This product is intended to prevent pregnancy. It does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
Introduction
Every woman who considers using Medroxyprogesterone Acetate Injectable Suspension, USP needs to understand the benefits and risks of this form of birth control and to discuss them with her health-care provider. This leaflet is intended to give you much of the information you will need in order to decide if Medroxyprogesterone Acetate Injectable Suspension, USP is the right choice for you. Your health-care provider will help you to compare Medroxyprogesterone Acetate Injectable Suspension, USP with other contraceptive methods and will answer any questions you have after you have read this information.
Medroxyprogesterone Acetate Injectable Suspension, USP is given as an intramuscular injection (a shot) in the buttock or upper arm once every 3 months (13 weeks). Promptly at the end of the 3-month interval, you will need to return to your health-care provider for your next injection in order to continue your contraceptive protection.
Medroxyprogesterone Acetate Injectable Suspension, USP contains medroxyprogesterone acetate, a chemical similar to (but not the same as) the natural hormone progesterone that is produced by your ovaries during the second half of your menstrual cycle. Medroxyprogesterone Acetate Injectable Suspension, USP acts by preventing your egg cells from ripening. If an egg is not released from the ovaries during your menstrual cycle, it cannot become fertilized by sperm and result in pregnancy. Medroxyprogesterone Acetate Injectable Suspension, USP also causes changes in the lining of your uterus that make it less likely for pregnancy to occur.
Effectiveness of Medroxyprogesterone Acetate Injectable Suspension, USP
To ensure that Medroxyprogesterone Acetate Injectable Suspension, USP is not administered inadvertently to a pregnant woman, the first injection must be given ONLY during the first 5 days of a normal menstrual period; ONLY within the first 5-days postpartum if not breast-feeding, and if exclusively breast-feeding, ONLY at the sixth postpartum week (see Administration of Medroxyprogesterone Acetate Injectable Suspension, USP). The efficacy of Medroxyprogesterone Acetate Injectable Suspension, USP depends on adherence to the recommended dosage schedule.
Medroxyprogesterone Acetate Injectable Suspension, USP is over 99% effective, making it one of the most reliable methods of birth control available. This means that the average annual pregnancy rate is less than one for every 100 women who use Medroxyprogesterone Acetate Injectable Suspension, USP. The effectiveness of most contraceptive methods depends, in part, on how reliably each woman uses the method. The effectiveness of Medroxyprogesterone Acetate Injectable Suspension, USP depends only on the patient returning every 3 months (13 weeks) for her next injection.
The following table shows the percent of women who become pregnant while using different kinds of contraceptive methods. It gives both the lowest expected rate of pregnancy (the rate expected in women who use each method exactly as it should be used) and the typical rate of pregnancy (which includes women who became pregnant because they forgot to use their birth control or because they did not follow the directions exactly).
Percent of Women Experiencing an Accidental Pregnancy in the First Year of Continuous Use| Method | Lowest | Typical |
|---|
| Source: Trussell et al; Obstet Gynecol 1990;76:558–567. |
| Medroxyprogesterone Acetate | 0.3 | 0.3 |
| Implants (Norplant) | 0.2
| 0.2
|
| Female sterilization | 0.2 | 0.4 |
| Male sterilization | 0.1 | 0.15 |
| Oral contraceptives (pill) | — | 3 |
| Combined | 0.1 | — |
| Progestogen only | 0.5 | — |
| IUD | — | 3 |
| Progestasert | 2 | — |
| Copper T 380A | 0.8 | — |
| Condom (without spermicide) | 2 | 12 |
| Diaphragm (with spermicide) | 6 | 18 |
| Cervical cap | 6 | 18 |
| Withdrawal | 4 | 18 |
| Periodic abstinence | 1–9 | 20 |
| Spermicide alone | 3 | 21 |
| Vaginal sponge | — | — |
| used before childbirth | 6 | 18 |
| used after childbirth | 9 | 28 |
| No method | 85 | 85 |
Who Should Not Use Medroxyprogesterone Acetate Injectable Suspension, USP
Certain women should not use Medroxyprogesterone Acetate Injectable Suspension, USP. You should not use Medroxyprogesterone Acetate Injectable Suspension, USP if you have any of the following conditions:
- if you think you might be pregnant
- if you have any vaginal bleeding without a known reason
- if you have had cancer of the breast
- if you have had a stroke
- if you have or have had blood clots (phlebitis) in your legs
- if you have problems with your liver or liver disease
- if you are allergic to Medroxyprogesterone Acetate Injectable Suspension, USP (medroxyprogesterone acetate or any of its other ingredients)
Other Things to Consider Before Choosing Medroxyprogesterone Acetate Injectable Suspension, USP
Before your doctor prescribes Medroxyprogesterone Acetate Injectable Suspension, USP, you will have a physical examination. It is important to tell your doctor or health-care provider if you have any of the following:
- a family history of cancer of the breast
- an abnormal mammogram (breast X-ray), fibrocystic breast disease, breast nodules or lumps, or bleeding from your nipples
- kidney disease
- irregular or scanty menstrual periods
- high blood pressure
- migraine headaches
- asthma
- epilepsy (convulsions or seizures)
- diabetes or a family history of diabetes
- a history of depression
- if you are taking any prescription or over-the-counter medications
This product is intended to prevent pregnancy. It does not protect against transmission of HIV (AIDS) and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.
