Birth Control

In-office shot (Depo-Provera)

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What is the in-office birth control shot (Depo-Provera)? The in-office birth control shot might be for you if... How do you use the in-office birth control shot? How much does the in-office birth control shot cost? What are the side effects and benefits of the in-office birth control shot? Where can you get the in-office birth control shot?

What is the in-office birth control shot (Depo-Provera)?

Depo-Provera (a.k.a. “the shot” or “Depo”) is an injection you get from a health care provider that prevents pregnancy for about three months. The shot contains progestin, which is the synthetic version of progesterone, a hormone made by the body. The shot prevents pregnancy by stopping ovulation from happening, which means that the ovaries don’t release an egg.

With the in-office version of the birth control shot, a health care provider injects the medicine into the muscle of your upper arm or your butt. You go back to your health care provider every 13 to 15 weeks to get a new shot.

There’s also an at-home version of the shot, called Depo-SubQ Provera, that you inject yourself into the fat on your belly or your thigh. It uses a smaller needle, and the medication goes just under your skin.

Quick Facts

Very effective if you use it correctly. Lasts for months, is private, and is a good hormonal option for those who can't take estrogen. Regular visits to a provider required.

Effectiveness

The in-office birth control shot is very effective the way most people use it.

Perfect use: Over 99% effective

Typical use: 96% effective

What are perfect use and typical use?
Hormones

The in-office shot contains the hormone progestin.
Side effects

Irregular bleeding, changes to appetite, and weight gain are the most common side effects.
Cost

Could range from $0 (with insurance) to $200 every three months.
STI protection

The in-office shot doesn’t protect against STIs.
Ongoing effort

You have to go to a provider to get a shot every 12 to 13 weeks.

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The in-office birth control shot might be for you if...

Effectiveness at preventing pregnancy is a top priority for you.

The in-office birth control shot is over 99% effective at preventing pregnancy when used perfectly (exactly as directed). That means fewer than one out of every 100 people using the in-office shot perfectly for a year will get pregnant.

However, the effectiveness of the in-office shot with perfect use is based on the experiences of people involved in clinical trials who are getting the shot on time, every single time, for an entire year. The effectiveness of the shot with typical use, which means the way real people use it in real life, is going to be more relevant for most people. When the in-office shot is used as people typically use it, it’s 96% effective at preventing pregnancy. That means that on average, four out of every 100 people using the in-office birth control shot for a year will get pregnant.

You just had a baby.

If you’ve recently given birth and want to be on birth control, your provider may prescribe the in-office birth control shot. That’s because it doesn’t contribute to blood clots, which you are at increased risk of after giving birth. Also, if you’re providing human milk through breastfeeding, chestfeeding, or expressing milk, both kinds of birth control shots have a lower risk of decreasing milk supply than methods that contain estrogen. However, there is a chance that the shot could decrease your milk supply—speak to your provider about changing methods if it does.

You can’t use birth control methods with estrogen.

The in-office Depo shot may be a good option for people who can’t use estrogen because the only hormone it contains is progestin. Some people experience side effects they can’t tolerate on birth control methods that contain estrogen (like the combination birth control pill), and others may not be able to take estrogen because they’re already at high risk for blood clots, they have breast cancer or another estrogen-sensitive cancer, they have just given birth, they have migraine with aura, or for other reasons.

You want to put in relatively little effort for your birth control to work.

The shot may be a good option if you have a hard time with taking a pill every day. There’s nothing you need to do every day or even every month to make the shot work. You only need to remember to do something once every three months—that’s four times a year.

You want a method that you don’t have to interrupt sex to use.

The shot works for three months every time you get a dose. There’s nothing you need to do besides get the shot on time, every time, in order for it to work. That means you don’t have to interrupt sex to apply spermicide and put in a diaphragm, for example (unless you want STI protection, and then you’ll need to use a condom or internal condom every time you have sex).

You don’t mind changes to your period (or not getting one anymore).

When you are using the Depo shot, you won’t have a regular period or a withdrawal bleed (the period-like bleeding you get when you’re on birth control methods that contain both estrogen and progestin). With the Depo shot, it’s normal to have bleeding or spotting that comes and goes or to have no bleeding at all. It’s totally safe and doesn’t mean you’re pregnant.

You’re comfortable with needles.

If you have a severe fear of needles that causes you to faint or be very upset when you have to get an injection, the in-office birth control shot is probably not for you.

You aren’t looking for STI protection, or you’re okay with combining the in-office Depo shot with another method.

Neither the in-office birth control shot nor the at-home birth control shot offers any STI protection. So if that’s something you’re looking for, you can use condoms or internal condoms along with the Depo shot. Dental dams and/or gloves can also offer STI protection, depending on what kind of sex you’re having. You may also want to consider PrEP (pre-exposure prophylaxis), which is a daily pill or an injection you can get every two months to decrease your risk of getting HIV.

