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Depo-Provera is a contraceptive or birth control product which is injected every 3 months. Image File history File links Unbalanced_scales. ... . The initial letter is shown capitalized due to technical restrictions. ... Birth control is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of a woman becoming pregnant or giving birth. ...

It is the brand name for a depot formulation of medroxyprogesterone acetate manufactured by Pfizer Inc. It is a hormonal birth control method containing the pregnane (17α-hydroxyprogesterone derivative) progestin medroxyprogesterone acetate, without estrogen, and is administered to women in the form of an intramuscular injection once every 11 to 13 weeks. Depo-Provera causes the ovaries to stop releasing eggs. An injection is a method of putting liquid into the body with a hollow needle and a syringe which is pierced through the skin long enough for the material to be forced into the body. ... Medroxyprogesterone is a molecule used in hormonal contraceptives. ... Pfizer, Incorporated (NYSE: PFE), is a global pharmaceutical company based in New York City. ... A progestin is a synthetic progestagen. ... Estriol. ... Human female internal reproductive anatomy Ovaries are a part of a female organism that produces eggs. ... A human ovum Sperm cells attempting to fertilize an ovum An ovum (plural ova) is a haploid female reproductive cell or gamete. ...

Mechanism

The mechanism of action of progestin-only contraceptives depends on the progestin activity and dose.^[1][2] High dose progestin-only contraceptives, such as injectable Depo-Provera, completely inhibit follicular development and ovulation. Like all progestin-only contraceptives, Depo-Provera also increases cervical mucus viscosity, thereby inhibiting sperm penetration. In anovulatory cycles using progestin-only contraceptives, the endometrium is thin and atrophic. If the endometrium was also thin and atrophic during an ovulatory cycle, this could theoretically interfere with implantation of a blastocyst (embryo). Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. ... The endometrium is the inner uterine membrane in mammals which is developed in preparation for the implantation of a fertilized egg upon its arrival into the uterus. ... Implantation occurs when a fertilized zygote attaches itself onto the lining of the uterus. ... The blastocyst is the structure formed in early mammalian embryogenesis, after the formation of the blastocele, but before implantation. ...

Failure Rates

Most sources cite the failure rate for Depo-Provera at 0.3 percent annually, which would be three women out of a thousand per year.^[3] This number is based on large prospective clinical trials of women actually using Depo-Provera. Another method of determining efficacy is based on retrospective surveys that rely on a woman's recall of her contraceptive use over the past 4 to 5 years, such as the National Surveys of Family Growth (NSFG) -- a primary source of data used for estimating user-dependent contraceptive failure rates in the United States. The number of women in the NSFG retrospective survey using Depo-Provera, Norplant, and IUDs is small, much smaller then number of women in the prospective clinical trials that evaluated the effectiveness of Depo-Provera, Norplant, and IUDs. NSFG survey data may uncover more realistic failure rates for user-dependent contraceptive methods, but has been found to produce unrealistically high failure rates for contraceptive methods that are not user-dependent (this has been attributed to contraceptive overreporting).^[4] For example, NSFG survey data combined from 1988 and 1995 for Depo-Provera, Norplant, and IUDs produced a combined standardized failure rate for these three methods of 3.2 per year. Higher rates (combining Depo-Provera, Norplant, and IUD use) for women aged 20-24 (5.1 percent) and for cohabiting couples (6.5 percent). The two year combined failure rate for Depo-Provera, Norplant, and IUD use for women aged 20-24 was 10.9 percent, which comes out to one woman in ten. ^[5] Norplant is a form of birth control released in 1991 by Wyeth Pharmaceuticals, consisting of a set of six small, silicone capsules filled with levonorgestrel, a synthetic progestin used in many birth control pills. ... This article is about contraceptive uterine devices that do not contain hormones. ...

Benefits

Depo-Provera has several advantages:^[6][7][3][8]

• Highly effective at preventing pregnancy.

• Injected every 3 months. The only continuing action is to book subsequent follow-up injections every twelve weeks, and to monitor side effects to insure that they do not require medical attention.

• No estrogen. No increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, or myocardial infarction.

• Culturally acceptable. Some cultures believe injections are especially efficacious. Injections also afford privacy because use is not detectable.

• Minimal drug interactions (compared to other hormonal contraceptives).