Return of Fertility
Because Medroxyprogesterone Acetate Injectable Suspension, USP is a long-acting birth control method, it takes some time after your last injection for its effect to wear off. Based on the results from a large study done in the United States, of those women who stop using Medroxyprogesterone Acetate Injectable Suspension, USP in order to become pregnant, about half of those who become pregnant do so in about 10 months after their last injection; about two-thirds of those who become pregnant do so in about 12 months, about 83% of those who become pregnant do so in about 15 months, and about 93% of those who become pregnant do so in about 18 months after their last injection. The length of time you use Medroxyprogesterone Acetate Injectable Suspension, USP has no effect on how long it takes you to become pregnant after you stop using it.
Risks of Using Medroxyprogesterone Acetate Injectable Suspension, USP
1. Losing Calcium from Your Bones
Medroxyprogesterone Acetate Injectable Suspension, USP use may decrease the amount of calcium in your bones. The longer you are on Medroxyprogesterone Acetate Injectable Suspension, USP the more calcium you may lose. This increases the risk of your bones weakening if you use Medroxyprogesterone Acetate Injectable Suspension, USP continuously for a long time (for more than 2 years). The loss of calcium may increase your risk of osteoporosis and broken bones, particularly after your menopause.
Calcium is generally added to the bones during teenage years. The decrease of calcium in your bones is of most concern if you are a teenager or have the following risk factors:
- -bone disease
- -anorexia nervosa (an eating disorder)
- -a strong family history of osteoporosis
- -drug use that can lower the amount of calcium in bones (drugs for epilepsy or steroids), or
- -drinking a lot of alcohol or smoking a lot.
If you need a birth control method for more than 2 years, your healthcare provider may ask you to switch to another birth control method or ask you to have a test of your bones before continuing Medroxyprogesterone Acetate Injectable Suspension, USP, especially if you have other risks for weak bones. When Medroxyprogesterone Acetate Injectable Suspension, USP is stopped, the calcium in bones begins to come back. Your healthcare provider may tell you take calcium and Vitamin D as this may lessen the loss of calcium from your bones.
2. Irregular Menstrual Bleeding
The side effect reported most frequently by women who use Medroxyprogesterone Acetate Injectable Suspension, USP for contraception is a change in their normal menstrual cycle. During the first year of using Medroxyprogesterone Acetate Injectable Suspension, USP, you might have one or more of the following changes:
- irregular or unpredictable bleeding or spotting,
- an increase or decrease in menstrual bleeding, or
- no bleeding at all.
Unusually heavy or continuous bleeding, however, is not a usual effect of Medroxyprogesterone Acetate Injectable Suspension, USP and if this happens you should see your health-care provider right away.
With continued use of Medroxyprogesterone Acetate Injectable Suspension, USP, bleeding usually decreases and many women stop having periods completely. In clinical studies of Medroxyprogesterone Acetate Injectable Suspension, USP, 55% of the women studied reported no menstrual bleeding (amenorrhea) after 1 year of use and 68% of the women studied reported no menstrual bleeding after 2 years of use.
The reason that your periods stop is because Medroxyprogesterone Acetate Injectable Suspension, USP causes a resting state in your ovaries. When your ovaries do not release an egg monthly, the regular monthly growth of the lining of your uterus does not occur and, therefore, the bleeding that comes with your normal menstruation does not take place. When you stop using Medroxyprogesterone Acetate Injectable Suspension, USP your menstrual period will usually, in time, return to its normal cycle.
3. Cancer
Studies of women who have used different forms of contraception found that women who used Medroxyprogesterone Acetate Injectable Suspension, USP for contraception had no increased overall risk of developing cancer of the breast, ovary, uterus, cervix, or liver. However, women under 35 years of age whose first exposure to Medroxyprogesterone Acetate Injectable Suspension, USP was within the previous 4 to 5 years may have a slightly increased risk of developing breast cancer similar to that seen with oral contraceptives. You should discuss this with your health-care provider.
4. Unexpected Pregnancy
Because Medroxyprogesterone Acetate Injectable Suspension, USP is such an effective contraceptive method, the risk of unexpected pregnancy for women who get their shots regularly (every 3 months [13 weeks] ) is very low. While there have been reports of an increased risk of low birth weight and neonatal infant death or other health problems in infants conceived close to the time of injection, such pregnancies are uncommon. If you think you may have become pregnant while using Medroxyprogesterone Acetate Injectable Suspension, USP for contraception, see your health-care provider as soon as possible.
5. Allergic Reactions
Severe allergic reactions known as anaphylaxis and anaphylactoid reactions have also been reported in some women using Medroxyprogesterone Acetate Injectable Suspension, USP.
6. Other Risks
Women who use hormone-based contraceptives may have an increased risk of blood clots or stroke. Also, if a contraceptive method fails, there is a possibility that the fertilized egg will begin to develop outside of the uterus (ectopic pregnancy). While these events are rare, you should tell your health-care provider if you have any of the Warning Signals listed in the next section.
