There are several options marketed around the world, which vary by the hormones used and how long the protection lasts, but only one (Depo-Provera) is approved for use in the United States.
Depo-Provera is 99% in preventing pregnancy if taken as directed, although it’s real-world efficacy is said to be around 94%. In addition to preventing pregnancy, Depo-Provera is approved for use in treating endometriosis and abnormal uterine bleeding.
Each Depo-Provera injection lasts for around 12 weeks. There are two versions currently available in the United States:
Depo-Provera: The standard formulation delivered by an injection into a large muscle of the shoulder or buttocksDepo-subQ Provera: A newer formulation delivered by injection under the skin of the abdomen or thigh
Medroxyprogesterone acetate is also sold under other brand names, including Curretab, Cycrin, Farlutal, Gestapuran, Perlutex, and Veramix.
The Depo Provera carries a black box warning advising consumers of the risk of significant and often irreversible bone mineral loss with long term use. Depo-Provera is also associated with an increased risk of breast cancer and should not be used in women with a known or suspected breast malignancy.
Although not approved for use in the United States, Noristerat is considered safe with similar efficacy and side effects as Depo-Provera. Used widely in the United Kingdom, Latin America, Africa, and parts of Europe, Noristerat is included on the World Health Organization’s List of Essential Medicines.
Norethisterone enanthate is also sold under the brand names Doryxas, Norigest, Nur-Isterate, Syngestal, and Unidepo.
As with Depo-Provera, Noristerat is delivered by injection into the muscle of the shoulder or buttocks.
On the flip side, women who used Noristrat are able to return to fertility faster once treatment is stopped, often within three months.
CICs are available mainly in Africa, Asia, and Latin America under various brand names, including:
Cyclofem Feminena Lunella Lunelle Lunella Mesigyna Novafem
Lunelle was the first and only CIC approved for use by the U.S. Food and Drug Administration in 2000 but was voluntarily discontinued three years later due to concerns about its effectiveness. There have since been no CIC submitted for approval in the United States.
Because CICs also contain less progestin that Depo-Provera or Noristerat, women are more likely to have monthly cycles.
Despite its convenience, Depo-Provera may cause side effects and pose health risks to certain women. This includes a greater risk of weight gain, mood changes, loss of libido, and osteoporosis compared to its oral counterparts.
