Contraception · Patient guide
The Depo-Provera injection, explained honestly.
A three-monthly progestogen-only contraceptive injection — reliable, discreet, and with a few real trade-offs. This is the plain-English guide, written to FSRH and NICE standards.
Why patients choose us
- 01
An FSRH-trained contraception clinician
Not a rushed 10-minute GP slot. A clinician who does the FSRH UK MEC screen properly and takes the honest downsides seriously.
- 02
The BMD conversation, up front
Bone density is the real trade-off with long-term Depo. We raise it before your first injection, not after year two.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
What Depo-Provera is, in one screen.
Medroxyprogesterone acetate 150mg, intramuscular, every 12 to 13 weeks. Progestogen-only, no oestrogen. Very effective, and with a few real trade-offs.
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How effective
Pearl index under 1 per 100 woman-years with perfect use, about 6 with typical use — more forgiving than a daily pill.
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How it works
Suppresses ovulation, thickens cervical mucus, thins the endometrium. Most users have lighter periods or none at all after 6–12 months.
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What to weigh up
Bone mineral density on long-term use, delayed return of fertility (up to 12 months), possible weight change, and mood — the honest downsides.
The journey
From consult to three-monthly recall — what happens, in order.
One clinician for the eligibility screen, the first injection, and every review after that.
Phase 1 · Before your first dose
Consult and eligibility screen
Phase 2 · First injection day
Twenty minutes at the clinic
Phase 3 · After
Three-monthly recall
- 01
Before
You tell us what you are after
A short, confidential form. Whether you want contraception, help with heavy periods, endometriosis pain, or menstrual suppression for gender-affirming care.
- 02
Before
A proper UK MEC eligibility screen
The FSRH UK Medical Eligibility Criteria are checked — bone health, cardiovascular risk, migraine, liver, breast history, current medication.
- 03
On the day
First injection in clinic
A 150mg intramuscular dose of medroxyprogesterone acetate — usually in the buttock or upper arm. Sayana Press 104mg subcutaneous is an alternative and can be self-administered later.
- 04
On the day
The honest counselling before you leave
What to expect in the first three to six months: irregular bleeding, possible weight change, mood, and the plan for a two-yearly review.
- 05
After
Three-monthly recall
Repeat injection every 12 to 13 weeks (14 at the outside). Missed the window? We tell you what to do and whether a pregnancy test is needed first.
- 06
After
Two-year review, honestly
The FSRH advises reviewing continuation every two years — weighing benefits against BMD, and considering an alternative if risk factors have changed.
- 07
After
Stopping and return of fertility
Fertility can take up to 12 months to return after the last dose. If you are planning pregnancy, we help you switch to a shorter-acting method well in advance.
Recall window: every 12–13 weeks (up to 14). Continuation review: every two years.
When it helps
When Depo-Provera is the right choice.
The situations we see most, plus the one red flag that means the next injection cannot just be given on trust.
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Long-acting contraception
A three-monthly injection for people who want reliable contraception without a daily pill or a device.
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Heavy menstrual bleeding
Depo often reduces or stops periods over time — useful when heavy bleeding is the main complaint.
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Endometriosis pain
Progestogen-only injectables can suppress ovulation and reduce endometriosis-related pain in the right patient.
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Menstrual suppression
Used to stop periods for gender-affirming care, for medical reasons, or by preference.
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Oestrogen not suitable
A useful option when combined hormonal contraception is contraindicated — migraine with aura, VTE history, older smokers.
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Discreet and no-daily-decision
Nothing to take, nothing to feel, nothing partners can see — chosen by people who want privacy from a method.
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Bridging while planning something else
Sometimes used short-term while waiting for a coil, sterilisation or another longer plan to be arranged.
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Red flag: injection overdue past 14 weeks
If your injection is more than 14 weeks after the last dose, a pregnancy test and back-up contraception are needed before restarting.
Options
Depo is one option — not the only one.
What each option on the table actually involves — and which fits which situation.
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Depo-Provera 150mg IM
The classic three-monthly intramuscular medroxyprogesterone injection, given in the buttock or upper arm by a clinician.
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Sayana Press 104mg SC
A lower-dose subcutaneous version, given into the thigh or abdomen — often better tolerated and easier to self-inject.
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Self-administered Sayana Press
After teaching and a first supervised dose, many people give their own Sayana Press at home every 13 weeks.
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Progestogen-only pill (POP)
A daily desogestrel pill — no BMD concern and quickly reversible, but needs to be taken every day.
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Hormonal coil (IUS)
A five to eight-year intrauterine device — often preferred when BMD or delayed fertility is a concern.
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Contraceptive implant
A three-year subdermal rod — long-acting, quickly reversible, and does not affect bone density.
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Copper coil (IUD)
A ten-year non-hormonal option — worth considering if you would rather avoid hormones altogether.
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Consultation only
An honest discussion of whether Depo is the right method for you at all, and which alternative might fit better.
