WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memorial Hospital

CLINICAL GUIDELINES
OBSTETRICS AND GYNAECOLOGY

CONTRACEPTION

Date Issued: June 2001

Date Revised: October 2012
Review Date: October 2015
Authorised by: OGCCU
Review Team: OGCCU

Depot Medroxyprogesterone Acetate (DMPA)

Obstetrics & Gynaecology
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia

DEPOT MEDROXYPROGESTERONE ACETATE (DMPA)

Note: Click on the individual subjects below; the hyperlink will then take you to that section in the
document.
Background information
Key points
Efficacy
Contra-indications
Side effects
Medical history and examination
Dosage and administration
Initiation of DMPA
Counselling
Follow-up
BACKGROUND INFORMATION
Depot medroxyprogesterone acetate (DMPA) is a progestogen only method of contraception which is
given by intramuscular injection. It is available in Australia as Depo-Provera or Depo-Ralovera.
DMPA works by prevention of ovulation, causes cervical mucus thickening, and possibly interferes with
1
implantation .
DMPA contraception may be a preferable option for women who cannot tolerate oestrogen, or who
have a past history of ectopic pregnancy as the anovulant effect prevents pregnancy in any location.
Women with a history of epilepsy using DMPA may have the frequency of seizures reduced, and for
women with whom long term progesterone is indicated e.g. sickle cell disease it may be an option
2
(causes an improvement of the haematological picture). It can provide a suitable alternative method of
contraception for women who are unable to tolerate oral methods e.g. women with inflammatory bowel
1
disease or malabsorption problems.
Evidence has shown that DMPA is associated with a reduction of bone mineral density, although this is
mostly reversible after discontinuation of use. This is particularly relevant for adolescents who have
not yet reached peak bone mass. Women more than 45 years of age should consider other forms of
contraception as there are concerns regarding the hypo-oestrogenic effects of DMPA and the onset of
1
menopause, however this is not a contraindication. 40% women will have a weight gain of up to 2 kg
2
during the first year of use.
KEY POINTS

DPMS
Ref: 8489

1.

Pregnancy should be excluded prior to administration of DPMA contraception.

2.

DPMA injection can be given any time after 6 weeks postpartum.

3.

DPMA is given by deep intramuscular injection every 12 weeks 14 days. Repeat injections
1
however can be given up to 16 weeks after the previous injection with little risk of pregnancy.

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 1 of 5

4.

DMPA users experience a mean reduction in bone mineral density of 7.7% and 6.4% in the hip
and spine compared to 1.6% in controls over a 4 year period. DPMA users regain some bone
mineral density after discontinuation. There is no evidence linking DPMA to increased risk of
1
fractures.

5.

The World Heath Organisation recommends women 18 - 45 years can use DPMA without
restriction. Sexual Health and Family Planning Australia recommend alternative contraceptive
methods should be considered first for women who are under 18 or over 45 years of age before
1
prescribing DPMA.

6.

Fertility may be delayed for up to 18 months following DPMA.

EFFICACY
Perfect use 99.7% efficacy, and typical use results in 97% efficacy.

CONTRAINDICATIONS
1

ABSOLUTE CONTRAINDICATIONS
Breast cancer diagnosed within the last five years.
1

STRONG RELATIVE CONTRAINDICATIONS

Cardiovascular disease including angina or myocardial infarction, peripheral vascular disease,

transient ischaemic attack or stroke, hypertensive retinopathy, and multiple risk factors for
cardiovascular disease.
Cerebrovascular accident.
Current deep vein thrombosis/pulmonary embolus, defined as currently being treated with an
anticoagulant.
Migraine with aura occurring for the first time, or recurring with DPMA use.
Type 2 diabetes with vascular complications (including hypertension, nephropathy, retinopathy
or neuropathy), or of greater than 20 years duration.
Past history of breast cancer with no current disease for 5 years.
Active viral liver disease, decompensated cirrhosis, benign or malignant liver tumours.
Unexplained abnormal vaginal bleeding.
Gestational trophoblastic neoplasia with abnormal hCG.
SIDE EFFECTS
1

Include :
irregular bleeding
weight gain
delay in return to fertility
headaches
breast tenderness
acne
loss of bone density.

Date Issued: June 2001

Date Revised: October 2012
Review Date: October 2015
Written by:/Authorised by: OGCCU
Review Team: OGCCU
DPMS
Ref: 8489

Depot Medroxyprogesterone Acetate (DMPA)

Obstetrics & Gynaecology
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 2 of 5

WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memorial Hospital

MEDICAL HISTORY AND EXAMINATION

Medical History
This includes:
Risk for osteoporosis detailed assessment and advice should be completed for new users,
1
and every year for continuing users. Discuss risk of bone mineral density reduction which is
associated DPMA use.
Menstrual history ensure the last period was not an implantation bleed. Note: a negative
pregnancy test does not exclude early pregnancy if the woman had unprotected sex in the
1
previous 3 weeks.
Cardiovascular history assess risk. Note: multiple risk factors increase risk for
1
cardiovascular disease.
1

Thromboembolic disease e.g. assess risk for thrombogenic mutation and family history
Plan for future pregnancy fertility may be delayed for up to 18 months.

