called Cushing's syndrome, it could make the Depo-Provera less potent, which could lead to unexpected pregnancy. Check with your doctor before taking Cytadren if you are on Depo-Provera.

Special information if you are pregnant or breastfeeding

Depo-Provera is not given to pregnant women. If an unexpected pregnancy occurs 1 to 2 months after a Depo-Provera injection, the baby is more likely to have a low birth weight or other health problems; birth defects are possible if you use the drug during the first 3 months of pregnancy. Children born to women who were taking Depo-Provera show no signs of poor health or development. Because Depo-Provera does not prevent the breasts from producing milk, it can be used by women who are breastfeeding. However, to minimize the amount of Depo-Provera that is passed to the infant during the first weeks of life, the drug is not given until 6 weeks after childbirth. Studies show Depo-Provera is not harmful to the infant then or later in life.

Recommended dosage for Depo-Provera

Depo-Provera is given as a single 150-milligram injection every 3 months (13 weeks).

Overdosage

An overdose of Depo-Provera is highly unlikely, since it is given as a single injection by your doctor. However, if you suspect you have received an overdose, seek medical attention immediately.

Why is Provera prescribed?

Provera is derived from the female hormone progesterone. You may be given Provera if your menstrual periods have stopped or a female hormone imbalance is causing your uterus to bleed abnormally. Provera is also prescribed to prevent abnormal growth of the uterine lining in women taking estrogen replacement therapy.

Other forms of medroxyprogesterone, such as Depo-Provera, are used as a contraceptive injection and prescribed in the treatment of endometrial cancer.

Some doctors prescribe Provera to treat endometriosis, menopausal symptoms, premenstrual tension, sexual aggressive behavior in men, and sleep apnea (temporary failure to breath while sleeping).

Most important fact about Provera

You should never take Provera during the first 4 months of pregnancy. During this formative period, even a few days of treatment with Provera might put your unborn baby at increased risk for birth defects. If you take Provera and later discover that you were pregnant when you took it, discuss this with your doctor right away.

How should you take Provera?

Provera may be taken with or between meals.

Do not change from one brand to another without consulting your doctor or pharmacist.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.

--Storage instructions...

Store at room temperature.

Provera side effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Provera.

• Side effects may include:
  Acne, anaphylaxis (life-threatening allergic reaction), blood clot in a vein, lungs, or brain, breakthrough bleeding (between menstrual periods), breast tenderness or sudden or excessive flow of milk, cervical erosion or changes in secretions, depression, excessive growth of hair, fever, fluid retention, hair loss, headache, hives, insomnia, itching, lack of menstruation, menstrual flow changes, spotting, nausea, rash, skin discoloration, sleepiness, weight gain or loss, yellowed eyes and skin

Why should Provera not be prescribed?

Provera should never be taken during pregnancy. Avoid it if you even suspect you're pregnant. Doctors once prescribed Provera as a test for pregnancy, but no longer do so for 2 reasons:

• Quicker, safer pregnancy tests are now available.
• If you are in fact pregnant, Provera might injure the baby.

Similarly, Provera used to be given to try to prevent miscarriage. However, doctors now believe that this treatment is not only ineffective but also potentially harmful to the baby.

Do not take Provera if you have:

• Cancer of the breast or genital organs
• Liver disease or a liver condition
• A dead fetus still in the uterus
• Undiagnosed bleeding from the vagina

Do not take Provera if you have, or have ever developed, blood clots. Avoid it, too, if it gives you an allergic reaction.

Special warnings about Provera

Before you start to take Provera, your doctor will give you a complete physical exam, including examination of your breasts and pelvic organs. You should also have a cervical smear (Pap test).

Provera may cause some degree of fluid retention. If you have a medical condition that could be made worse by fluid retention--such as epilepsy, migraine, asthma, or a heart or kidney problem--make sure your doctor knows about it.

Provera may mask the onset of menopause. In other words, while taking Provera you may continue to experience regular menstrual bleeding even if your menopause has started.

Provera may make you depressed, especially if you have suffered from depression in the past. If you become seriously depressed, tell your doctor; you should probably stop taking Provera.

If you are diabetic, Provera could make your diabetes worse; your doctor will want to watch you closely while you are taking this drug.

There is some concern that Provera, like birth control pills, may increase your risk for a blood clot in a vein. If you experience any symptoms that might suggest the onset of such a condition--pain with swelling, warmth, and redness in a leg vein, coughing or shortness of breath, vision problems, migraine, or weakness or numbness in an arm or leg--see your doctor immediately.

Tell your doctor right away if you lose some or all of your vision or you start seeing double. You may have to stop taking the medication.

Possible food and drug interactions when taking Provera

If Provera is taken with certain other drugs, the effects of either may be increased, decreased, or altered. It is especially important to check with your doctor before combining Provera with aminoglutethimide (Cytadren).

Special information if you are pregnant or breastfeeding

You should not take Provera during pregnancy. If you are pregnant or plan to become pregnant, inform your doctor immediately.

Provera appears in breast milk. If you are a new mother, you may need to choose between taking Provera and breastfeeding your baby.

Recommended dosage for Provera

ADULTS

Overdosage

Although no specific information is available, any medication taken in excess can have serious consequences. If you suspect an overdose of Provera, seek medical attention immediately.