In-office shot (Depo-Provera)

Effectiveness at preventing pregnancy is a top priority for you.

The in-office birth control shot is over 99% effective at preventing pregnancy when used perfectly (exactly as directed). That means fewer than one out of every 100 people using the in-office shot perfectly for a year will get pregnant.

However, the effectiveness of the in-office shot with perfect use is based on the experiences of people involved in clinical trials who are getting the shot on time, every single time, for an entire year. The effectiveness of the shot with typical use, which means the way real people use it in real life, is going to be more relevant for most people. When the in-office shot is used as people typically use it, it’s 96% effective at preventing pregnancy. That means that on average, four out of every 100 people using the in-office birth control shot for a year will get pregnant.

You just had a baby.

If you’ve recently given birth and want to be on birth control, your provider may prescribe the in-office birth control shot. That’s because it doesn’t contribute to blood clots, which you are at increased risk of after giving birth. Also, if you’re providing human milk through breastfeeding, chestfeeding, or expressing milk, both kinds of birth control shots have a lower risk of decreasing milk supply than methods that contain estrogen. However, there is a chance that the shot could decrease your milk supply—speak to your provider about changing methods if it does.

You can’t use birth control methods with estrogen.

The in-office Depo shot may be a good option for people who can’t use estrogen because the only hormone it contains is progestin. Some people experience side effects they can’t tolerate on birth control methods that contain estrogen (like the combination birth control pill), and others may not be able to take estrogen because they’re already at high risk for blood clots, they have breast cancer or another estrogen-sensitive cancer, they have just given birth, they have migraine with aura, or for other reasons.

You want to put in relatively little effort for your birth control to work.

The shot may be a good option if you have a hard time with taking a pill every day. There’s nothing you need to do every day or even every month to make the shot work. You only need to remember to do something once every three months—that’s four times a year.

You want a method that you don’t have to interrupt sex to use.

The shot works for three months every time you get a dose. There’s nothing you need to do besides get the shot on time, every time, in order for it to work. That means you don’t have to interrupt sex to apply spermicide and put in a diaphragm, for example (unless you want STI protection, and then you’ll need to use a condom or internal condom every time you have sex).

You don’t mind changes to your period (or not getting one anymore).

When you are using the Depo shot, you won’t have a regular period or a withdrawal bleed (the period-like bleeding you get when you’re on birth control methods that contain both estrogen and progestin). With the Depo shot, it’s normal to have bleeding or spotting that comes and goes or to have no bleeding at all. It’s totally safe and doesn’t mean you’re pregnant.

You’re comfortable with needles.

If you have a severe fear of needles that causes you to faint or be very upset when you have to get an injection, the in-office birth control shot is probably not for you.

You aren’t looking for STI protection, or you’re okay with combining the in-office Depo shot with another method.

Neither the in-office birth control shot nor the at-home birth control shot offers any STI protection. So if that’s something you’re looking for, you can use condoms or internal condoms along with the Depo shot. Dental dams and/or gloves can also offer STI protection, depending on what kind of sex you’re having. You may also want to consider PrEP (pre-exposure prophylaxis), which is a daily pill or an injection you can get every two months to decrease your risk of getting HIV.

You’re not planning to get pregnant within the next year.

The shot is NOT permanent birth control. The only birth control method that permanently affects your fertility is sterilization.

It is possible to get pregnant as soon as 15 weeks following your last injection, though for some people who use the shot, it can take up to a year after your last injection for your chances of getting pregnant to go back to what’s normal for you. So if you want to prevent pregnancy only in the very short term and would like to get pregnant as soon as you stop birth control, the shot is probably not the best choice for you.

You don’t mind a method that requires a visit to your health care provider.

With the in-office birth control shot, you will have to go see your provider in person every 13 to 15 weeks. If you want to use the shot but don’t want to have to go see your provider regularly, you can check out the at-home birth control shot, which allows you to inject yourself.

You want a method that you can stop without help from a provider.

You can stop using the shot at any time without having to go in for an appointment—all you have to do is not get your next shot. Just keep in mind that it’s possible you will quickly return to whatever level of fertility was normal for you before being on the shot. That means you may be able to get pregnant soon after stopping the shot.

You want to keep your birth control private.

No one can tell when you’ve gotten the in-office birth control shot. There’s no tell-tale packaging, no prescription to refill every month, and nothing you need to do just before you have sex. The only thing you have to worry about if you want to keep your birth control private is keeping your appointments every three months private.

You don’t have these risk factors.

Most people can use the Depo shot safely. However if you currently have breast cancer, the Depo shot is not a good option for you. The shot is not the safest option for you, and you’ll need to talk with a provider about your health before using it if you have a history of breast cancer, chronic kidney disease, are on dialysis, have certain liver conditions or liver tumor, complications from diabetes, have had a blood clot and are still at risk for a blood clot, very elevated blood pressure, heart disease or multiple risk factors for heart disease, rheumatoid arthritis, certain complications of lupus, sickle cell disease (not the trait), or unexplained vaginal bleeding.