Depo-Provera (redirected from Depo shot)

Depo-Provera/Norplant 

Definition

Norplant is a long-acting hormone that is inserted under the skin and prevents conception for up to five years. Depo-Provera is also a hormone, but is administered by intramuscular injection and provides protection against pregnancy for three months. Lunelle is another injectable contraceptive that is administered monthly (every 28 to 30 days); it was approved by the Food and Drug Administration (FDA) in October 2000. The hormone in Norplant and Depo-Provera is progestin, a synthetic hormone similar to one found naturally in a woman's body; Lunelle contains the hormones progestin and estrogen.

Purpose

The purpose of these hormones is to prevent pregnancy; they are about 99% effective in achieving this goal. No hormonal contraceptive methods provide protection from AIDS or other sexually transmitted diseases.

Depo-Provera and Lunelle are given as an injection and work in several ways to prevent conception. First, the egg (ovum) is prevented from maturing and being released. The mucus in the cervix (opening into the uterus or womb) becomes thicker, making it difficult for the sperm to enter. Depo-Provera and Lunelle also cause the lining of the uterus to become thinner, making implantation of a fertilized egg unlikely.

An injection of Depo-Provera or Lunelle must be given within the first five days of a normal period. Depo-Provera provides protection against pregnancy for three months, while Lunelle provides similar protection for one month. Ovulation (release of a mature egg) typically occurs within 60 days of the last injection of Lunelle, about twice as fast after use of Depo-Provera. Also, because Lunelle is a combined hormone contraceptive as opposed to progestin-only Depo-Provera and Norplant, it is less likely to cause irregular or absent menstruation.

Norplant capsules contain a synthetic hormone that is slowly released over a period of up to five years. It functions like Depo-Provera in that it prevents the ovaries from producing ova (eggs) and also results in thicker mucus in the cervix, which prevents the sperm from passing through the cervix. Norplant can be inserted at any time.

Preparation

The woman being considered for Depo-Provera or Lunelle will have a pelvic and breast examination, a Pap test (a microscopic examination of cell samples taken from the cervix), blood pressure check, weight check, and a review of her medical history. Women who have diabetes mellitus, major depression, blood clotting problems, liver disease, or weight problems should use these methods only under strict medical supervision. Depo-Provera or Lunelle should not be used if the woman is pregnant, has unexplained vaginal bleeding, suffers from severe liver disease, has breast cancer, or has a history of blood clots or stroke.

Individuals who select Norplant will receive the same basic physical examination. If approved for this method, a site of implantation will be selected (usually the inside of the upper arm), and the area prepared for minor surgery. The skin will be washed with soap and water, and an antiseptic, such as iodine solution, will be applied. The physician will use a local anesthetic to numb the area, a small incision will be made, the six Norplant capsules will be inserted, and the incision sewn up (sutured). Protection against pregnancy normally begins within 24 hours. If necessary, the implants can be removed in 15-20 minutes. Norplant should not be used by women who are pregnant, have blood clotting problems, or have unexplained vaginal bleeding. Advantages include light periods with less cramping and decreased anemia. This form of birth control may also be protective against endometrial cancer.

Because Depo-Provera and Norplant use only the hormone progestin, they may provide an alternative for women who can not use estrogen-containing birth control pills. One benefit of Lunelle, however, is that its effects wear off more quickly than Depo-Provera, an important factor in the event that a woman has serious side effects or wants to become pregnant.

Key terms

Hormone — A chemical produced in a gland or organ and transported by the blood to another area of the body where it produces a specific effect.

Pap test — A microscopic examination of cell samples taken from the cervix.

Risks

The most common side effects associated with Depo-Provera and Lunelle are yellowing of the skin, headache, nervousness, dizziness, abdominal pain, hair loss, rash, increase in the number of migraine headaches, increased or decreased interest in sexual intercourse, the development of dark spots on the skin, depression, and weakness. Danger signs that need to reported immediately include weight gain, heavy vaginal bleeding, frequent urination, blurred vision, fainting, severe abdominal pain, and coughing up blood. Because the effects of Depo-Provera may last up to 12 weeks, it may take a longer time for women trying to conceive to become pregnant after discontinuing the injections.

The main reactions to Norplant include headache, weight gain, irregular periods or no period at all, breast tenderness, acne, gain or loss of facial hair, color changes of the skin over the area of insertion, and ovarian cysts. The doctor should be notified immediately of lumps in the breast, heavy vaginal bleeding, yellowing of the skin or eyes, or infection of the incision. Women who use Norplant are discouraged from smoking.

Normal results

These hormone contraceptive methods normally result in a success rate of 99%.

Resources

Other

"Depo Provera." Planned Parenthood of Western Washington. http://www.ppww.org/depo.htm.

"Is Depo-Provera For You?" Planned Parenthood Federation of America, Inc. 〈http://www.plannedparenthood.org/Library/birthcontrol/depoforyou.html〉.

"Lunelle." Food and Drug Administration (FDA) Page. http://www.fda.gov/cder/foi/label/2000/20874lbl.pdf.

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medroxyprogesterone acetate Warning - Hazardous drug!

Alti-MPA (CA), Climanor (UK), Depo-SUBQ-Provera 104, Depo-Provera, Gen-Medroxy (CA), Novo-Medrone (CA), Provera

Pharmacologic class: Hormone

Therapeutic class: Progestin

Pregnancy risk category X

FDA Boxed Warning

• Injection form may cause significant bone density loss. Loss increases with duration of use and may not be completely reversible. It's unknown if use during adolescence or early adulthood reduces peak bone mass and increases risk for osteoporotic fracture later in life.
• Injection form should be used as long-term contraceptive (more than 2 years) only if other contraceptive methods are inadequate.

