Myth

I’m on the pill so we don’t need condoms.

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The Shot

"The shot" is an injectable progestin-only prescription method of reversible birth control. It contains a hormone that is similar to the progesterone made by a woman's ovaries to regulate the menstrual cycle. 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 common brand name for the DMPA shot is Depo-Provera.

A shot of DMPA can prevent pregnancy for 12 weeks. It:

• usually, prevents the ovaries from releasing an egg
  (ovulation)
• less often, thickens cervical mucus to prevent sperm
  from joining an egg
• alters the lining of the uterus, which, in theory, may
  prevent implantation of a fertilized egg

Effectiveness

The shot is one of the most effective reversible methods of birth control. Of every 1,000 women who use it correctly and consistently, only three will become pregnant during the first year of use. Three in 100 women will become pregnant with typical use.

Protection is immediate if you take the shot during the first seven days of your period. Otherwise, use a backup method of contraception for the first week. Protection lasts for 12 weeks.

The shot is not effective against sexually transmitted infections. Use a latex or female condom to reduce the risk.

Advantages & Disadvantages

Advantages:

• can be used by women who cannot take estrogen
• can be used while breastfeeding
• effective for 12 weeks
• helps prevent cancer of the lining of the uterus
• no pill to take daily
• nothing to put in place before vaginal intercourse
• very private method — no packaging or other evidence of use that might embarass some users.

Disadvantages:

• must receive shot every three months
• pregnancies, which very rarely occur, are more likely to be ectopic (in a fallopian tube)
• takes an average of nine to 10 months — or sometimes more than a year — to get pregnant after getting the last shot

Possible Side Effects

Irregular bleeding is the most common side effect for women using DMPA. It is more common in the first six to 12 months of use.

• Periods become fewer and lighter for most women, and often stop altogether. The longer a woman uses the shot, the more likely her periods will stop. It may take up to a year for periods to return after a woman's last shot.
• Some women will have longer, heavier periods.
• Some may have increased light spotting and breakthrough bleeding.

DMPA use is associated with temporary bone thinning. Talk with your health care provider about the risks. To help protect your bones, get regular exercise and get extra calcium and vitamin D — either through your diet or by using supplements.

Less Common Side Effects:

• change in sex drive
• change of appetite, weight gain
• depression
• hair loss, or increased hair on the face or body
• headache
• nausea
• nervousness, dizziness
• skin rash or spotty darkening of the skin
• sore breasts

There is no way to stop the side effects of the shot — they may continue until it wears off (12–14 weeks).

Warning Signs

Serious problems are rare. Tell your clinician immediately if you have:

• a new lump in your breast
• major depression
• severe pain in the stomach or abdomen
• unusually heavy or prolonged vaginal bleeding
• yellowing of skin or eyes

Who Can Use the Shot?

Most women can use the shot.

It may be especially appropriate if you:

• want very effective long-lasting contraception
• cannot take estrogen
• are unable to use barrier methods routinely or take a daily pill

Usually women who use the shot need special medical supervision if they have:

• current serious blood clotting conditions
• high blood pressure
• high risk for heart disease
• a history of severe depression
• liver disease, such as hepatitis, abnormal results on liver function tests, or a history of liver tumors

You should not use the shot if you:

• cannot put up with irregular bleeding or loss of your period
• are taking medicine for Cushing's syndrome
• are or might be pregnant
• have a known or suspected breast cancer
• have unexplained bleeding from the vagina
• want to become pregnant within the next year

How to Get the Shot

Your clinician will take your medical history. Depending on your medical history, you may need a partial or complete physical exam.

Your clinician will give you an injection — you may have a temporary bruise.

You will need an injection every 12 weeks for as long as you want to prevent pregnancy.

The Cost

Nationwide, the cost for an exam, if needed, ranges from $35 to $125. Further visits cost between $20 and $40. Each injection costs between $30 and $75. The total cost for each year of use ranges from $235 to $585. Costs vary from community to community, based on regional and local expenses. Contact your nearest PPSEV Health Center for information about costs in our area.

Medicaid may cover these costs. Private health insurance coverage for birth control varies. Family planning clinics usually charge less than private health care providers.

If you are more than two weeks late for your injection, you may need a pregnancy test before having the next one.