Approach to Administering Depo Shots

Administration Guidelines

The Centers for Disease Control and Prevention recommends administering the injection if the patient is within 15 weeks of the last injection, assessing satisfaction with the method, evaluating for new medical conditions, and monitoring weight changes 1, 2
Administer the injection if the patient is on time or up to 2 weeks late without requiring backup contraception, as recommended by the Centers for Disease Control and Prevention 1, 2, 3
If more than 2 weeks late, administer the injection only if reasonably certain the patient is not pregnant, and require abstinence or backup contraception for 7 days, as recommended by the Centers for Disease Control and Prevention 1, 2, 4

Assess patient satisfaction and concerns, and evaluate for any changes in health status or new medications that would change the appropriateness of DMPA, based on the U.S. Medical Eligibility Criteria, as recommended by the Centers for Disease Control and Prevention 1, 2, 4
Monitor weight changes, and counsel patients concerned about weight changes, as recommended by the Centers for Disease Control and Prevention 1, 2, 4
Screen for new contraindications, including history of stroke, myocardial infarction, pulmonary embolism, deep vein thrombosis, and history of meningiomas, as recommended by the Centers for Disease Control and Prevention 1, 2, 4, 5

Counsel patients to use condoms for STI protection, as DMPA provides no protection against sexually transmitted infections, as recommended by the Centers for Disease Control and Prevention 6
Reinforce daily calcium and vitamin D intake, regular weight-bearing exercise, and avoidance of smoking and alcohol, as recommended by the Centers for Disease Control and Prevention 6, 7

Two equivalent formulations are available: 150 mg intramuscularly every 13 weeks, and 104 mg subcutaneously every 13 weeks, as recommended by the Centers for Disease Control and Prevention 6, 7
The 104 mg subcutaneous formulation can be prescribed for self-administration as an off-label use, as recommended by the Centers for Disease Control and Prevention 8, 3, 6

Do not require routine follow-up visits between injections, as recommended by the Centers for Disease Control and Prevention 1, 8, 2, 3
Do not limit use to 2 years based solely on bone density concerns, as the benefits of pregnancy prevention outweigh the risks, as recommended by the Centers for Disease Control and Prevention 6, 7

The Centers for Disease Control and Prevention (CDC) recommends self-administered subcutaneous DMPA-SC as an additional approach to deliver injectable contraception, based on moderate-certainty evidence showing it is safe, effective, and has higher continuation rates compared with provider-administered DMPA 9, 10, 11

Healthcare providers can prescribe DMPA-SC for off-label self-administration when medically indicated, even though the FDA label states it should be administered by a healthcare professional, according to the CDC 9, 12
Self-administration improves contraceptive access by removing barriers such as required in-person visits while promoting reproductive autonomy, as recommended by the CDC 9, 12
Critical implementation elements for self-administration include instruction on self-injection technique, sharps disposal guidance, access to follow-up care, and reinjection reminders, as outlined by the CDC 12

Repeat injections should be provided every 3 months (13 weeks), as recommended by the CDC 9
The injection can be given up to 2 weeks late (15 weeks from last injection) without requiring additional contraceptive protection, according to the CDC 9
No routine follow-up visits are required between injections, but patients should be encouraged to contact a healthcare provider to discuss side effects, change methods, or address injection concerns, as recommended by the CDC 12

Self-administered DMPA-SC should be offered through shared decision-making in a noncoercive manner with focus on patient preferences, as recommended by the CDC 9, 10, 11
Provider-administered DMPA (both IM and SC formulations) must remain available alongside self-administration options to ensure patient choice and access to the full range of contraceptive methods, according to the CDC 9, 10, 12

The Centers for Disease Control and Prevention recommends administering 104 mg of Depo-Provera subcutaneously every 3 months (13 weeks) using proper subcutaneous injection technique 13, 14

The American Academy of Pediatrics states that HIV infection is not a contraindication to Depo-Provera use, with Depo-Provera levels not reduced by antiretroviral agents and largely free of antiretroviral interactions 15
The Centers for Disease Control and Prevention suggests that self-administered DMPA-SC is an option for adolescents eligible to use provider-administered DMPA, and should be offered through shared decision-making in a noncoercive manner with focus on patient preferences 16

The Centers for Disease Control and Prevention recommends counseling adolescents about age-appropriate calcium and vitamin D supplementation and regular weight-bearing exercise 15

The CDC recommends two equivalent depot medroxyprogesterone acetate (DMPA) formulations for hormonal suppression: 150 mg administered intramuscularly every 13 weeks or 104 mg administered subcutaneously every 13 weeks. 17

Both DMPA formulations may be given up to 2 weeks late (i.e., up to 15 weeks from the previous injection) without loss of efficacy. 17, 18

The American Academy of Pediatrics advises that patients receiving DMPA should be counseled to take ≈1300 mg calcium daily, 600 IU vitamin D, engage in weight‑bearing exercise, and cease smoking to mitigate bone‑density concerns. 19