Contraindications and precautions for depot medroxyprogesterone contraception

The only contraindication (UKMEC 4) to use of depot medroxyprogesterone is current breast cancer.

Depot medroxyprogesterone requires expert clinical guidance or referral (UKMEC 3) in individuals with:

unexplained vaginal bleeding (suspicious for a serious condition) before investigation for the cause
past breast cancer
severe (decompensated) cirrhosis
hepatocellular adenoma or malignant liver tumour
multiple risk factors for cardiovascular disease (eg older age, smoking, diabetes, hypertension, obesity)
hypertension, with vascular disease
history of ischaemic heart disease, stroke or transient ischaemic attack.

Unlike other progestogen-only methods of contraception, depot medroxyprogesterone use is associated with a theoretical but unproven increase in the risk of cardiovascular disease (likely due to its adverse effect on lipids). Use of depot medroxyprogesterone in individuals with multiple risk factors for, or a history of, cardiovascular disease requires specialist advice.

While not included in the UKMEC categorisation, some caution is required if considering depot medroxyprogesterone in individuals with known low bone mineral density (BMD), or risk factors for low BMD; this includes those younger than 18 years or older than 45 years.

See the Faculty of Sexual and Reproductive Healthcare website for a full list of precautions for depot medroxyprogesterone.