Medroxyprogesterone (Intramuscular)

Medroxyprogesterone, sold as Depo-Provera, is a birth control injection available only with a doctor's prescription and administration in a professional medical setting once every three months.

Overview

Medroxyprogesterone acetate or MPA is an injection that is sold and familiar as the name Depo-Provera, thanks to extensive marketing. It is a hormonal form of birth control that is typed as a progestin style of medication, which is the most potent form of the human hormone progesterone. Typically injected into the muscle of the arm or buttocks, this medication is given quarterly (every three months) in a hospital or clinic setting.

Considered highly effective, with a failure rate of only 0.3%, Medroxyprogesterone is not only used as a birth control method, it is also used as hormone replacement therapy in women who are menopausal. There have also been good results in using it on women with endometriosis, a growth issue in the lining of the uterus that causes infertility and pelvic pain. Medroxyprogesterone has also been prescribed for the treatment of abnormal bleeding occurrences in the uterus as well as certain types of cancer.

Patients who are diagnosed with breast cancer may be prescribed Medroxyprogesterone in high doses along with other medications to treat cancers that are hormone dependent. This medication, with regular use, is thought to decrease the risk of some cancers including endometrial and colon cancer.

For birth control purposes, the mechanism of Medroxyprogesterone is simple; it stops the egg from becoming fully developed and prevents it from being fertilized. While this method is not one hundred percent effective (no contraceptive is), it is one of the best pregnancy preventives on the market and second only to tubal ligation or abstinence in effectiveness. It is not an emergency contraception and does not prevent against diseases that are sexually transmitted such as HIV.

Conditions Treated

Type Of Medication

  • Contraceptive
  • Hormone therapy
  • Progestin contraceptive
  • Reproductive control agent

Side Effects

In effecting the hormones of the human body, Medroxyprogesterone causes many effects when bearing the patient's overall health or pregnancy prevention in mind. However, some of the effects that this medication has on the body are not desired and can cause long-term health issues. Alert your physician if you experience any of the following symptoms, as they could be warnings signs that something is wrong:

  • Irregular menstrual period, absent or missed
  • Changes in menstruation
  • Menstrual bleeding has stopped
  • Pain in breasts
  • Cramps
  • Bleeding heavily
  • Vaginal discharge that is white or clear
  • Itching genital area or vagina
  • Pain during sex
  • Swelling
  • Vaginal discharge that is thick and white, with or without odor
  • Pain in stomach or abdomen
  • Anxious demeanor
  • Black, tar-like stool
  • Stool with signs of blood
  • Itching, needles and pins, burning, tingling or crawling sensations
  • Skin color changes
  • Pains in chest area
  • Chills
  • Stools are clay-like in color
  • Nipple discharge, clear or bloody
  • Coughing
  • Urine that is dark
  • Height decrease
  • Difficulty breathing and swallowing
  • Breast dimples suddenly appear
  • Lightheaded, dizzy feeling
  • Pressure or ache in legs that feel heavy
  • Fainting or passing out
  • Irregular heart rhythm, pounding or fast
  • Elevated body temperature
  • Uncomfortable, unwell feeling
  • Headache
  • Itching rash or hives on skin
  • Thirst increases
  • Nipples are inverted
  • Veins appear damage and itch
  • Little to no appetite
  • Lumps under the arm or in breast
  • Nausea
  • Loss of feeling in legs
  • Breathing is noisy or wheezing
  • Pain in ribs, legs, arms or back
  • Tender, painful, red or swollen feet, legs or arms
  • Skin paleness
  • Scaly, crusty nipples
  • Swollen, puffy eyes, lips, tongue or face
  • Swollen, red breasts
  • Sores on breast that do not heal
  • Swollen ankles or feet
  • Chest constriction
  • Difficulty breathing when exerting oneself
  • Legs do not move
  • Halitosis
  • Bleeding or bruising that is unusual
  • Fatigue
  • Muscle weakness
  • Vomiting with signs of blood
  • Skin or eyes appear yellow

Other health symptoms may occur that are not an emergency in nature, but should still be reported to your physician in case there is a way to alleviate them temporarily. They include:

  • Discomfort in stomach or abdomen
  • Loss of sexual desire or interest, ability, performance or drive
  • Inability to achieve or maintain an erection
  • Weight gain
  • Nervous demeanor
  • Pain or ache in back
  • Skin blemishes
  • Bloating
  • Depressed mood
  • Moving is difficult
  • Overall warm feeling
  • Losing hair
  • Cramps in legs
  • Stiff, painful muscles
  • Joint pain
  • Acne
  • Neck, face, arms or upper chest are flushed and red
  • Overproduction of sweat
  • Difficulty sleeping
  • Skin spots that appear blotchy or brown in color
  • Appetite changes or loss
  • Diarrhea
  • Drowsy, sleepy demeanor
  • Skin dryness
  • Hoarse voice
  • Facial hair growth
  • Increased sexual drive, ability, performance or desire and interest
  • Body odor
  • Upset stomach
  • Indent, dimple, pain or tenderness at the site of the injection
  • Excess gas
  • Skin discoloration that appears deep brown or patchy
  • Full, uncomfortable, painful stomach
  • Underarm swelling
  • Milk production unexpectedly in breasts

Should you experience any change in your health or mood after your Medroxyprogesterone injection, get in touch with your physician right away.

Dosage

This medication is injected into your upper arm or buttocks by a trained healthcare professional such as a doctor or nurse.

Contraceptive doses are typically given once every 13 weeks at a 150 milligram dosage size. The initial dose will be given during the first five days of a menstrual period. If the woman has recently given birth, the contraceptive dose should be given within the first five days after the baby is born unless breastfeeding, in which case it must be held off until the sixth postpartum week.

Endometriosis patients who are sexually active and have regular menstrual cycles will be given 104 milligrams as an injection every 12 to 14 weeks. The duration of this treatment is typically only 24 months to avoid complications. The first dosage will be given after a pregnancy test comes back negative and within the first five days of the patient's menstrual period.

Endometrial or renal carcinoma patients will be prescribed anywhere from 400 milligrams to 1000 milligrams depending on their doctor's determination of their condition, overall health and other factors. The dosage will be repeated weekly until symptoms improve, at which time the dosage will be changed to once per month in a 400 milligram size.

Be sure to read and understand the printed information leaflet that comes with your prescription and explains how hormonal contraceptives work and what health effects they can cause. If you have any questions after reading, consult your physician.

You will need to regularly receive this medication so that it maintains a certain level in your body that continuously acts to prevent pregnancy. If you have recently given birth, you can start your Medroxyprogesterone injections as soon as five days postpartum if you are not breastfeeding. Breastfeeding mothers must wait at least six weeks to begin this treatment.

Your doctor will guide you on when to have this injection if you are switching from another form of birth control. It may be recommended that you use alternate forms of birth control during the switch until your body gets adjusted to the medication.

If you miss an injection appointment, you will need to consult with your doctor on when you can have your next injection; you may need to use an alternate form of birth control until you can get your next shot and for it to take effect.

Interactions

If you have ever experienced any hypersensitive reactions to animals, foods, dyes, perfumes or preservatives, explain these to your physician along with any adverse reactions to this drug or others. Read your patient information leaflet for a list of ingredients in this injection and discuss anything you have questions about with your doctor.

Pediatric patients have not been studied with any conclusive information on how this medication works for them or if it causes a greater risk due to their age. It is not expected, however, that teenage patients wouldn't be able to have Medroxyprogesterone injections with any lesser effect or greater risk than adult patients. While that is true, if the patient has not yet begun menstruating, this medication should not be used.

The geriatric population has not been the object of any study that provided data on how Medroxyprogesterone might affect this group. While this medication should not be used in elderly women if it is the Depo-Provera CI formulation, the other formulations may be used for cancer patients and others who can benefit from the activity on their condition.

Women who are pregnant should not have this medication injected as it has been proven to cause harm to developing babies. Before patients are given their first injection, they must have a negative pregnancy test and be in the first five days of their menstrual cycle.

While there is a minimal risk to breastfeeding infants whose mothers receive injections of Medroxyprogesterone, it is advised that initial injections be held off for six weeks postpartum or until the baby is weaned before administering this drug.