Warning Signals
If any of these problems occur following an injection of Medroxyprogesterone Acetate Injectable Suspension, USP, call your healthcare provider immediately:
- Sharp chest pain, coughing up of blood, or sudden shortness of breath (indicating a possible clot in the lung)
- Sudden severe headache or vomiting, dizziness or fainting, problems with your eyesight or speech, weakness, or numbness in an arm or leg (indicating a possible stroke)
- Severe pain or swelling in the calf (indicating a possible clot in the leg)
- Unusually heavy vaginal bleeding
- Severe pain or tenderness in the lower abdominal area
- Persistent pain, pus, or bleeding at the injection site
Side Effects of Medroxyprogesterone Acetate Injectable Suspension, USP
1. Weight Gain
You may experience a weight gain while you are using Medroxyprogesterone Acetate Injectable Suspension, USP. About two-thirds of the women who used Medroxyprogesterone Acetate Injectable Suspension, USP in the clinical trials reported a weight gain of about 5 pounds during the first year of use. You may continue to gain weight after the first year. Women in one large study who used Medroxyprogesterone Acetate Injectable Suspension, USP for 2 years gained an average total of 8.1 pounds over those 2 years, or approximately 4 pounds per year. Women who continued for 4 years gained an average total of 13.8 pounds over those 4 years, or approximately 3.5 pounds per year. Women who continued for 6 years gained an average total of 16.5 pounds over those 6 years, or approximately 2.75 pounds per year.
2. Other Side Effects
In a clinical study of over 3,900 women who used Medroxyprogesterone Acetate Injectable Suspension, USP for up to 7 years, some women reported the following effects that may or may not have been related to their use of Medroxyprogesterone Acetate Injectable Suspension, USP:
| • irregular menstrual bleeding | • swelling of the hands or feet |
| • amenorrhea | • backache |
| • headache | • depression |
| • nervousness | • insomnia |
| • abdominal cramps | • acne |
| • dizziness | • pelvic pain |
| • weakness or fatigue | • no hair growth or excessive hair loss |
| • decreased sexual desire | • rash |
| • leg cramps | • hot flashes |
| • nausea | • joint pain |
| • vaginal discharge or irritation | |
| • breast swelling and tenderness | |
| • bloating | |
Other problems were reported by very few of the women in the clinical trials, but some of these could be serious. These include: convulsions, jaundice, urinary tract infections, allergic reactions, fainting, paralysis, osteoporosis, lack of return to fertility, deep vein thrombosis, pulmonary embolus, breast cancer, or cervical cancer. If these or any other problems occur during your use of Medroxyprogesterone Acetate Injectable Suspension, USP, discuss them with your health-care provider.
General Precautions
1. Missed Periods
During the time you are using Medroxyprogesterone Acetate Injectable Suspension, USP for contraception, you may skip a period, or your periods may stop completely. If you have been receiving your injection of Medroxyprogesterone Acetate Injectable Suspension, USP regularly every 3 months (13 weeks), then you are probably not pregnant. However, if you think that you may be pregnant, see your health-care provider.
2. Laboratory Test Interactions
If you are scheduled for any laboratory tests, tell your health-care provider that you are using Medroxyprogesterone Acetate Injectable Suspension, USP for contraception. Certain blood tests are affected by hormones such as Medroxyprogesterone Acetate Injectable Suspension, USP.
3. Drug Interactions
Cytadren (aminoglutethimide) is an anticancer drug that may significantly decrease the effectiveness of Medroxyprogesterone Acetate Injectable Suspension, USP if the two drugs are given during the same time.
4. Nursing Mothers
Although Medroxyprogesterone Acetate Injectable Suspension, USP can be passed to the nursing infant in the breast milk, no harmful effects have been found in these children. Medroxyprogesterone Acetate Injectable Suspension, USP does not prevent the breasts from producing milk, so it can be used by nursing mothers. However, to minimize the amount of Medroxyprogesterone Acetate Injectable Suspension, USP that is passed to the infant in the first weeks after birth, you should wait until 6 weeks after childbirth before you start using Medroxyprogesterone Acetate Injectable Suspension, USP for contraception.
Administration of Medroxyprogesterone Acetate Injectable Suspension, USP
The recommended dose of Medroxyprogesterone Acetate Injectable Suspension, USP is 150 mg every 3 months (13 weeks) given in a single intramuscular injection in the buttock or upper arm. To ensure that you are not pregnant at the time of the first injection, it is essential that the injection be given ONLY during the first 5 days of a normal menstrual period. If used following the delivery of a child, the first injection of Medroxyprogesterone Acetate Injectable Suspension, USP MUST be given within 5 days after childbirth if you are not breast-feeding, or if you are exclusively breast-feeding, the injection MUST be given 6 weeks after childbirth. If you wait longer than 3 months (13 weeks) between injections, or longer than 6 weeks after delivery, your health-care provider should determine that you are not pregnant before giving you your injection of Medroxyprogesterone Acetate Injectable Suspension, USP.