Depo-Provera vs. Skyla

See how Depo-Provera and Skyla compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Depo-Provera is a progestin injection given every 3 months, while Skyla is a small hormonal IUD placed once and left in place for up to 3 years.

  • Depo-Provera carries a boxed warning for bone density loss with prolonged use, a risk that Skyla does not share.

  • Skyla requires a clinician insertion and removal procedure, while Depo-Provera only needs a quick injection at each visit.

Depo-Provera vs. Skyla Drug Summary

Depo-Provera

Depo-Provera is a progestin injection that prevents pregnancy by suppressing ovulation. It is given by a healthcare provider once every 3 months, either into a muscle or under the skin. It has been available since 1992 and is one of the longest-used hormonal contraceptives on the market.

Skyla

Skyla is a small, T-shaped intrauterine device that releases a low, steady dose of the progestin levonorgestrel directly into the uterus. It is placed once by a clinician and can prevent pregnancy for up to 3 years. Skyla was approved in 2013 and delivers the lowest hormone dose among currently marketed levonorgestrel IUDs.

Depo-Provera vs. Skyla Side Effects

Depo-Provera

Most common
headache (up to 17%)
abdominal pain/discomfort (up to 11%)
nervousness (up to 11%)
dizziness (up to 6%)

Skyla

Most common
vulvovaginitis (up to 20%)
abdominal/pelvic pain (up to 19%)
acne/seborrhea (up to 15%)
ovarian cyst (up to 13%)

Depo-Provera vs. Skyla Dosage

Depo-Provera

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 150 mg every 3 months At the start
Maximum dose 150 mg every 3 months Same as starting
Dose changes None Fixed dose

Skyla

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 13.5 mg IUS, one insertion At the start
Maximum dose 13.5 mg IUS, one insertion Same as starting
Dose changes None Fixed dose

Depo-Provera vs. Skyla Indications

Depo-Provera

Depo-Provera is FDA-approved solely to prevent pregnancy. It works by delivering a steady dose of progestin every 3 months, which suits people who want effective birth control without a daily routine. It is not intended for continuous use beyond 2 years unless other methods are inadequate, due to bone density concerns.

  • Prevents pregnancy with an injection every 3 months

  • No daily pill or ongoing device to manage

  • Not recommended for continuous use over 2 years without reassessment

  • Not approved for use before the first menstrual period

Skyla

Skyla is FDA-approved to prevent pregnancy for up to 3 years after a single insertion. It delivers a low, steady dose of levonorgestrel directly to the uterus and is approved for women who have and have not been pregnant. It is not approved for emergency contraception or for use before the first period.

  • Prevents pregnancy for up to 3 years per insertion

  • Approved for both nulliparous and parous women

  • Not approved for emergency contraception

  • Not approved for use before the first menstrual period

Depo-Provera vs. Skyla Pros and Cons

Depo-Provera

Depo-Provera offers effective contraception without a device or procedure, which appeals to people who want to avoid insertion or removal. Its main tradeoff is the boxed warning for bone mineral density loss with prolonged use, plus a return to fertility that can take several months after stopping. Cost is spread across quarterly visits rather than paid upfront.

Pros

  • No insertion or removal procedure required

  • Can be discontinued at any time without a clinical procedure

  • Cost is spread out over quarterly injections rather than one lump sum

  • Available as a subcutaneous option (Depo-SubQ Provera 104)

Cons

  • Boxed warning for bone mineral density loss with prolonged use

  • Requires a clinic visit every 3 months to stay protected

  • Fertility may take several months to return after stopping

  • Weight gain and irregular bleeding are common early on

Skyla

Skyla provides long-acting contraception from a single insertion, with no ongoing visits needed for up to 3 years. Its tradeoffs are the insertion and removal procedures themselves, plus rare but serious risks like uterine perforation or ectopic pregnancy if the device fails. The device requires one large upfront payment rather than smaller recurring costs.

Pros

  • Effective for up to 3 years from one insertion

  • No repeat dosing or clinic visits needed once placed

  • Effectiveness does not depend on remembering routine care

  • Fertility returns immediately once the device is removed

Cons

  • Requires a clinician procedure for both insertion and removal

  • Small risk of uterine perforation or device displacement

  • Requires one large upfront payment rather than smaller recurring costs

  • Ectopic pregnancy risk if pregnancy occurs with device in place

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