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

Most common
Menstrual irregularities (up to 57%)
Weight gain (up to 38%)
Headache (up to 17%)
Abdominal pain/discomfort (up to 11%)

Mirena

Most common
Unscheduled uterine bleeding (up to 31.9%)
Abdominal/pelvic pain (up to 22.6%)
Amenorrhea (up to 18.4%)
Headache/migraine (up to 16.3%)

Depo-Provera vs. Mirena Dosage

Depo-Provera

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 150 mg At the start
Maximum dose 150 mg Same as starting
Dose changes None Fixed dose

Mirena

Dosage
Dosage Table
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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