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In a year of typical use, an estimated 3 out of 100 women using Depo-Provera will get pregnant. But the risk of pregnancy is much lower in women who return every 12 weeks for their injections. Depo-SubQ Provera 104 was highly effective in initial studies. However, it's a newer medication, so current research may not reflect pregnancy rates in typical use.

Among the things to consider about Depo-Provera are:

• You may have a delay in your return to fertility. After stopping Depo-Provera, it may be 10 months or more before you begin ovulating again. If you want to become pregnant in the next one year or so, Depo-Provera might not be the right birth control method for you.
• Depo-Provera doesn't protect against sexually transmitted infections. In fact, some studies suggest that hormonal contraceptives such as Depo-Provera may increase a woman's risk of chlamydia and HIV. It isn't known whether this association is due to the hormone or behavioral issues related to the use of reliable contraception. Using condoms will decrease your risk of a sexually transmitted infection. If you're concerned about HIV, talk with your health care provider.
• There's a potential for loss of bone mineral density. Research has suggested that Depo-Provera and Depo-SubQ Provera 104 may cause a loss of bone mineral density. This loss may be especially concerning in teens who haven't yet reached their peak bone mass. And it's not clear whether or not this loss is completely reversible.

Because of this, the Food and Drug Administration added strong warnings to the injection packaging cautioning that Depo-Provera and Depo-SubQ Provera 104 shouldn't be used for longer than two years. The warning also states that using these products may increase a woman's risk of osteoporosis and bone fractures later in life. It's a good idea for a woman who has other risk factors for osteoporosis, such as a family history of bone loss and certain eating disorders, to discuss the potential risks and benefits of this form of contraception with her doctor, as well as learn about other contraceptive options.

Other side effects of Depo-Provera may include:

• Abdominal pain
• Acne
• Breast soreness
• Decreased interest in sex
• Depression
• Dizziness
• Headaches
• Irregular periods and breakthrough bleeding
• Nervousness
• Weakness and fatigue
• Weight gain

Consult your health care provider as soon as possible if you have:

• Depression
• Heavy bleeding or concerns about your patterns of bleeding
• Trouble breathing
• Pus, prolonged pain, redness, itching or bleeding at the injection site
• Severe lower abdominal pain
• A serious allergic reaction
• Other symptoms that concern you

Many experts believe progestin-only contraceptive methods, such as Depo-Provera, carry significantly lower risks of these types of complications than do contraceptive methods that contain both estrogen and progestin.

You'll need to request a prescription for Depo-Provera from your health care provider. He or she will likely review your medical history and check your blood pressure. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products. If you're interested in giving yourself Depo-Provera injections at home, ask your health care provider if that's an option.

To use Depo-Provera:

• Consult your health care provider about a starting date. To make sure you're not pregnant when you're injected with Depo-Provera, your health care provider will likely do your first injection within five days of the start of your period.

If you've just given birth and you're not breast-feeding, your first injection will be done within five days of giving birth. If you're breast-feeding, your first injection will be done six weeks after you give birth. You can start Depo-Provera at other times, but you may need to take a pregnancy test first.

• Prepare for your injection. Your health care provider will clean the injection site with an alcohol pad. After the injection, don't massage the injection site.

Depending on when your start date is, your health care provider may recommend that you use a backup method of birth control for seven days after your first injection. Backup birth control isn't necessary after subsequent injections as long as they're given on schedule.

• Schedule your next injection. Depo-Provera injections must be given every 12 weeks. If you wait longer than 13 weeks between injections, you may need to take a pregnancy test before your next injection to verify that you aren't pregnant.