Contraceptive injections (medroxyprogesterone)

Medroxyprogesterone injections are used as contraception. The injection is long lasting and stops you from getting pregnant for at least 3 months after you have it.

Medroxyprogesterone (also known as medroxyprogesterone acetate) is a type of medicine called a progestogen. Progestogens are similar to a natural hormone made in the body called progesterone.

Medroxyprogesterone works in the same way as natural progesterone, but has stronger effects. The injection stops your body from releasing an egg each month and also makes it less likely that an egg would be fertilised or develop.

Medroxyprogesterone contraceptive injections are only available on prescription. You'll usually have them at a GP surgery, contraception clinic or sexual health clinic.

The most commonly used brand is called Depo-Provera. There is another brand called Sayana Press that you can be taught to give yourself.

Medroxyprogesterone also comes as tablets used to treat hormonal conditions including heavy periods, endometriosis, polycystic ovary syndrome (PCOS) and hot flushes caused by treatment for prostate cancer.

It also comes mixed with another hormone called oestrogen as a type of hormone replacement therapy (HRT), for menopause symptoms.

High dose medroxyprogesterone tablets (100mg, 200mg and 400mg) are used to treat some types of cancer.

Most women and girls who've started their periods can have medroxyprogesterone contraceptive injections.

Medroxyprogesterone contraceptive injections are not suitable for some people. To make sure they're safe for you, tell your doctor before having the injection if you:

• have ever had an allergic reaction to medroxyprogesterone or any other medicine
• are pregnant, trying to get pregnant or breastfeeding
• have a rare condition called porphyria
• have had breast cancer or another type of cancer that is affected by hormones, or if a close relative has had one of these cancers
• have ever had liver problems
• have had a blood clot in a vein (deep vein thrombosis – DVT) or in your lung (pulmonary embolism)
• have had a type of brain tumour called a meningioma
• have high blood pressure
• have had a heart attack or have a heart condition called angina
• have ever had mental health problems
• have migraines
• have diabetes
• have epilepsy
• have hearing loss caused by otosclerosis
• have asthma
• have gallstones
• have lupus
• are at risk of osteoporosis

Medroxyprogesterone contraceptive injections come in syringes that already contain the right dose.

For Depo-Provera the dose is 150mg and for Sayana Press, the dose is 104mg.

You'll usually need to see a doctor or nurse to get the injection. This could be at your GP surgery or at a sexual health or contraception clinic.

Depo-Provera is injected either into a muscle in your bottom or into the top of your arm.

Sayana Press is injected under the skin in your tummy or thigh. You can be taught how to inject it yourself. However, the Sayana Press injection is not available everywhere.

You have the injection during the first 5 days from when your period starts.

You'll usually need to have an injection once every 12 to 13 weeks. Your clinic will advise you on how often to have it.

This will depend on how long you need contraception and your reasons for choosing the injection.

Medroxyprogesterone injections are sometimes stopped after 2 years, but you can keep having them for longer.

If you stay on medroxyprogesterone injections for more than 2 years a doctor may suggest a bone scan to check the strength of your bones.

If you do not have the injection 14 weeks after your last injection, you could get pregnant.

If you forget to have it, talk to the doctor or nurse as soon as you remember. You'll need to use another type of contraception. You will not be able to have the dose late if there's a chance you might be pregnant.

If you have the injection less than 12 weeks after your last injection, it's unlikely to harm you but you could get more of the common side effects.

Talk to the nurse, doctor or your pharmacist.

These common side effects of medroxyprogesterone contraceptive injections happen in more than 1 in 100 people. There are things you can do to help cope with them:

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Talk to your doctor if headaches last longer than a week or are severe.

Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you're in a lot of pain, speak to your pharmacist or doctor.

Try not to eat foods that cause wind (like lentils, peas, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly. There are pharmacy medicines that can also help, such as charcoal tablets or simeticone. Speak to a pharmacist for advice.

It may help if you avoid rich or spicy food.

If it does not go away or it's severe, tell your doctor. They may be able to prescribe an extra medicine to help with this side effect.

