Depo-Provera and the Birth Control Pill

Medically Reviewed by Jabeen Begum, MD on March 14, 2023
5 min read

Depo-Provera, or the birth control shot, and birth control pills are two types of contraceptives that use hormones to prevent pregnancy. Both are very effective, but there are some key differences between them. You can switch from one to the other, but you should consider their similarities and differences first.

Remember, you’ll also need condoms to help prevent sexually transmitted diseases (STDs). The pill and the shot don’t do that.

Depo-Provera is a contraceptive injection that contains the hormone progestin. The hormone in the shot stops your ovaries from releasing an egg and thickens your cervical mucus, which prevents sperm from reaching the egg. It also thins the lining of the uterus, preventing implantation of a fertilized egg.

How you take it: You need to get the injection every 3 months for it to continue to prevent pregnancy.

Depo-SubQ Provera 104 is a new and lower-progestin version of Depo-Provera that's injected under your skin instead of into your muscle. It may cause fewer hormone-related side effects. 

How you take it: It's injected under your skin every 3 to 4 months.

Most birth control pills are made up of two hormones: estrogen and progesterone (except for the minipill, which has progestin only). These are “combination” pills. The hormones in them work together to prevent ovulation, the process that triggers your ovaries to release an egg. This type of pill also makes the mucus around your cervix thicker, which makes it harder for sperm to reach the egg.

Sometimes, the pill changes the lining inside the uterus. This can help stop fertilized eggs from implanting.

How you take it: You must take the pill every day around the same time to maximize pregnancy prevention.

How fast they work. It takes about 7 days for the pill to take effect. But to be safe, use extra protection, like condoms, for the first month.

The shot starts to work right away as long as you get it in the first 5 to 7 days of your period. If your doctor decides to start the shot in the middle of your cycle, you’ll need to use condoms as a backup method for a week afterward.

Side effects for both methods can include:

  • Weight gain
  • Depression
  • Nausea
  • Headaches
  • Mood changes
  • Blood clots, which are rare for women under 35 who don’t smoke

Benefits of both methods include:

  • You might have lighter periods with less blood and cramping (and sometimes no period at all).
  • You have a lower risk of anemia because of lighter periods.
  • They help prevent certain cancers, ovarian cysts, and other illnesses.

The pill also keeps your period more regular. It tends to start more predictably, about every 28 days. And it could help clear up your skin. The hormones may help prevent acne, though it could take a few months before you see the difference.

The shot could also help with symptoms of sickle cell disease and epilepsy (less seizures). And it could be a good replacement for the pill if you want birth control without estrogen, which can raise your risk of blood clots.

Can you take both? Doctors recommend choosing one effective birth control method that works for you. Unless you’re switching from the pill to the shot or vice versa, you probably won’t take both.

Both the birth control pill and the shot are effective ways to prevent pregnancy. To find out which method might be better for you, consider these things:

  • Success rate. Both methods are very effective. Only 6 out of every 100 women who get the shot will become pregnant, which is a 94% success rate. The pill has a 90% success rate overall -- but the success rate is higher when used perfectly.
  • Risks. Most women have few to no side effects after taking the birth control pill, but you shouldn’t take it if you have a history of blood clots, certain cancers, or migraine headaches with aura. You should also avoid the birth control shot if you have a history of any of those conditions or liver disease. Other risks linked to the shot include a loss in bone density in women, which may not recover completely. You should also know that the shot can also lower fertility for up to a year after you stop getting it. And if you smoke, are over age 35, have uncontrolled high blood pressure, or have had breast cancer, your doctor may recommend that you not take the pill.
  • Your lifestyle. You’ll need to take the pill every day around the same time to get the best results. The shot is most effective when you get an injection every 3 months. Before you decide, consider which method will best fit your lifestyle.
  • Cost. If not covered by insurance, birth control pills can cost anywhere from $0 to $50 a month depending on the type. Each injection (which you’ll need every 3 months) can cost up to $150 if your health insurance doesn’t cover it. Progestin-only pills are now available over the counter for about $50.

If you’re thinking of making a change, talk to your doctor. Make sure you have no gaps between methods. You may also want to use a backup method (such as condoms) during the transition.

If you’re switching from a birth control pill to a shot, get your first shot 7 days before you stop taking the pill. You need to finish your pill pack before you switch methods.

If you switch from the shot to a pill, you can take your first pill up to 15 weeks after your last birth control shot.

You may notice some changes in your period after you switch birth control methods. That’s normal. You don’t need to wait for your period to start before you stop the old method or start the new one.

How do you get them? It depends on where you live. In some states, you need to see your doctor for a prescription for combination birth control pills. But pharmacists can also prescribe them in some states. Progestin-only pills are now available over the counter.

You get Depo-Provera shots from your doctor.

How much do they cost?

  • Depo-Provera: Each shot costs between $0 and $150. Your insurance should cover it, but check your plan to be sure it includes Depo-Provera.
  • The pill: Many insurance plans cover the pill. You’ll probably pay between $0 and $50. Over-the-counter progestin-only pills are about $50.

If you don’t have insurance, family planning clinics will usually provide the pill, Depo-Provera, or some other form of safe birth control at little or no cost.