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What are the contraindications and key risks of DMPA?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP.

Posted: 1 October 2026Updated: 1 October 2026 Guideline-Aligned (High Confidence) Clinically Reviewed

Contraindications and precautions

The supplied SmPC extracts refer to contraindications in section 4.3 but do not reproduce that section, so a complete list of absolute contraindications cannot be extracted here .

  • Meningioma: stop medroxyprogesterone acetate if meningioma is diagnosed .
  • Under 18 years or significant osteoporosis risk: consider alternative contraception; in adolescents, use DMPA only when other methods are unsuitable or unacceptable .
  • Long-term use: review risks and benefits every 2 years; women are generally advised to switch to another method at age 50, although continuation can be considered after individual assessment .

Key risks and counselling

  • Bone mineral density loss: DMPA reduces BMD, with greater loss during longer use and recovery usually occurring after discontinuation . The effect on fracture risk later in life remains uncertain .
  • Bleeding changes: irregular bleeding, spotting, prolonged bleeding and amenorrhoea are common, with amenorrhoea becoming more frequent over time . Persistent or severe abnormal bleeding requires investigation .
  • Weight gain: common; gaining more than 5% of baseline weight within 6 months predicts continued weight gain .
  • Delayed fertility return: fertility may take up to 1 year to return after stopping, and the injection's effects are not rapidly reversible . There is no evidence that DMPA causes permanent infertility .
  • Meningioma: observational evidence suggests increased risk, predominantly with prolonged use; a French case-control study reported an odds ratio of 5.55 (95% CI 2.27–13.56) .
  • Breast cancer: current or recent use may be associated with a small increase in risk, but the absolute risk remains very small .
  • Other adverse effects: possible mood changes/depression, reduced libido, acne, headache, hot flushes and injection-site reactions, which are more common with subcutaneous DMPA .
  • Cardiovascular uncertainty: a causal association with venous thrombosis has not been demonstrated, and available evidence cannot confirm or exclude an association with myocardial infarction or stroke .
  • STIs: DMPA provides no protection against sexually transmitted infections .

Educational content only. Always verify information and use clinical judgement.