Certain medications work well together and are often prescribed together to create a full health treatment for certain patients. Other medications react poorly, causing worse health effects and possibly endangering patients when combined. To protect your health, alert your physician to all medications you are taking including those obtainable over-the-counter, vitamin supplements, herbs and holistic treatments as well.

Specifically, the following medication should be avoided if you are taking Medroxyprogesterone injections. If you are already taking it, your physician may hold off on your injection for your safety. Let your physician know if you take:

  • Tranexamic acid

While not typically prescribed together, the following medications may be indicated for your use during Medroxyprogesterone, but will most likely have their dosage adjusted for your safety. Let your physician know if you take:

  • Carbamazepine
  • Darunavir
  • Dabrafenib
  • Theophylline
  • Isotretinoin

Some adverse health effects may be amplified if you take the following medications during your treatment with Medroxyprogesterone, but with adjustment from your doctor, any dangerous situations can be avoided. Let your physician know if you take:

  • Aprepitant
  • Amprenavir
  • Bacampicillin
  • Atazanavir
  • Bexarotene
  • Betamethasone
  • Cyclosporine
  • Colesevelam
  • Efavirenz
  • Delavirdine
  • Fosamprenavir
  • Etravirine
  • Fosphenytoin
  • Fosaprepitant
  • Lamotrigine
  • Griseofulvin
  • Mycophenolate Mofetil
  • Licorice
  • Nelfinavir
  • Mycophenolic Acid
  • Phenobarbital
  • Oxcarbazepine
  • Prednisolone
  • Phenytoin
  • Rifapentine
  • Primidone
  • Rosuvastatin
  • Ritonavir
  • Selegiline
  • Rufinamide
  • Topiramate
  • Telaprevir
  • Warfarin
  • Troleandomycin

Avoid caffeine when you are having Medroxyprogesterone injections, as this stimulant has been known to increase adverse effects on your health. Discuss the consumption of certain foods, alcoholic beverages and the use of tobacco products with your physician as well.

Medical issues such as the ones listed below could become worse if you are taking Medroxyprogesterone injection, so be sure to let your doctor know if you have:

Warnings

Your physician will want to examine you regularly to make sure that this medication is working and isn't causing any undue harm to your health. Though you will have regular injections, some physicians may require more frequent visits than that. Expect to have your blood pressure monitored and other health checks during your treatment.

Though this is a medication intended to prevent pregnancy, be aware that if you have an injection while pregnant, you will cause harm to the unborn child. If you think you may be pregnant, let your physician know right away.

Calcium loss in your bones is a common adverse health effect of Medroxyprogesterone injections, which could turn into osteoporosis over time. During your entire treatment duration, you will be slowly losing bone density, which can rebuild after you stop using the medicine. Patients who should be most concerned about this effect of the medication are teenagers, regular smokers, regular alcohol drinkers or people who suffer from anorexia nervosa and those that have a history of osteoporosis in their family. You should also be concerned if you have other medications for your health treatment that affect your bone density such as seizure medication and steroids. Discuss this risk and ways to mitigate it with your physician.

If you need to be treated with this medication longer than two years, you'll want to discuss this with your physician. You will need to undergo regular bone density tests if you will be on long-term treatment duration of this medication.

Alert your physician if you have any pain symptoms in your groin, calves, legs or chest and if you have difficulty breathing, severe headaches, speech changes, loss of muscle coordination or changes in vision while you're in treatment with this medication, as you could be experiencing a severe sensitivity to it.

Report changes in vision, especially blurriness or problems with reading during or post-treatment, as the medication could be affecting your sight. To avoid long-term damage to the health of your eyes, alert your physician to these symptoms right away. You may be referred to an ophthalmologist for specialized testing of your eyes.

Some women could be at a slightly higher risk for breast cancer if they get Medroxyprogesterone injections, especially those with a history of breast cancer in their family. Be certain that your doctor is aware of any such history and perform regular self-examinations as directed and any other instructions your doctor has for you.

Patients have reported an increase in ectopic pregnancy occurrence while on Medroxyprogesterone injections. Symptoms of this condition include severe pain in the lower stomach or abdomen. This can be a life-threatening situation that can also affect your future fertility. Seek emergency medical help if you have any painful abdominal symptoms.

