A shot in the ass you think about just 4x a year
Depo-Provera is the brand name of a prescription, synthetic, progesterone-like hormone called depo-medroxyprogesterone acetate (DPMA), which can be injected in women to prevent conception for about three months at a time. Its contraceptive effects are similar to the birth control pill: suppressing ovulation, thickening cervical mucus and changing the endometrium to prevent implantation. It also costs about the same per year as birth control pills.
Because it contains no estrogen, the shot is sometimes touted as having fewer side effects than the birth control pill (no estrogen-provoked migraines, for example). However, it can have more of the progesterone-related side effects that are counteracted by estrogen in combination pills (weight gain, acne, loss of bone density, etc.). It is also delivered in significantly higher doses. Whatever the side effects turn out to be, they last for 3 months or more. It can take over 6 months for the hormones to be completely flushed from the body after the last shot, and longer than that to become pregnant after stopping the shot. There is no antidote or reversal except waiting for the hormone to dissipate.
Judging from the masses of internet discussions about Depo (e.g.), many women have had problems with under-informed or uncommunicative doctors providing inadequate information about side-effects and risks. That is one of the major reasons that I think it is important to look these things up yourself if you can, rather than relying on a doctor. The Planned Parenthood and Feminist Women's Health Center sites both have good listings of possible side-effects and risk factors for women considering Depo Provera. For a paper reference, the excellent Our Bodies, Ourselves For The New Century is in most libraries.
The shot does have some major benefits. Because the hormone dose is constant and steady, it is very effective in preventing pregnancy (99.7% success in the first year). It is also very convenient, and very private, since there is no evidence to show and no procedure to remember except for a doctor's appointment once every three months.
I myself would add the occasional pregnancy test to that regimen, since absent periods can be expected with Depo and that leaves you without the most obvious warning sign of pregnancy. It is a really good idea to have a pregnancy test two to three weeks after starting hormonal birth control of any kind, to double-check that you weren't newly pregnant when you started and that you didn't become pregnant in the brief window before the birth control became effective (24 hours to two weeks depending on when you get the shot— read the package inserts or talk to your doctor).
A few of my female friends have used Depo for years at a time, most often because they tried the pill and found it changed their mood too much or otherwise had too many side effects. The most common side effect of the shot is irregular bleeding— anything from constant, light, daily bleeding (which one friend reported), to periods that are long and heavy (happened to another friend), to complete absence of periods (which other friends reported, and which is more common the longer you use Depo).
Two of these friends have since switched to other methods, having become unhappy with side effects that developed after extended use (lack of sexual lubrication and distasteful vaginal odor are the ones that I heard about).
For myself, I am uneasy about committing to 3 months of hormones at once. Since I don't seem to have trouble remebering to take my pills, and since I find the side effects of the pill mostly tolerable, I'm sticking with the daily doses for now.
Among the interesting tidbits in this article critiquing the use of Depo Provera for teens, population control, etc., are statistics showing that only 27-34% of "urban teens" stayed on Depo after their first year. That is a lot of disatisfaction.
For the few people who experience extreme side-effects on Depo Provera: a collection of horror stories, support and resources.
And since I seem to be offering a lot of negative links, here is one about women who love Depo Provera.
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