Depression caution is warranted, however evidence for linkage is not strong.

Examination
1. Perform a blood pressure.
2. Measure weight and calculate the BMI.
3. Screen for cervical cancer as required.
4. Check for sexually transmitted infections (STIs) as required.
DOSAGE AND ADMINISTRATION
Administer 150mg medroxyprogesterone acetate in a 1ml aqueous microcrystalline solution by deep
1
intramuscular injection into the gluteal or deltoid muscle every 12 weeks 14 days.
MANAGEMENT IF LATE FOR THE DMPA INJECTION

A women can have a repeat injection after her menstrual period if 16 weeks has elapsed since
the last DPMA injection provided:

the woman has an negative pregnancy test

is advised to use condoms for 7 days

returns for a pregnancy test in 4 weeks time

A DPMA injection can be safely given if no intercourse has occurred during the 14 weeks since
the last injection, but abstinence or condom use is advised for 7 days.
12-14 weeks since the last injection DMPA can be safely given.
INITIATION OF DPMA1
SITUATION
No contraception or barriers

Combined pill or vaginal ring

DPMS
Ref: 8489

GIVEN

EFFECTIVE

Day 1 of the first day of bleeding

in normal menstrual cycle to day
5

Immediately

At any other time; exclude

pregnancy

7 days

Anytime if the pills / vaginal ring

have been taken/used correctly

Immediately

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 3 of 5

SITUATION

GIVEN

EFFECTIVE

DMPA injection

Anytime if within 14 weeks of

injection

Immediately

Etonogestrel Implant

Anytime if within 3 years of

insertion

7 days, or remove the implant 7

days after the injection

Progestogen only pill (POP)

Anytime if the pills have been

taken correctly otherwise
pregnancy should be excluded

Effective within 7 days, or

continue POP for an additional 7
days

Abortion

Immediately

Immediately

Copper or levonorgestrel IUD

Day 1 of the first day of bleeding

in normal menstrual cycle to day
5

Immediate

Other times condoms for 7

days prior to removal of IUD

7 days, or leave the IUD in place

for an additional 7 days

Less than 6 weeks postpartum

(DPMA is category 2 which

Immediately

Post partum fully

breastfeeding

indicates it can be generally used

before 6 weeks but follow-up is
required)

Post partum not or not fully

breastfeeding

More than 6 weeks post partum

and no menses-anytime if
pregnancy is excluded

7 days

If the menstrual cycle has

resumed as above for no
contraception or barriers

As above

Less than 21 days postpartum

anytime

Immediate

More than 21 days postpartum

and no menses anytime if
pregnancy is excluded

7 days

If the menstrual cycle has

resumed as above for no
contraception or barriers

As above

COUNSELLING
Discussion should include:
method and frequency of injections
risk factors and side-effects
follow-up with the GP or family planning services
3

Provide the women with written information, or where to access information about DPMA which is
available from Family Planning Western Australia at http://www.fpwa.org.au/

Date Issued: June 2001

Date Revised: October 2012
Review Date: October 2015
Written by:/Authorised by: OGCCU
Review Team: OGCCU
DPMS
Ref: 8489

Depot Medroxyprogesterone Acetate (DMPA)

Obstetrics & Gynaecology
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 4 of 5

FOLLOW-UP
Women should be reviewed following each DPMA injection for the following:
presence of side-effects
new medical conditions
new medications

change in bleeding patterns

assessment of risk for osteoporosis

risk for STIs

1
1

cervical and breast screening

pregnancy planning

signs or symptoms of infection at the injection site

REFERENCES
1.

Sexual Health & Family Planning Australia. Contraception: an Australian clinical practice handbook.
2nd ed. Canberra2008.

2.

Guillebaud J. Your questions answered. Contraception. 4th edition ed: Churchill Livingstone; 2004.

3.

Family Planning Association of Western Australia. Contraception Injection. 2011; Available from:
http://www.fpwa.org.au/resources/Infosheet_Depo_web.pdf.

4.

Faculty of Sexual and Reproductive Healthcare. Progesterone-only Injectable Contraception. 2009;

Available from: http://www.fsrh.org/pdfs/CEUGuidanceProgestogenOnlyInjectables09.pdf.

Date Issued: June 2001

Date Revised: October 2012
Review Date: October 2015
Written by:/Authorised by: OGCCU
Review Team: OGCCU
DPMS
Ref: 8489

Depot Medroxyprogesterone Acetate (DMPA)

Obstetrics & Gynaecology
Clinical Guidelines
King Edward Memorial Hospital
Perth Western Australia

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 5 of 5