Dear Kerri,

Since the Depo-provera shot is given at three-month intervals, planning ahead is important. If you and your husband want to try to conceive in the near future, you may choose not to have another injection.

Although it is possible for fertility to resume once the last injection has worn off, women experience an average of ten months after the injection for ovulation to return. After stopping Depo-provera, more than 90 percent of women become pregnant within two years.

Women's bodies respond differently to hormonal contraceptives. No one knows your body better than you do. Following are some basic questions to ask yourself:

• How regular was your menstrual cycle before you used hormonal contraceptives?
• How easy has it been to conceive in the past?
• Are there any medical and family risk factors to consider?

Your answers to these questions may help you to determine how your body will respond once ovulation returns.

In case you want to use Depo at some point in the future, — after the birth of a child, for instance:

• If a mother does not plan on breastfeeding, she can receive an injection within five days of giving birth.

• If a mom decides to breastfeed, she can receive a shot six weeks after the birth of the child. The reason that it is advised to wait six weeks is that there are theoretical concerns that the injection may be a risk to infants in the first month. Another reason is that women should abstain from sex for at least six weeks after childbirth. Therefore, there is no need to prevent against pregnancy during these six weeks. In addition, the baby's suckling of the nipples during breastfeeding can delay the return of ovulation. This delay varies depending on a number of characteristics, including how often and how long a baby is breastfed at each feed. Since this delay varies among women, it is best to use a method of contraception to prevent pregnancy.

• However, if a mother is breast- and bottle-feeding her newborn, it is recommended by medical providers that she receive the Depo injection within the first five days of her next menses. In the meantime, another contraception method needs to be used to prevent pregnancy.

For more information about Depo-provera and the pros and cons of all the progestin-only contraceptive methods, see Alice's answers to Depo-provera, Depo-provera backup, and Norplant vs. Progestin-only Pill in her Sexual Health archive.

Alice

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