Are you thinking about how to change from depo shot birth control to other methods?

This post shows the key considerations – keep reading.

Introduction

The Depo shot is also known as the depot provera or Depo Progesterone injection.

It is a form of birth control which contains the human-made hormone Progesterone given as an injection.

The Depo shot prevents pregnancy mainly by preventing the release of a mature egg from your ovary (ovulation).

It also affects the cervical mucus so that sperm are unable to freely travel within the vagina and womb, reducing the likelihood of pregnancy.

A third effect of the Depo shot is making the environment in your womb unfavourable for a pregnancy to plant in it.

When you take it at the recommended interval, the failure rate of the Depo shot is approximately 0.2% in the first year of use— that is, 99.8% effectiveness.

You will need to return every 13 weeks for a repeat injection of your Depo shot.

This will either be:

• An injection goes into the buttock’s muscle (IM Depot Provera). It can sometimes be given to the shoulder muscle (upper arm).
• Alternatively, an injection under the skin of the abdomen or the front of the thigh (SC – you may buy this as Sayana Press), which you can give yourself (self-administered)

Depo Shot Side Effects, Benefits and Risks

Women who take the Depo injection may experience the following benefits, risks and side effects:

Benefits:

1. Amenorrhoea (absent periods) or reduced menstrual bleeding is common in women using this method. Therefore it may help women with menstrual problems. 
2. Depot Provera use may reduce pain from endometriosis, a chronic condition that causes pelvic pain and heavy menstrual bleeding.
3. Women using the Depo shot may have some protection from ovarian or endometrial cancer. Studies suggest users have no increased risk of these conditions. 
4. Women with sickle cell disease have the Depo shot as a birth control option. Studies do not show a link with developing blood clots (venous thromboembolism). It may reduce the severity of sickle crisis pain.

Risks:

1. Using the Depo shot is associated with a small loss of bone mass. However, that loss returns after you stop the injections.
2. Studies show there is possibly a weak link between the current use of this method and breast cancer. Any increased risk is likely to be small and vanishes with time after stopping.
3. We also recognise a weak association between cervical cancer and the use of depo shot for 5 years or longer. However, any increased risk appears to reduce with time after stopping. Scientists also recognise there may be other factors contributing to cervical cancer among women in the studies.
4. Depo Shot appears to be associated with weight gain. This appears especially in women under 18 years of age with a body mass index (BMI) ≥30 kg/m2.
5. Injection site reactions appear to be more common with the use of subcutaneous (SC) injection than with the use of intramuscular (IM) DMPA.
6. Women need to know that there can be a delay of up to 1 year in the return of fertility after discontinuation of IM or SC depo shots.

Side Effects 

Whilst there is little evidence available to show a direct cause, many possible side effects can happen using the depo shot:

• Acne,
• Decreased libido (sex drive),
• mood swings,
• Headache,
• Hot flushes and
• Vaginitis (irritation in the vagina).

Switching Safely from Depo Shot To Other Methods

There are a few basic principles:

1. Women who stop their Depo shot and do not wish to conceive should be advised to start another contraceptive before or at the time of their next scheduled injection, even if they are not bleeding.
2. You can start depot up to Day 5 of your menstrual cycle and do not need extra protection.

An injection of DMPA can be administered up to 7 days late (up to 14 weeks after the last injection) without the need for additional contraceptive precautions (outside the product licence for IM DMPA)  

Less than 13-14 weeks since your last Depo Shot

You can safely switch to any of the following methods without using extra protection as long as the next injection of your depo is not yet due:

• Combined pill
• Mini pill
• Implant
• Mirena (Progesterone) coil
• Copper Coil

Over 13-14 weeks since your last Depo Shot (and no sex in 14 weeks)

The key issue here is that after 14 weeks, you no longer have the protection of the depo shot hormone and can be at risk of pregnancy. If you have not had sex in the 14 weeks before, then we believe you are not pregnant at the time of switching. But pregnancy could happen in the 2-7 days after the switch. Therefore you should use extra protection (condom or female diaphragm) with your new method as follows:

• Combined pill for 7 days
• Mini pill for 2 days
• Implant for 7 days
• Mirena (Progesterone) coil for 7 days

If you choose to switch to the Copper coil, you have no need to use extra protection in the first week as it begins to work immediately.

Over 13-14 weeks since your last Depo Shot and sex within the last 14 weeks

Things are a little different if you fall into this category, where it’s been over 13-14 weeks after your last shot, but you’ve also had sexual intercourse during that contraception-free time.

We will need to deal with this first – should you consider an emergency method first? Do you wish to wait and do a pregnancy test to see if you are pregnant? Some ladies find themselves in the scenario where they are pregnant and wish to continue and have their baby.

• You can switch to using the combined pill (plus 7 days with a condom) and mini pill (plus 2 days with a condom) after using emergency protection or getting a negative test.
• If you wish to use the implant, first get a pregnancy test – at least 3 weeks after sex before getting the implant. You will need to use a condom for 7 days to allow the hormone in the implant to start working.
• If you wish to use the Mirena coil, you must be sure you are not pregnant before the coil is inserted.
• You can switch to the Copper coil if you only had sex in the last 5 days. In this case, it behaves as your emergency contraceptive method. If it has been over 5 days, the risk of pregnancy co-existing with the coil is present, so you do not use the Copper coil; get a pregnancy test first.

Final Thoughts

You can switch to a condom as your birth control method after the Depo shot. After 14 weeks, you no longer have the protection of the Depo hormone.

However, please remember the condom is not as effective as the shot – even though it provides protection from sexually transmitted infections.

There’s a lot to take in, yes. So please speak to your medical provider to be sure which method best works for you and address whether you are safe to continue.

Use our email information service to reach out for any further clarifications.

More Reading

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• Dangers of Dehydration & How to Prevent Them
• Birth Control Side Effects – These Methods will Not Affect Your Sex Drive!
• Libido – Choose These Birth Control Methods If You Can’t Have Hormones!

Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on various healthcare conditions to provide evidence-based guidance and help promote quality healthcare. 

The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org

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