You’re not planning to get pregnant within the next year.

The shot is NOT permanent birth control. The only birth control method that permanently affects your fertility is sterilization.

It is possible to get pregnant as soon as 15 weeks following your last injection, though for some people who use the shot, it can take up to a year after your last injection for your chances of getting pregnant to go back to what’s normal for you. So if you want to prevent pregnancy only in the very short term and would like to get pregnant as soon as you stop birth control, the shot is probably not the best choice for you.

You don’t mind a method that requires a visit to your health care provider.

With the in-office birth control shot, you will have to go see your provider in person every 13 to 15 weeks. If you want to use the shot but don’t want to have to go see your provider regularly, you can check out the at-home birth control shot, which allows you to inject yourself.

You want a method that you can stop without help from a provider.

You can stop using the shot at any time without having to go in for an appointment—all you have to do is not get your next shot. Just keep in mind that it’s possible you will quickly return to whatever level of fertility was normal for you before being on the shot. That means you may be able to get pregnant soon after stopping the shot.

You want to keep your birth control private.

No one can tell when you’ve gotten the in-office birth control shot. There’s no tell-tale packaging, no prescription to refill every month, and nothing you need to do just before you have sex. The only thing you have to worry about if you want to keep your birth control private is keeping your appointments every three months private.

You don’t have these risk factors.

Most people can use the Depo shot safely. However if you currently have breast cancer, the Depo shot is not a good option for you.

How do you use the in-office birth control shot?

To get started using the shot, you will go to the clinic or health center, have a conversation with a provider, and get the shot. A pelvic exam is not medically necessary before getting the shot. Then you’ll schedule your next appointment for three months later. Make sure to discuss where you are in your menstrual cycle (how long ago your last period was) with your provider, which will help you determine how soon after your first shot you’ll be protected from pregnancy.

Most importantly, for the shot to be effective at preventing pregnancy, you need to remember to get it on time—once every 13 to 15 weeks (about every three months). If it’s been more than 15 weeks since your last shot, you will need to use a backup form of birth control, like condoms, until you get your next shot and for seven days afterward. And depending on when you had sex before getting your shot late, your provider may recommend you take a pregnancy test two weeks after you’ve gotten the shot.

How much does the in-office birth control shot cost?

With insurance

If you have health insurance—whether it’s from work, school, your parents, the ACA marketplace, or Medicaid—chances are good that you’ll be able to get this method with no out-of-pocket cost.

Without insurance

If you don’t have insurance or if you’re on a plan that doesn’t cover birth control, the in-office shot can cost up to $200. If you want to get an exam before you start using the shot, the exam may cost extra. You can also ask for the generic version, called medroxyprogesterone acetate, which is usually much more affordable than the brand name version. Depending on your income, you may be able to go to a low-cost clinic to get the shot at a reduced cost. Pfizer’s patient assistance program also offers low cost or free Depo to people who qualify.

What are the side effects and benefits of the in-office birth control shot?

Every method of birth control has positives and negatives. And everyone’s different, so what you experience may not be the same as what someone else experiences.

The Positive

There are lots of things about birth control that are good for your body as well as your sex life. Here are some of the benefits of the in-office birth control shot:

Easy to use
Doesn’t interrupt the heat of the moment
Super private—after you get the shot, no one will know you’re using it unless you tell them
You don’t have to worry about remembering to take it every day
Might give you shorter, lighter periods, or no periods at all
Nothing to worry about with your birth control for three months at a time
Can be used by people who can’t take estrogen
Very effective at preventing pregnancy if you get the shots on time
Safe to use while you’re breastfeeding

The Negative

It’s normal to worry about negative side effects, but for many people, they’re not a problem. Most people adjust to the shot pretty quickly, but it could take a few months.

The most common side effects include:

Irregular bleeding, especially for the first 6-12 months. This could mean longer, heavier periods or spotting in between periods.
Change in appetite and/or weight gain. Some shot users gain around five pounds in the first year, while others gain nothing.

Less common side effects include:

Bone thinning while you’re using the shot.
A change in your sex drive.
Depression.
Hair loss.
More hair on your face or body.
Nervousness or dizziness.
Headache.
Nausea.
Sore breasts.

Many people find that side effects go away over time even if they keep using the shot. If you don’t like the side effects you are having with the shot, it’s totally okay to switch methods, but once you’ve gotten a dose of the shot, there’s no way to undo that dose, so your side effects may continue for a few months. A provider may be able to help with side effects.

In addition to potential side effects, there are some disadvantages to using the shot:

Doesn’t provide STI protection
Requires in-person visits to a provider every three months

Where can you get the in-office birth control shot?

You need to visit a health care provider to get the in-office birth control shot. Find a health center here.