As Medroxyprogesterone directly affects your menstruation, you may experience irregular bleeding, heavy bleeding, lighter bleeding or irregular periods during your injection treatment. If you have excessive, prolonged bleeding, get in touch with your physician right away.

Report symptoms of anaphylaxis, a life-threatening reaction to this medication, including difficulty breathing or swallowing, swollen face, mouth or hands and hoarse vocal symptoms or itching after you've had your injection. These symptoms should be reported to your doctor right away.

Serious liver problems have been reported in some patients after being injected with Medroxyprogesterone. Symptoms such as dark urine, pale stool, appetite loss, nausea, fatigue, muscle weakness or skin and eyes that are yellow are all signs of liver issues and should be reported to your doctor immediately.

Your body may retain fluid and swell and you may gain weight when you are being treated with Medroxyprogesterone injection. This is known as edema, and typically first shows up in your hands, feet, lower legs, face or arms by making them appear swollen or bloated. Alert your physician to these conditions immediately.

Medroxyprogesterone may give you problems with your adrenal glands. Symptoms of this will include skin darkening, diarrhea, weight gain in the upper back, breast, waist or face and nausea. Report these signs to your physician, should you experience them.

It may take up to 12 months for you to become pregnant after you stop having Medroxyprogesterone injections; however, the medication is only effective for up to 13 weeks. You will not be protected from any diseases that are sexually transmitted by this medication, including HIV and AIDS. Discuss how to protect yourself from STDs with your physician or pharmacist.

Alert any doctor, including dentists, who are giving you any kind of medical testing during this time that you are taking Medroxyprogesterone injections, as the results of some tests and procedures may be altered by the way this drug affects your body.

Avoid taking other medications while you are being treated with this medication, including over the counter medications as well as other prescription drugs, vitamin and herbal supplements and holistic remedies.

Storage

This injected solution is stored by medical professionals in a hospital or clinic according to the manufacturer's instructions. Typically the injection suspension solution can be stored in a controlled room temperature environment with no exposure to excessive heat, light or moisture.

Summary

Medroxyprogesterone or Depo-Provera and Depo-Provera CI are contraceptive drugs available only with a doctor's prescription and only via professional injection into the patient's upper arm or buttock. This is a very effective form or hormonal birth control that only needs to be re-injected every 13 weeks, making it very convenient for many people. This medication is indicated for the prevention of pregnancy but can also be prescribed for the treatment of some cancers, endometriosis symptoms and symptoms of menopause.

Medroxyprogesterone works by preventing the female ovum from maturing and being able to be fertilized, thus preventing pregnancy with a 0.3% failure rate. Its other actions in the reproductive system include a thickening of the vaginal fluids, impeding the sperm from making it to the egg as well as altering the lining of the uterus in such a way to prevent a fertilized egg from attaching itself. Patients should keep in mind that no birth control is effective one hundred percent of the time and that this type of birth control does not protect them against diseases that are sexually transmitted such as HIV.

Endometriosis is a condition in which the lining of the uterus grows outside the womb, causing painful symptoms and decreasing or eliminating fertility. Medroxyprogesterone is effective on this condition in that it decreases the growth of the tissues that are causing the disease, reducing symptoms and pain.

Patients are given a dosage of Medroxyprogesterone depending on the condition it is used for. Cancer patients, for example, will have a larger, more frequent dose of the medication than those patients preventing pregnancy. Endometriosis patients will have still another amount and frequency of dosage. No matter your prescription, it is imperative to keep all appointments for your injections and any in between that your doctor makes to monitor your condition. If you miss an injection, use another form of birth control according to your doctor's time schedule after the missed dose is made up.

Typical side effects resulting from Medroxyprogesterone include changes to your menstrual cycle, weight gain, fatigue, acne, hot flashes, tender breasts, headache and pain at the site of injection. You may not have periods when you are receiving this injection, which can last for up to 12 months. If any of these symptoms become prolonged or severe, they should be reported to your physician immediately.

Report any signs of liver damage, ectopic pregnancy, breast cancer, any unusual vaginal bleeding, blood clots or hypersensitivity to the medication to your physician immediately. Patients will be required to have a negative pregnancy test prior to their initial injection of Medroxyprogesterone. Be aware that this medication has been proven to cause harm to developing babies. If you suspect you are pregnant, get in touch with your physician right away.