Should You Try Birth Control Shots?

Photographed by Megan Madden.
Sometimes, it takes a little shopping around to find the right birth control method for you. But there is a right one for you, we promise. One method, the birth control shot, is far too often overlooked simply because it seems like a hassle — but it doesn't have to be. And there are actually some upsides to it: You don't have to remember to take a pill at exactly the right time or endure the experience of having an IUD shoved into your uterus.
Depo-Provera — a.k.a. "the birth control shot," just "Depo," or the generic form "medroxyprogesterone" — is a three-month dose of progesterone that gets injected in your arm or bum muscle by a doctor, says Taraneh Shirazian, MD, assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Medical Center. The birth control shot isn't necessarily new (it's been around since 1959), and only about one in five sexually active women use it, according to the CDC.
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But it's still totally a thing, and if you're having trouble finding a birth control method that you like, you might want to ask your doctor about the shot. Ahead, Dr. Shirazian answered some questions that you might have if you're considering giving Depo a — ahem — shot.
How does the birth control shot work?
Unlike some hormonal birth control pills, which contain both progesterone and estrogen, the shot just contains progesterone. So the shot works the same way that a progesterone-only pill does, but it's injected directly into your muscle, Dr. Shirazian says. The hormones in the shot "keep you in the second phase of the menstrual cycle perpetually," she explains. That means you won't ovulate, the lining of your uterus will be thinner, and you'll have a much lighter period. The shot will also thicken your cervical mucous so that it's harder for sperm to enter the uterus and fertilise an egg, according to the American College of Obstetricians and Gynecologists (ACOG).
You can start the shot at any time during your menstrual cycle (as long as you're not pregnant), and the hormones kick in right away, ACOG says. But you have to be strict about getting your repeat dose every 13 weeks in order for the hormones to work. Technically, you can get your subsequent shot up to two weeks late, but you'd have to use a backup form of birth control (e.g. condoms) if you're trying to avoid pregnancy.
You do have to physically go to your doctor to get your shot, Dr. Shirazian says, but there is one version of the shot that's meant for home use. If you think you can stomach giving yourself an injection every few months, ask your doctor about that option. Otherwise, be prepared to make (and keep) a bunch of appointments.
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Why do some people get a shot instead of just taking a pill?
Perhaps the most appealing aspect of birth control shots is that you don't have to remember to take a pill each day, Dr. Shirazian says. Of course, if you have an IUD, you don't have to do anything either, but the shot is a "reliable contraceptive method for teenagers or very young women who can't remember to take any other method," or who aren't psyched about the idea of an implant, she says. Also, if you're someone who can't take pills with estrogen (because you get migraines with auras, for example), but don't find that progesterone-only pills work for you, the shot might be a smart alternative.
Beyond the convenience, the progesterone-only shot might have some legit medical benefits. For instance, if you use the shot long-term (at least three years, according to the American Cancer Society) it can reduce your risk of cancer in the uterus, according to the ACOG. Depo could also relieve some symptoms of sickle cell disease and seizure disorders, according to Mayo Clinic. And if you have endometriosis, the ACOG says Depo might actually help lessen your pelvic pain because it makes your uterine lining thinner.
That lighter lining could also cause you to have lighter periods on the shot — or none at all. "You might have irregular spotting because the lining is thin, but not stable," Dr. Shirazian says.
Are there side effects?
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The shot isn't perfect and — like all hormonal birth control methods — it comes with side effects, Dr. Shirazian says. Research suggests that using Depo can decrease your bone mineral density, and perhaps lead to osteoporosis over time, according to the ACOG. So that's pretty worrisome, especially for teens or young people receiving the shot. For this reason, the FDA also has strong warnings against using Depo for longer than two years.
And, after you stop using Depo, it may take 10 months or more for you to start ovulating again. So, if you're trying to get pregnant in the near future, it might not be the right birth control method for you, according to the Mayo Clinic. According to Dr. Shirazian, about 25% of patients experience weight gain with the shot, so that's another side effect to keep in mind. And remember that the birth control shot is, obviously, an injection, which means it might hurt a little bit or cause some bruising around the injection site.
Even though these side effects might seem a little bit scary, many people use Depo and are just fine. Who knows? It might turn out to be exactly what you're looking for. If you're not a fan of other birth control options, "weigh the risk of pregnancy with the [potential] side effects [of the shot]," Dr. Shirazian says. "If pregnancy wouldn't be a good thing for you, then Depo is better than nothing."
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