The DMPA contraceptive injection is a generally used reversible technique of contraception amongst ladies in the US. Also called the “shot,” the injection is often recognized by the model identify Depo Provera (depot medroxyprogesterone acetate or DMPA), though generic options can be found. It was first launched in the US in 1959 for the remedy of menstruation and was accredited by the U.S. Meals and Drug Administration (FDA) in 1992 for contraceptive use. This truth sheet offers an outline of the categories, use, consciousness, availability and insurance coverage. protection of contraceptive injections within the US

How does the DMPA injection work?

The injection works by releasing the hormone DMPA, a progestin, which suppresses ovulation and thickens the cervical mucus, additionally stopping sperm from fertilizing an egg. DMPA might be administered through an intramuscular injection (DMPA-IM), administered by a health care provider, or through a subcutaneous injection (DMPA-SC), which might be injected by the affected person at house (desk 1). Each varieties are FDA accredited and should be administered as soon as each 12 weeks to be efficient. Model identify Depo-Provera and the generic equivalents for medroxyprogesterone acetate are intramuscular injections, delivering 150 mg of progestin in a single dose. The Depo-subQ Provera 104 injection makes use of a smaller needle and a decrease dose of progestin (104 mg) than the intramuscular various. As a result of Depo-subQ Provera 104 makes use of a smaller needle, it could be much less painful than the intramuscular injection and might be administered by the affected person at house. This technique is taken into account a protected, “off-label” technique, whereas having the identical contraceptive effectiveness. Like most contraceptives, the DMPA injection doesn’t shield in opposition to STDs; The usage of condoms is beneficial to scale back the danger of STDs, together with HIV, whereas utilizing DMPA injections.

The DMPA injection has a typical failure price of 4% when used each 12 weeks or three months. Lengthy-acting reversible contraceptive strategies (LARCs), equivalent to implants, intrauterine units (IUDs), and everlasting contraceptive strategies equivalent to vasectomies and tubal ligations, are usually more practical than the injection as a result of these strategies contain little to no aftercare, whereas injections should be executed each 12 weeks to be repeated to be efficient. Condoms or one other non-hormonal contraceptive are beneficial as a backup for 7 days after the primary injection. If a affected person is greater than 4 weeks late for an injection (16 weeks after the final injection), it is suggested that she take a being pregnant take a look at earlier than the subsequent dose and use condoms or one other non-hormonal contraceptive technique as a backup. one other 7 days in the event that they get one other injection. After stopping the injection, it takes a mean of 10 months for being pregnant to happen, which is akin to different strategies equivalent to IUDs and oral contraceptive capsules.

Advantages and unwanted effects

The DMPA injection has a number of non-contraceptive advantages, but it surely additionally has some unwanted effects and dangers. Advantages embrace a decrease danger of uterine most cancers and lowered signs of endometriosis. Nonetheless, the injectable has the best discontinuation price amongst contraceptives within the US, which is related to unwanted effects equivalent to irregular intervals (recognizing or cessation of intervals) and weight achieve. Be aware that Depo-Provera comes with a black field warning from the FDA that the contraceptive injection shouldn’t be used as a long-term technique (longer than 2 years) except different strategies of contraception are thought-about insufficient, as ladies taking Depo-Provera use, vital bone density might be misplaced. Nonetheless, the American Faculty of Obstetricians and Gynecologists (ACOG) and the World Well being Group (WHO) disagree with this warning and state that loss in bone density as a consequence of DMPA will not be related to fractures and seems to be reversible upon discontinuation of the injectable. Each organizations conclude that the advantages of DMPA use outweigh the theoretical fracture danger, and that DMPA might be prescribed with out restrictions on the period of use.

Use, consciousness and availability of the contraceptive injection

Primarily based on the latest information on contraceptive use from the Nationwide Survey of Household Progress, about 3% of girls who used contraception from 2017 to 2019 reported utilizing the contraceptive shot up to now month. Over the previous 20 years, ladies's entry to and choices for varied contraceptive selections have modified, and general use of the shot has declined as extra ladies use LARCs, equivalent to IUDs and implants. Nonetheless, throughout the early years of the COVID-19 pandemic, availability and curiosity in utilizing DMPA-SC elevated as a consequence of restrictions on in-person clinic appointments. A 2023 contraceptive research studies that there was a big enhance within the provision of DMPA-SC for self-injection throughout this era, though this nonetheless represents a small proportion of whole DMPA-SC use.

Amongst ladies of reproductive age who used any type of contraception between 2017 and 2019, the contraceptive shot was used most frequently by younger ladies, lower-income ladies and Black ladies. Use of the shot additionally decreased with increased training ranges – smaller numbers of girls with a bachelor's diploma reported utilizing the shot as a way of contraception (Determine 1).

Insurance coverage protection and price of the contraceptive injection

The Reasonably priced Care Act (ACA) requires most personal insurance policy and Medicaid growth packages to cowl one in all every of the 18 FDA-approved contraceptive strategies with out value sharing. Ladies with personal insurance coverage and ladies with Medicaid protection are eligible for affected person training, counseling and entry to no less than one type of the contraceptive shot with out value sharing. Protection additionally consists of the primary physician go to, discontinuation of the injection and remedy of unwanted effects. Though protection consists of no less than one type of the injection, plans might not cowl each the intramuscular formulation and Depo-subQ Provera 104; Nonetheless, if a doctor determines {that a} explicit injectable formulation is medically acceptable for a affected person, the plan should cowl that kind as effectively.

Security internet clinics that take part within the federal Title The Workplace of Inhabitants Affairs (OPA) of the U.S. Division of Well being and Human Providers (HHS) reported that in 2022, roughly 302,000 ladies obtained the DMPA injection as their main technique of contraception from a Title

In 16 states (CA, CO, HI, ID, IL, IN, MD, ME, MN, NV, NM, NH, OR, SC, TN, VA) and the District of Columbia, pharmacists can straight dispense the intramuscular contraceptive injection to ladies with out having to go to a health care provider first to acquire the prescription and injection (Determine 2). In some states, equivalent to Hawaii, Indiana, and Maryland, the statewide protocol or standing order doesn’t explicitly state that the DMPA injection might be provided, however does state that each one FDA-approved hormonal contraceptive strategies might be prescribed by pharmacists are administered. Nonetheless, pharmacist participation in these packages will not be required and implementation varies from nation to nation. As well as, though the precise DMPA injection is often coated, ladies will doubtless should pay out-of-pocket pharmacy session charges, which aren’t required to be coated underneath the contraceptive legal guidelines in most of those states and by the federal authorities. proper via the ACA.