The DMPA contraceptive injection is a generally used reversible contraceptive technique amongst girls in america. Also referred to as the “shot,” the injection is often identified by its brand-name Depo Provera (depot-medroxyprogesterone acetate or DMPA), though generic options can be found. It was first launched in america in 1959 for administration of menstruation and was accepted for contraceptive use by the U.S. Meals and Drug Administration (FDA) in 1992. This factsheet gives an summary of the categories, use, consciousness, availability, and insurance coverage protection of contraceptive injection within the U.S.
How does the DMPA Injection work?
The shot works by releasing the hormone DMPA, a progestin, which suppresses ovulation and thickens cervical mucus that additionally helps preserve sperm from fertilizing an egg. DMPA will be supplied by an intramuscular shot (DMPA-IM) administered by a clinician or by a subcutaneous shot (DMPA-SC) that may be injected by the affected person at residence (Desk 1). Each kinds are FDA-approved and should be administered as soon as each 12 weeks to be efficient. Model-name Depo-Provera and the generic equivalents for medroxyprogesterone acetate are intramuscular injections, offering 150mg of progestin in a single dose. The Depo-subQ Provera 104 injection makes use of a smaller needle and a decrease dose of progestin (104 mg) than the intramuscular different. As a result of Depo-subQ Provera 104 makes use of a smaller needle, it may be much less painful than the intramuscular injection and will be administered by the affected person at residence. This technique is taken into account a protected, “off-label” technique whereas having the identical contraceptive effectiveness. Like most contraceptives, the DMPA shot doesn’t shield in opposition to STDs; use of condoms is really helpful to cut back the danger for STDs, together with HIV, whereas utilizing DMPA pictures.
Desk 1
Kinds of Delivery Management Injections
Injection Technique
Injection Identify
Injection Administrator
Dosage
Injection Frequency
Potential Facet Results
Intramuscular
Model: Depo-Provera
Generic options are additionally out there.
Supplier solely.
150mg of progestin.
12 weeks (3 months).
Menstrual irregularities.
Weight acquire.
Bone density loss.
Subcutaneous
Model: Depo-SubQ Provera 104
No generic different is accessible but.
Supplier or affected person.
104mg of progestin.
The DMPA shot has a typical use failure price of 4% when used as soon as each 12 weeks or three months. Lengthy-acting reversible contraceptive (LARCs) strategies equivalent to implants, intrauterine units (IUDs), and everlasting contraceptive strategies equivalent to vasectomies and tubal ligations are usually simpler than the shot as a result of these strategies contain little to no follow-up care, whereas injections should be repeated each 12 weeks so as to be efficient. Condoms or one other non-hormonal contraceptive are really helpful as a back-up for 7 days after the primary injection. If a affected person is greater than 4 weeks late for a shot (16 weeks after their final shot), it’s endorsed that they take a being pregnant check earlier than the subsequent dose and that they use condoms or one other non-hormonal contraceptive as a back-up for one more 7 days in the event that they obtain one other shot. It takes a mean of 10 months for being pregnant to happen after stopping the injection, which is corresponding to different strategies equivalent to IUDs and oral contraceptive drugs.
Advantages and Facet Results
The DMPA shot has a number of non-contraceptive advantages but in addition has some unwanted effects and dangers. Advantages embrace decrease threat of uterine most cancers and diminished signs of endometriosis. Nonetheless, the injectable has the best discontinuation price amongst contraceptives within the U.S., related to unwanted effects which embrace menstrual irregularities (recognizing or cessation of intervals) and weight acquire. Of observe, Depo-Provera comes with a black field warning from the FDA that the contraceptive injection shouldn’t be used as a long-term (longer than 2 years) technique until different contraceptive strategies are thought-about insufficient, as girls who use Depo-Provera could lose vital bone density. Nonetheless, the American Faculty of Obstetricians and Gynecologists (ACOG) and the World Well being Group (WHO) disagree with this warning, stating that loss in bone density from DMPA just isn’t related to fractures and seems to be reversible after discontinuation of the injectable. Each organizations conclude that the advantages of DMPA use outweigh the theoretical fracture threat, and that DMPA could also be prescribed with out limitations on its length of use.
Use, Consciousness, and Availability of the Contraceptive Injection
Primarily based on the latest knowledge on contraceptive use from the Nationwide Survey of Household Development, roughly 3% of girls who used contraception from 2017-2019 reported that they used the contraceptive injection previously month. During the last 20 years, girls’s entry to and choices of varied contraceptive decisions have modified, and total use of the injection has declined, as extra girls are utilizing LARCs, equivalent to IUDs and implants. In the course of the first few years of the COVID-19 pandemic, nonetheless, the provision of and curiosity in utilizing DMPA-SC elevated resulting from restrictions positioned on in-person clinic appointments. A 2023 Contraception research experiences that there was a big enhance in provision of DMPA-SC for self-injection throughout this time, though that is nonetheless a small portion of total use of DMPA-SC.
Amongst reproductive age girls who used any type of contraception from 2017-2019, the contraceptive injection was most frequently utilized by younger girls, lower-income girls, and Black girls. Use of the injection additionally decreased with academic attainment – smaller shares of girls with bachelor’s levels reported utilizing the shot as their contraceptive technique (Determine 1).
Insurance coverage Protection and Price of the Contraceptive Injection
The Reasonably priced Care Act (ACA) requires most non-public insurance coverage and Medicaid growth packages to cowl considered one of every of the 18 FDA-approved contraceptive strategies with out price sharing. Girls with non-public insurance coverage and people with Medicaid protection are eligible for affected person schooling, counseling, and entry to at the least one type of the contraceptive injection with out cost-sharing. Protection additionally contains the primary physician’s go to, discontinuation of the shot, and administration of unwanted effects. Though protection contains at the least one type of the injection, plans could not cowl each the intramuscular formulation and Depo-subQ Provera 104; nonetheless, if a clinician determines {that a} explicit injectable formulation is medically acceptable for a affected person then the plan should cowl that kind.
Security-net clinics that take part within the federal Title X household planning program provide low or no-cost contraceptives to uninsured adults and teenagers on a sliding scale and should forego costs for these on the bottom finish of the earnings scale. The Workplace of Inhabitants Affairs (OPA) throughout the U.S. Division of Well being and Human Companies (HHS) reported that, in 2022, roughly 302,000 girls acquired the DMPA injection as their major contraceptive technique from a Title X service supplier.
In 16 states (CA, CO, HI, ID, IL, IN, MD, ME, MN, NV, NM, NH, OR, SC, TN, VA) and the District of Columbia, pharmacists can present the intramuscular contraceptive shot on to girls with out the necessity to first go to a doctor to acquire the prescription and injection (Determine 2). In some states like Hawaii, Indiana, and Maryland, the statewide protocol or standing order doesn’t explicitly state that the DMPA injection will be provided however does state that every one FDA-approved hormonal contraceptive strategies will be administered by pharmacists. Nonetheless, pharmacist participation in these packages just isn’t required and implementation has assorted throughout states. Moreover, whereas the precise DMPA shot is often coated, girls will seemingly must must pay out-of-pocket for a pharmacist session price, which isn’t required to be coated beneath the contraceptive protection legal guidelines in most of those states and by federal legislation by way of the ACA.
