Depo-Provera Gluteus Maximus muscle using a Z-track method

Depo-Provera is a brand
name for Medroxyprogesterone acetate, a female contraceptive injection that
contains progestin hormone. Ideally called the injection or DP, it was approved
in 1992 by the Federal Drug Administration as a type of contraception (Shoup, 2012). The progesterone in the infusion is
similar to that produced naturally in a woman’s reproductive system. The
contraceptive once administered leaves a deposit of medroxyprogesterone which
is released gradually over a 12 week period for prevention of pregnancy. And It
is highly efficient, long-lasting requires little adherence.

How the Method is used

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The first dose of 150mg
Depo-Provera is administered through a deep intramuscular injection into the
Gluteus Maximus muscle using a Z-track method (Depo-Provera,
2018). It works the same way to the implant, as it slowly releases
progesterone hormone into the bloodstream. It is given the first five days of
the menstrual cycle for immediate contraceptive effect; Even though giving it
later than this will require an additional method for at least seven days, but
the injection is then repeated after twelve weeks, and at this time must be
administered before five days. After delivery, the person can have the
injection as soon as five days postpartum if not breastfeeding. However, this
can lead to prolonged bleeding. Thus patients need counseling before
administration of the DP. On the other hand if the injection interval exceeds 12
weeks and five days, a pregnancy test has to be carried out first, and after
administration, the patient has to use additional contraceptive for 14 days.

Again, when a patient
is switching to another hormonal contraception, they have to work on a regime that
works for them. It means that if using oral pills and changing to the DP, the
injection should be administered within seven days after taking the last active
pill. Women that are concerned with Depo-Provera require counseling from a doctor
on potential adverse effects which include bleeding irregularities, weight
gain, bone mineral density, and delayed return to fertility.

How it prevents Pregnancy

The DP prevents
conception in three significant ways. The first is by stopping the ovary from
releasing an egg every month to prevent ovulation. It inhibits ovulation by
lowering the level of follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) and eliminating the LH surge (Hampton, 2013). Suppression of FSC
causes the concomitant destruction of estradiol and estrone production in the
ovaries (Perry 2014). Some other process include thickening of the natural
cervical mucus; making the endometrium less receptive to implantation, and make
sure to limit the activity of cilia in the fallopian tube.

Adverse Effects

One of the most effects
of Depo-Provera is weight gain which affects about 1% of patients. A woman may
experience about 2.25-3.5kg weight gain in the first one or two years of use
(PR, 2013). The weight increases with prolonged use; As a result, users should
consider weight management to manage their weight. The injection also causes
menstrual changes which include Amenorrhoea or heavy bleeding and spotting.
With that being said, practicing nurses should note that Depo-Provera lowers
estrogen levels, which leads to loss of BMD. They should, therefore, maintain
great caution on adolescents and young women below 21 years because they may
have immature bones, and regularly re-evaluating the risks and benefits. A
study demonstrated that women between 21 to 51 years who used Depo-Provera for
five years had reduced bone density in Lumbar spine and the femoral neck
especially those whose family has a history of osteoporosis (PR, 2013).
However, when it’s stopped being use, the bone density returns to normal. Some short
term adverse effects are headaches, abdominal bloating, breast tenderness, and
mood changes plus reduced libido.

Unique Advantages

When it’s correctly
used, the DP is 99% effective, meaning less than one person in 100 who use the
contraceptive injection becomes pregnant in a year (Mumuni,
2014). Again, because it lasts for several weeks, there will be no
strain of thinking about contraceptives every time one wants to have sex. It
is, therefore, a good method for women who easily forget to take the daily
contraceptive pill. Besides, the contraceptive injection provides limited
protection against ovarian cancer and pelvic inflammatory disease because the
thickened mucus in the cervix can stop bacteria from entering the womb (Perry
2014). It is also not affected by other medications and does not interrupt sex.
The injection is also a suitable choice for those who cannot use estrogen-based
contraceptives such as the combined pill, patch, or vaginal ring. The injection
at times reduces heavy and painful menstruation and aids with premenstrual symptoms
in some women.

Protection from STI

Women who use
Depo-Provera are at a higher risk of getting sexually transmitted diseases.
They are more likely to acquire chlamydia or gonorrhea in a one year course
compared to those who birth control pills or non-hormonal contraceptives. In
fact, about 150 million cases of chlamydia and gonorrhea are reported globally
every year, and are responsible for conditions such as infertility and pelvic
inflammatory disease (PR 2013). Due to this, sexually active women with more
than one sexual partner should use condoms consistently. They can also reduce
the number of partners to lower the risk of STI. The injection acts by stopping
the ovaries from releasing eggs thus protecting against pregnancy. This,
however, does not protect against reproductive tract infections. The injectable
contraceptive decreases estrogen levels thus leading to susceptibility to
vaginal and cervical infections. Women should, therefore, consider using
condoms along-side the contraceptive injection for double protection against
pregnancy and sexually transmitted diseases.

 

Cost and Where it can be Obtained

Most contraceptives are
available in most general principal surgeries, community contraception clinics,
and genitourinary medicine (GUM) clinics. It is easy to get the birth control
shot as one can also get it from sexual health clinics which offer
contraceptives and STI testing services. Its cost mostly depends on the place
where you live and the health insurance. In cases where one needs an exam
before the shot, there may be additional costs, and can approximately cost
between $0-$250 (Varney, 2015). The good thing is with
the Affordable Care Act; one gets a cover for birth control for free. Contraception
services are also given for free even for those with no insurance covers
depending on their income and legal status in the U.S. They may qualify for
other programs like Medicaid and local programs that can help pay for birth
control.

How to Bring up the Topic with a New Partner

Taking charge of your
sexuality is very healthy and partners should discuss methods of birth control
to find one that works for them, and learn how to efficiently and consistently
use it. It can start with having a conversation over dinner, or on the phone,
or during a sex discussion before hitting the sheets. You can share what you
like, and discuss protection preference which will actually boost the intimate
adventure as the partners feel comfortable and connected. The woman should be
the first to raise the contraception topic with a new partner in the first
date. Getting intimate with a new person is always nervous and bringing up the
birth control topic may add up the tension. It is therefore many ways to bring
it up before getting intimate with your partner.

In conclusion, women
should take charge of their sexuality. They should understand that apart from
birth control, they need to get protection from sexually transmitted
infections. The contraception injection is an effective method of preventing
pregnancy but should be backed up with condoms to protect against STI and HIV/Aids.