Depo Provera discussion paper on clinical care effectiveness and side effects.

This paper discusses the clinical care effectiveness and side effects of Depo-Provera. Initial Depo-Provera injection is usually given on Day 1-5 of the menstrual cycle and subsequently every 12 weeks. On the other hand postpartum administration of Depo-Provera can be done within 5 days of childbirth if the woman is not breast-feeding or 6 weeks after childbirth if she is. The timing of the first postpartum injection depends on the following factors: risk of pregnancy possibility of ovulation and frequency of sexual intercourse as well as adverse effects of depot-medroxyprogesterone acetate (DMPA) in the immediate postpartum period. Incidence of increased vaginal bleeding is possible; however the evidence for this is weak. Following a spontaneous miscarriage or termination of pregnancy Depo-Provera is often given on Day 1. Furthermore in a consultation where exclusion of pregnancy is impossible the next injection should be delayed until this can be done. Arrangements are otherwise made for women who are persistent late attendees. It must be noted that in the US Depo-Provera is licensed for 13-week injection intervals and if more evidence were released into the public domain or made available to the UK authorities the authors would revise this advice.