Depo-Provera vs. Mirena
See how Depo-Provera and Mirena compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Depo-Provera is an injection given every three months, while Mirena is a hormonal IUD that can prevent pregnancy for up to eight years after a single placement.
Both can cause irregular bleeding and headaches, but Depo-Provera carries a boxed warning for bone density loss with long-term use.
Mirena also treats heavy menstrual bleeding and involves a one-time in-office procedure, while Depo-Provera needs no procedure but requires ongoing injections.
Depo-Provera vs. Mirena Drug Summary
Depo-Provera
Depo-Provera is a progestin injection that prevents pregnancy by suppressing ovulation. A healthcare provider gives the shot once every three months, so there is no daily routine to remember. Continuous use beyond two years is generally discouraged because of the risk of bone density loss.
Mirena
Mirena is a progestin-releasing intrauterine device that a clinician places in the uterus to prevent pregnancy for up to eight years. It slowly releases levonorgestrel and is also FDA-approved to treat heavy menstrual bleeding for up to five years. Once placed, it works continuously until removed.
Depo-Provera vs. Mirena Side Effects
Depo-Provera
Mirena
Depo-Provera vs. Mirena Dosage
Depo-Provera
Mirena
| STAGE | DOSE | WHEN |
| Starting dose | 150 mg | At the start |
| Maximum dose | 150 mg | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | ~21 mcg/day release | Day 24 |
| Maximum dose | ~7 mcg/day release | If needed |
| Dose changes | 2 increases | As tolerated |
Depo-Provera
| STAGE | DOSE | WHEN |
| Starting dose | 150 mg | At the start |
| Maximum dose | 150 mg | Same as starting |
| Dose changes | None | Fixed dose |
Mirena
| STAGE | DOSE | WHEN |
| Starting dose | ~21 mcg/day release | Day 24 |
| Maximum dose | ~7 mcg/day release | If needed |
| Dose changes | 2 increases | As tolerated |
Depo-Provera vs. Mirena Indications
Depo-Provera
Depo-Provera is FDA-approved solely for pregnancy prevention through an injection given every three months. It is not intended for continuous use beyond two years unless other contraceptive methods are inadequate, due to the risk of bone mineral density loss.
Prevents pregnancy with an injection every 3 months
Not recommended for continuous use beyond 2 years unless necessary
Not approved for use before the first period (menarche)
Administered by a healthcare provider, no device placement
Mirena
Mirena is FDA-approved to prevent pregnancy for up to eight years and to treat heavy menstrual bleeding for up to five years in those using it for contraception. A clinician inserts and removes the device, and it works continuously without daily attention.
Prevents pregnancy for up to 8 years
Treats heavy menstrual bleeding for up to 5 years
Inserted and removed by a clinician in-office
Not approved for emergency contraception
Depo-Provera vs. Mirena Pros and Cons
Depo-Provera
Depo-Provera offers convenient quarterly dosing without any procedure, but it carries a boxed warning for bone density loss with prolonged use. Its per-injection cost is generally lower than an IUD's upfront price.
Pros
No insertion or removal procedure needed
Only requires a visit every 3 months
Lower per-visit cost than Mirena's one-time device price, roughly $60 to $130 per injection versus $900 to $1,725 for Mirena
Fertility returns after stopping, though it may take several months
Cons
Boxed warning for bone mineral density loss with long-term use
Requires remembering repeat injections every 3 months
Irregular bleeding is very common, especially in the first year
Not recommended for continuous use beyond 2 years unless necessary
Mirena
Mirena provides years of continuous protection after a single placement and can also reduce heavy menstrual bleeding. It requires an in-office procedure and carries device-related risks, along with a higher upfront cost than Depo-Provera's per-injection price.
Pros
Lasts up to 8 years without any repeat dosing
Also FDA-approved to treat heavy menstrual bleeding
Periods often become lighter or stop entirely over time
Delivers hormone locally, limiting systemic exposure
Cons
Requires a clinical procedure for insertion and removal
Small risk of uterine perforation or device expulsion
Higher upfront cost, roughly $900 to $1,725 per device versus $60 to $130 per Depo-Provera injection
No generic version currently available
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