In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure depot medroxyprogesterone may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.
What is depot medroxyprogesterone?
Depot medroxyprogesterone is a lab-made hormone similar to the female hormone progesterone. Depot medroxyprogesterone is sold under the brand name Depo Provera®.
Depot medroxyprogesterone injection is effective for preventing pregnancy for approximately 90 days but may be found in the bloodstream longer. It is recommended that women receive a shot every 90 days to prevent pregnancy. Depot medroxyprogesterone is not the same as oral birth control pills, which contain other hormones.
Depot medroxyprogesterone can also be used to treat menstrual disorders and, at high doses, can be used to treat certain types of cancer. This fact sheet is written specifically for the contraceptive depot medroxyprogesterone injection.
I am using depot medroxyprogesterone as birth control, but I would like to try to get pregnant. How long does the drug stay in my body?
Everyone is different. However, on average, it takes around 120 to 200 days following your last injection for the medicine to be undetectable in your system. The manufacturer of the drug found that most women who try to get pregnant after using the Depo-Provera injection get pregnant within 18 months after their last shot. Again, this can vary from person to person. Women trying to get pregnant should talk to their health care provider about taking folic acid before trying to get pregnant.
What are the effects on my baby if I was already pregnant when I received my depot medroxyprogesterone shot?
The majority of studies have not found an association between non-genital birth defects after depot medroxyprogesterone exposure during the first trimester. Also, children exposed to depot medroxyprogesterone during pregnancy or breastfeeding did not show adverse effects on their long-term health or development, including the age or stage when a person can reproduce (called sexual maturity).
There have been case reports of depot medroxyprogesterone and high-dose progesterone hormone use in early pregnancy and babies born with external (outside) genitals that are not clearly male or female (called ambiguous genitalia) in animal and human studies. These effects do not change the internal (inside) reproductive organs or sexual behavior. If correct, these effects are thought to happen less than 1% of the time. This means that 99% of the time we would not expect to find this change.
One study showed there may be an increased chance low birth weight among babies exposed to depot medroxyprogesterone during pregnancy. These pregnancies were unplanned and were compared to pregnancies among women who were planning a pregnancy. No other studies have shown long term health issues from use of depot medroxyprogesterone during pregnancy. Also, there is no evidence that depot medroxyprogesterone causes an increased chance for ectopic pregnancy (when a fertilized egg implants somewhere other than the uterus), or pregnancy loss. When you know you are pregnant you should not continue getting the depot medroxyprogesterone injections.
Are there any effects if I use depot medroxyprogesterone while breastfeeding?
In women using depot medroxyprogesterone during breastfeeding, the amount of hormone found in the breast milk is very small. Many studies have shown that the hormone in breast milk appears to have no effect on the baby’s long term growth and development. If a woman is going to use depot medroxyprogesterone, the World Health Organization and the product label recommend waiting 6 weeks after the baby’s birth before starting. Be sure to talk to your health care provider about all your breastfeeding questions.
- Baheiraei A, et al. 2001. Effects of progestogen-only contraceptives on breast-feeding and infant growth Int J Gynaecol Obstet, 74; 203–205
- Borgatta L, et al. 2002. Pregnancies diagnosed during Depo- Provera use.Contraception. Sep;66(3):169-72.
- Dahlberg K. 1982. Some effects of depotmedroxyprogesterone acetate (DMPA): Observations in the nursing infant and in the long-term user. Int J Gynaecol Obstet 20:43-48.
- Gray RH and Pardthaisong T. 1991. In utero exposure to steroid contraceptives and outcome of pregnancy. Am J Epidemiol 134:795-803.
- Hogue CJ. 1991. Invited commentary: the contraceptive technology tightrope. Am J Epidemiol 134: 812-815; author response 816-817.
- Jaffe B, et al. 1990. Health, growth and sexual development of teenagers exposed in utero to medroxyprogesterone acetate. Paediatr Perinat Epidemiol 4:184-95.
- Jimenez J, et al. 1984. Long-term follow-up of children breast-fed by mothers receiving depotmedroxyprogesterone acetate. Contraception 30:523-533.
- Koetsawang S, et al. 1982. Transfer of contraceptive steroids in milk of women using long-acting gestagens. Contraception 25:321- 331.
- Pardthaisong T, et al. 1992. The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation. Contraception 45:313-24.
- Pardthaisong T and Gray RH. 1991. In utero exposure to steroid contraceptives and outcome of pregnancy. Am J Epidemiol 134:795-803.
- PDR Entry for:Depo-Provera Contraceptive Injection. 2016. Pharmacia and Upjohn Company LLC..
- Ratchanon S and Taneepanichskul S. 2000. Depot medroxyprogesterone acetate and basal serum prolactin levels in lactating women. Obstetrics & Gynecology 96(6):926-8.
- Saxena BN, et al. 1977. Levels of contraceptive steroids in breast milk and plasma of lactating women. Contraception 16:605-613.
- Virutamasen P, et al. 1996. Pharmacodynamic effects of depot-lprogesterone acetate (DMPA) administered to lactating women on their male infants. Contraception 54:153-157.
- World Health Organization Department of Reproductive Health and Research. 2015. Medical eligibilty criteria for contraceptive use: Executive summary. Fifth ed. Geneva. http://apps.who.int/iris/bitstream/10665/172915/1/WHO_RHR_15.07_eng.pdf?ua=1
- Yovich JL, et al. 1988. Medroxyprogesterone acetate therapy in early pregnancy has no apparent fetal effects. Teratology 38:135-144.