Action

Inhibits pituitary gonadotropin secretion, preventing follicular maturation, ovulation, and pregnancy

Availability

Suspension for depot injection: 150 mg/ml, 400 mg/ml

Tablets: 2.5 mg, 5 mg, 10 mg

⊘Indications and dosages

➣ Secondary amenorrhea

Adults: 5 to 10 mg/day P.O. for 5 to 10 days, starting at any time during menstrual cycle

➣ Dysfunctional uterine bleeding; menses induction

Adults: 5 to 10 mg/day P.O. for 5 to 10 days, starting on day 16 or 21 of menstrual cycle

➣ To prevent estrogen-related endometrial changes in postmenopausal women

Adults: 2.5 to 5 mg/day P.O. given with 0.625 mg conjugated estrogens P.O. (monophasic regimen); or 5 mg/day P.O. on days 15 to 28 of cycle, given with 0.625 mg conjugated estrogens P.O. daily throughout cycle (biphasic regimen)

➣ To prevent pregnancy

Adults: 150 mg (Depo-Provera) deep I.M. injection q 13 weeks. Give first injection during first 5 days of normal menstrual period or first 5 postpartal days if patient isn't breastfeeding, or during sixth postpartal week if patient is breastfeeding exclusively.

➣ Renal or endometrial cancer

Adults: 400 to 1,000 mg I.M.; may repeat weekly. If improvement occurs, decrease to 400 mg q month.

Off-label uses

• Advanced breast cancer

Contraindications

• Hypersensitivity to drug or its components
• Cerebrovascular or thromboembolic disease
• Hepatic dysfunction or disease
• Breast or genital cancer
• Undiagnosed vaginal bleeding
• Known or suspected pregnancy

Precautions

Use cautiously in:
• seizure disorder, renal or cardiovascular disease, asthma, diabetes mellitus, depression, migraine
• history of hepatic disease.

Administration

• Before starting therapy, obtain thorough history and physical examination, with emphasis on breast and pelvic organs. Also obtain Pap smear, and repeat annually during therapy.
• With contraceptive use, rule out pregnancy before first dose and when more than 14 weeks have passed since previous dose.
• For I.M. injection, inject deep into gluteal, deltoid, or anterior thigh muscle. Rotate injection sites.
• Be aware that when drug is used to prevent estrogen-related endometrial changes in postmenopausal women, lowest dosage should be used for shortest time, because treatment exceeding 1 year correlates with cancer. (Some combination products have 0.3 mg estrogen/1.5 mg progesterone or 0.45 mg estrogen/1.5 mg progesterone.)

Route	Onset	Peak	Duration
P.O.	Unknown	Unknown	Unknown
I.M.	Wks-1 mo	1 mo	Unknown

Adverse reactions

CNS: insomnia, migraine, nervousness, drowsiness, dizziness, fatigue, depression, mood changes

CV: thrombophlebitis, thromboembolism

EENT: diplopia, proptosis, retinal vascular lesions, papilledema

GI: abdominal pain, bloating

GU: amenorrhea, leukorrhea, spotting, cervical secretions, galactorrhea, breast tenderness and secretion, cervical erosions, pelvic pain, infertility

Hepatic: jaundice

Metabolic: fluid retention, hyperglycemia

Musculoskeletal: leg cramps, back pain

Respiratory: pulmonary embolism

Skin: pruritus, urticaria, rash, acne, alopecia, hirsutism, cholasma, melasma, sterile abscesses, induration at I.M. site

Other: weight and appetite changes, edema, angioedema, allergic reactions including anaphylaxis

Interactions

Drug-drug. Bromocriptine: decreased bromocriptine efficacy

Carbamazepine, phenobarbital, phenytoin, rifampin: decreased contraceptive efficacy

Drug-diagnostic tests. Alkaline phosphatase, low-density lipoproteins: increased levels

High-density lipoproteins, pregnanediol excretion: decreased levels

Thyroid hormone assays: altered results

Drug-behaviors. Alcohol use: additive CNS depression

Patient monitoring

• Monitor patient for fluid retention and for signs and symptoms of thrombophlebitis, including pain, swelling, and redness of lower legs.
☞ Assess for visual disturbances and headache. If ocular exam shows papilledema or retinal vascular lesions, drug should be discontinued.
• Evaluate liver function tests.
☞ Watch for abdominal pain, fever, malaise, jaundice, darkened urine, and clay-colored stools.

Patient teaching

• Advise patient that drug may cause nausea, vomiting, headache, abdominal pain, painful breast swelling, and abnormal bleeding pattern. Instruct her to report these effects if pronounced.
☞ Tell patient to promptly report bloating, swelling, appetite loss, rash, yellowed skin, mood changes or depression, nervousness, dizziness, chest pain, shortness of breath, visual disturbances, or severe headache.
• Teach patient how to perform breast self-exams.
• Tell patient she must undergo yearly physical examinations with Pap smear.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

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Depo-Provera

Medroxyprogesterone, Provera^® Endocrinology A synthetic progestin that is structurally an androgen; it is a highly effective contraceptive, given q 3 months; it is also used for ♀ precocious puberty, DUB, dysmenorrhea, endometriosis, threatened abortion, to suppress postpartum lactation Side effects Weight gain, dysmenorrhea, fatigue, vertigo, nervousness, headaches, abdominal pain. See Androcur; Cyproterone.