Family Planning of Clallam County

Client Information for Informed Consent

DMPA — THE SHOT

The shot is a contraceptive injection that provides protection for three months (12 weeks). It contains a hormone that is similar to the progesterone made by a woman’s body. The shot is also known as DMPA. The D stands for “depot,” the solution in which the hormone is suspended. The hormone is medroxyprogesterone acetate. The DMPA shot keeps the ovaries from releasing eggs and makes cervical mucus so thick that it is hard for sperm to get through.

Two types of shots are available. One is a higher dose that is injected deep into the muscle. A new, lower-dose version is injected into the tissue just under the skin.

Shots are very effective if each one is taken on time. Of every 100 women who use the shot, about three will become pregnant with typical use. The shot will not be as effective in preventing pregnancy if you wait longer than 12 weeks between injections.

The shot offers no protection against sexually transmitted infections (STIs). Condoms are the best way for sexually active people to reduce the risk of STIs. Always use a condom if you or your partner have other sex partners.

Advantages of the Shot

                •  lasts for 12 weeks                                                      

                •  no medicine to take every day

                •  helps prevent cancer of the uterine lining       

                •  nothing to do right before sex to make it work

Disadvantages of the Shot

•       If you stop the shot in order to get pregnant, it can take an average of nine to 10 months — sometimes  up to a year or more — before pregnancy occurs. But some women get pregnant right away.
•       Women who use DMPA may have temporary bone thinning. It increases the longer they use DMPA. Bone  growth begins again when women stop using the shot. The recovery of bone mass is probably complete – except in older women who have reached menopause. Because the bone thinning is temporary, it is unlikely that it will lead to a greater risk of bone fracture much later in life, but further studies are needed.  To protect your bones, stop smoking, limit your alcohol, get regular exercise and get extra calcium, either through your diet or by using calcium and vitamin D supplements.
•       The area where the shot was injected might be sore or bruised for a day or two. 
•       Most women experience a change in menstrual periods, including bleeding more days than usual,spotting between periods, no periods, or more than one of these changes. This is most common during the first year. After 12 months, about half of all women using the shot stop getting their periods. It can take several months for periods to return after stopping the shot. (An unusual period may be a sign of pregnancy.)
•       If you experience side effects, there is no way to neutralize the shot or reverse its side effects. They may continue and you may need evaluation and/or treatment until the shot wears off.         

Risks of using the Shot

The more risk factors a woman has for heart disease, the greater the chance of developing certain serious health problems while using the shot. Risk factors include

                •  being 35 or older                                                         •  high levels of cholesterol

                •  heavy cigarette smoking                                          •  diabetes

                •  high blood pressure

Tell your clinician if you have any of these risk factors or conditions and about any other past or current medical problems or concerns you may have. Your clinician will help you to decide if the shot is right for you. Sometimes special tests or follow up may be needed.

If you decide to use the shot for longer than two years, you should discuss with your clinician the benefits and risks of continuing.

Women should not use the shot if they

                      •  have a known or suspected cancer of the breast

                      •  a history of fragility fractures

                      •  use the drug aminoglutethamide for the treatment of  

                          Cushing's syndrome

                      •  are, or think they are, pregnant

Other possible side-effects with the Shot

                •  potentially significant weight gain                       

                •  depression

                •  headaches                                                                    

                •  skin rash or spotty darkening of the skin

                •  sore breasts                                                                 

                •  hair loss or increased hair on face or body

                •  nausea, abdominal discomfort                             

                •  increased or decreased sex drive

                •  nervousness, dizziness                                            

                •  very rarely, a small indentation at the injection site that may

                     be permenant

Warning Signs — call the health center right away if you have

                •  a new lump in your breast                                      

                •  severe depression

                •  yellowing of the skin or eyes                                 

                •  unusually heavy bleeding from the vagina

                •  migraine with aura — gradual onset,                

                •  pus, prolonged pain, or bleeding at injection site yet short-term, visual

                    experience of arcing, bright, flashing zig-zag lines.

                •  severe pain in the stomach or abdomen

Regular physical examinations for routine health care and for screening sexually transmitted infections and cancer are strongly recommended.

2/09  FPCC 8.11