Our vetted London network
A small panel of clinicians, we picked them.
FSRH-trained contraception clinicians across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand what you want.
Selection criteria
How we choose every clinician in our network.
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FSRH-trained clinicians, working to UK MEC standards
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Both Depo-Provera IM and Sayana Press SC offered
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BMD, fertility and mood risks discussed before first injection
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Alternatives (IUS, implant, POP) offered impartially where appropriate
Safety and eligibility
The honest downsides — worth knowing.
Depo-Provera is very effective and, for most people, well tolerated. The trade-offs are BMD on long-term use, delayed return of fertility, and the reality of irregular bleeding for the first few months.
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Irregular bleeding, especially early on
Unpredictable spotting or breakthrough bleeding is common in the first three to six months and usually settles — many people stop bleeding entirely.
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Bone mineral density (BMD) reduction
Prolonged use is associated with a small, largely reversible reduction in BMD. FSRH advises reviewing continuation every two years.
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Delayed return of fertility
Fertility can take up to 12 months to return after the last injection. This is a real consideration if you are planning pregnancy.
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Weight change
Weight gain is small in many users and notable in some — worth tracking, especially if you already have concerns about weight.
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Mood effects
Some people notice low mood or worsening of pre-existing depression on Depo. Tell your clinician — a switch of method usually helps.
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No protection against STIs
Depo prevents pregnancy, not sexually transmitted infections. Condoms remain important for STI prevention.
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Higher-risk groups need extra thought
Under 18 or over 45, low BMI, family history of osteoporosis, long-term glucocorticoids, or a history of anorexia — an alternative is often preferred.
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Do not delay the next injection
The window is 12 to 13 weeks, up to 14. Past 14 weeks a pregnancy test is needed and back-up contraception is used until cover is re-established.
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Red flags
Unexplained vaginal bleeding, a positive pregnancy test, current breast cancer, active liver disease, uncontrolled hypertension, migraine with aura, active thrombosis, or an allergic reaction — do not restart until reviewed.
Reading your notes
Your consultation note in four parts. Read the last one first.
Whichever product was used, the note the clinician sends you keeps to the same shape.
A quiet reminder
Clinical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your next injection, just ask.
- 01 Header
Method chosen and dose
Which product (Depo-Provera 150mg IM or Sayana Press 104mg SC), the dose given, the site of injection, and the batch number.
- 02 Screen
UK MEC eligibility screen
Blood pressure, BMI, migraine history, VTE, breast, liver, bone risk factors — all documented against the FSRH UK MEC categories.
- 03 Counselling
Counselling and consent
A record that irregular bleeding, BMD, delayed fertility, weight, mood, and no STI protection were discussed before your first dose.
- 04 Plan
Recall, review and safety-net
Read this first: the date of your next injection, when a two-year review is due, and what to do if you miss the window or notice a red flag.
Recognised by major UK insurers
Contraception is often self-pay privately, though some insurers cover the consultation where the injection is prescribed for a medical indication (heavy bleeding, endometriosis). We confirm cover before booking.
Frequently asked
Everything we get asked about Depo-Provera.
Quick answers on how it works, bones, fertility, and what to do if an injection is late.
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How does Depo-Provera actually work?
Medroxyprogesterone acetate suppresses ovulation, thickens cervical mucus and thins the endometrium. With perfect use the Pearl index is under 1 per 100 woman-years; with typical use it is around 6 — still very effective, better than the pill in real-world use.
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Depo-Provera or Sayana Press — what is the difference?
Depo-Provera is a 150mg intramuscular injection given by a clinician, usually in the buttock or upper arm. Sayana Press is a lower 104mg subcutaneous version, given into the thigh or abdomen, and can be self-administered at home after teaching. Both are given every 13 weeks.
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Should I be worried about my bones on Depo?
Prolonged use is linked to a small reduction in bone mineral density, which is largely reversible after stopping. The FSRH advises reviewing continuation every two years and considering an alternative in higher-risk groups — under 18 or over 45, low BMI, family history of osteoporosis, long-term steroids, or a history of anorexia.
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How long does it take to get pregnant after stopping Depo?
Fertility can take up to 12 months to return after the last injection. If you are planning pregnancy, we help you switch to a shorter-acting method — such as the pill, implant or coil — well before you want to conceive.
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What if I am late for my injection?
The window is 12 to 13 weeks, and up to 14 weeks the injection can usually be given without a pregnancy test. Past 14 weeks a pregnancy test is needed and condoms should be used for seven days after the next injection.
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Can Depo help with heavy periods or endometriosis?
Often, yes. Depo suppresses ovulation and thins the endometrium, so many users have lighter periods or none at all — useful for heavy menstrual bleeding and for endometriosis-related pain in the right patient.
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Will Depo make me gain weight or feel low?
Some people notice modest weight gain, and some notice low mood or worsening of pre-existing depression. It is worth tracking both, and telling your clinician early — a change of method usually helps.
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