Talk to your doctor if you have problems with mood changes and it does not improve.

Talk to your doctor if you have irregular bleeding, or bleeding after you have not had a period for a while. They may be able to prescribe medicine to help, or arrange for extra tests if you need them.

You may lose weight when having medroxyprogesterone injections, but it's more common to gain weight. This is often a small amount.

Eating a healthy, balanced diet and regular exercise will help you keep to a healthy weight.

Speak to your doctor if you have problems with your sex drive (loss of libido). You may need to consider using a different contraceptive.

Stop what you're doing and sit or lie down until you feel better. Do not drive, cycle or use tools or machinery if you're feeling dizzy.

Try to wear a well-fitting and comfortable bra.

Try taking a painkiller, such as paracetamol or ibuprofen.

Try to get plenty of rest. Do not drive, cycle or use tools or machinery if you're feeling tired. Do not drink alcohol as it will make you feel worse.

It may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Wash with a mild soap or cleanser and lukewarm water. Avoid using too much make-up and cosmetics. Speak to a pharmacist for advice about treating acne.

Thinning hair or mild hair loss can be stressful but it is not usually a sign of anything to worry about. Talk to your pharmacist or doctor if you're concerned. Some hair loss treatments are available.

Raise your legs when you're sitting down. Try not to stand for a long time.

If it does not improve or you're also short of breath, talk to your doctor.

Changes including an increase in vaginal discharge are common and are not usually anything to worry about. Talk to your doctor if your discharge changes in smell, colour or texture, as it might be a sign of an infection.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects are rare and happen in less than 1 in 1,000 people.

Call your doctor or call 111 now if:

• you have a high temperature or feel cold and shivery, get a burning feeling when peeing, have pain in your back or side, or blood in your pee – these can be signs of a urinary tract infection (UTI)
• you get pain, swelling, redness and warmth in a leg or arm – this could be a sign of deep vein thrombosis (DVT)
• you get a red painful lump or swelling where you had the injection – this could be a sign of an injection site abscess or infection and it will need to be treated straight away before the infection gets worse
• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin, or if you have pale poo and dark pee – these can be signs of liver problems
• you get blurred vision or double vision – this could be a sign of a build-up of fluid in your eye (oedema)

• you're suddenly short of breath or get a sharp pain in your chest and a cough, or you're coughing up blood – these may be signs of a blood clot in your lungs
• you lose vision suddenly in one or both eyes – this could be a sign of a blood clot

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to a medroxyprogesterone contraceptive injection.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

If you have medroxyprogesterone contraceptive injections for a long time, your bones may become weaker or more fragile (osteoporosis).

To help prevent this, try exercising regularly, and make sure you get enough calcium in your diet to help strengthen your bones. Milk, cheese and leafy greens contain lots of calcium.

Having medroxyprogesterone contraceptive injections for 3 years or longer my also increase your chance of getting a type of brain tumour called meningioma. However, this type of brain tumour is rare, so your chance of getting it is still quite small.

These are not all the side effects of medroxyprogesterone contraceptive injections. For a full list, see the leaflet inside your medicine packet.

Do not have a medroxyprogesterone contraceptive injection if you think you might be pregnant.

If you find that you're pregnant after having the injection, talk to your doctor. But do not worry, as the injection only gives a small amount of progesterone over a long period of time and is unlikely to affect your baby.

It's OK to have a medroxyprogesterone contraceptive injection while you're breastfeeding.

It passes into breast milk in very small amounts and your baby will not be able to absorb a lot into their body from the breast milk. It has not been known to cause any side effects in breastfed babies.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your doctor, pharmacist, health visitor or midwife as soon as possible.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Other medicines will not usually affect how medroxyprogesterone contraceptive injections work.

But tell your nurse or doctor when you go for the injection if you're taking other medicines. You can also talk to a pharmacist.

Do not take St John's wort, a herbal remedy used for depression, with medroxyprogesterone contraceptive injections. It can affect the way medroxyprogesterone works.

There's not enough information to say that other complementary medicines, herbal remedies and supplements are safe to take with medroxyprogesterone contraceptive injections. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.