Written by Mariela Cabrera, MD

Depot medroxyprogesterone acetate (DMPA), considered to be one of the oldest forms of modern contraception, received FDA approval in 1992.¹ It has proven to be a safe, reliable, and convenient method of contraception for many people. It is a progestin-only form of contraception that is administered intramuscularly or subcutaneously.⁴ Because of its slow release from the muscle, DMPA has a prolonged duration of action, lasting approximately 3 months. The circulating progesterone works by inhibiting the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) surge during a menstrual cycle, thus preventing ovulation.² The lack of estrogen makes DMPA a good option for people who breast/chestfeed and for individuals with medical conditions that preclude the use of estrogen.

Multiple studies have shown the safety profile of DMPA.^5,8 The most widely recognized side effects are changes in menstrual bleeding and potential impacts on bone density. However, a study published in March 2024 discussing the use of progesterones and the risk of intracranial meningiomas has sparked much debate.³ This case-control study, based in France from 2009 to 2018, examines the association between intracranial meningiomas and exposure to different types of progestins throughout a person’s lifetime. The study claims that individuals exposed to DMPA for more than 1 year, throughout their life, have an increased risk of developing meningiomas compared to people without DMPA exposure (5 out of 10,000 people (0.05%) vs 1 out of 10,000 people (0.01%) respectively).³ The study findings had a significant impact, and in December 2025, the FDA approved changes to the warning label of DMPA to include the risk of developing meningiomas.⁶ 

However, the study has significant limitations, and great caution should be used when interpreting the results. First, the study identified 18,000 people affected by meningiomas, and of those, only 9 individuals had been exposed to intramuscular DMPA. The findings from such a small sample of individuals exposed to DMPA should not be applied widely to the general population. Second, study conclusions and reports of causality are based on a faulty premise, as this was an observational case-control study, which cannot establish disease causation. Making definitive claims that using DMPA causes meningiomas undermines the safety of this medication. 

While the risk of developing meningiomas with DMPA exposure should not be overlooked, it remains very low. A second large retrospective cohort study published in 2025 further investigated the relationship between meningiomas and DMPA exposure. Xiao et al demonstrated that patients who used DMPA had a 2.43 fold higher relative risk of developing meningiomas, but this finding was concentrated in patients who had received DMPA for more than 4 years or were over 31 years old, suggesting a duration and age-dependent effect.^10* The authors calculated the number needed to harm (NNH) at 1152 patients, which is high. So although DMPA use is statistically associated with meningioma risk, the high NNT suggests that this association may not be clinically significant.¹⁰

Shared decision-making should always be used when counseling patients about contraception.⁷ It is important to recognize the findings and limitations of these studies and discuss them with individuals. DMPA has many health benefits beyond contraception, such as reduced painful menses and decreased risk of ovarian cancer, that should be understood.⁹ Discussing the benefits and risks of DMPA can instill confidence in patients’ choice of contraception and lead to greater patient satisfaction and patient-provider trust. 

*02/17/2026: This article was updated to correct for a grammar error in the sentence.

RHAP Resources:

Your Birth Control Choices Fact Sheet

Progestin Injection Perpetual Calendar

The Shot (Depo Provera) User Guide

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Sources:

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