• Decreased risk of endometrial cancer. Depo-Provera reduces the risk of endometrial cancer by 80%.^[9][10][11] The reduced risk of endometrial cancer in Depo-Provera users is thought to be due to both the direct anti-proliferative effect of progestogen on the endometrium and the indirect reduction of estrogen levels by suppression of ovarian follicular development.^[12]

• Decreased risk of iron deficiency anemia, pelvic inflammatory disease (PID), ectopic pregnancy, and uterine fibroids.

• Decreased symptoms of endometriosis.

• Decreased incidence of primary dysmenorrhea, ovulation pain, and functional ovarian cysts.

• Decreased incidence of seizures in women with epilepsy. Additionally, unlike most other hormonal contraceptives, Depo-Provera's contraceptive effectiveness is not affected by enzyme-inducing antiepileptic drugs.^[13]

• Decreased incidence and severity of sickle cell crises in women with sickle-cell disease.^[6]

Estriol. ... Deep-vein thrombosis (also known as deep-venous thrombosis or DVT and colloquially as economy class syndrome) is the formation of a blood clot (thrombus) in a deep vein. ... A pulmonary embolism (thromboembolism) occurs when a blood clot, generally a venous thrombus, becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. ... A stroke, also known as cerebrovascular accident (CVA),[1] is an acute neurological injury in which the blood supply to a part of the brain is interrupted. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Drug interaction is a situation in which two or more separate drugs have been absorbed into the body and their effects are affected by each other, i. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ... Iron deficiency anemia is the most common type of anemia, and the most common cause of microcytic anemia. ... Pelvic inflammatory disease (or disorder) (PID) is a generic term for infection of the female uterus, fallopian tubes, and/or ovaries. ... Uterine fibroids (leiomyomata, singular leiomyoma) are the most common neoplasm in females, and may affect about 25 % of white and 50% of black women during the reproductive years. ... Dysmenorrhea (or dysmenorrhoea), cramps or painful menstruation, involves menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen. ... Mittelschmerz (German: middle pain) is a medical term for ovulation pain. Some women have mittelschmerz regularly and can time their ovulation by it, but many never experience it. ... Benign ovarian cyst. ... This article is about the medical condition. ... Enzyme induction is a process in which a molecule ( a drug) induces ( initiates or enhances) the expression of an enzyme. ... The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... Sickle-cell disease is a general term for a group of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S). ...

Pregnancy and breastfeeding

Depo Provera may be used by breast-feeding mothers. Heavy bleeding is possible if given in the immediate postpartum time and is best delayed until six weeks after birth. It may be used within five days if not breast feeding. While a study showed "no significant difference in birth weights or incidence of birth defects" and "no significant alternation of immunity to infectious disease caused by breast milk containing DMPA", a subgroup of babies whose mothers started Depo Provera at 2 days postpartum had a 75% higher incidence of doctor visits for infectious diseases during their first year of life.^[14] Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ...

A larger study with longer follow-up concluded that "use of DMPA during pregnancy or breastfeeding does not adversely affect the long-term growth and development of children". This study also noted that "children with DMPA exposure during pregnancy and lactation had an increased risk of suboptimal growth in height," but that "after adjustment for socioeconomic factors by multiple logistic regression, there was no increased risk of impaired growth among the DMPA-exposed children." The study also noted that effects of DMPA exposure on puberty require further study, as so few children over the age of 10 were observed.^[15]

Disadvantages and side effects

Warnings and precautions

• Depo Provera can require up to fourteen days to take effect. This means pregnancy can occur within fourteen days of the first Depo injection.

• Takes seven days to take effect if given after the first four days of the period cycle. Effective immediately if given during the first four days of the period cycle.

• Offers no protection against Sexually transmitted diseases (STDs).

• Depo Provera can affect menstrual bleeding. After a year of use, 55% of women experience amenorrhoea; after 2 years, the rate rises to 68%. In the first months of use "irregular or unpredictable bleeding or spotting, or rarely, heavy or continuous bleeding" was reported.^[16]

• Delayed return of fertility. The average return to fertility is 9 to 10 months after the last injection. By 18 months after the last injection, fertility is the same as that in former users of other contraceptive methods^[3][8]

• Long-term studies of users of Depo-Provera have found slight or no increased overall risk of breast cancer. However, the study population did show a slightly increased risk of breast cancer in recent users (Depo use in the last four years) under age 35, similar to that seen with the use of combined oral contraceptive pills.^[16]

• Infants born to women exposed to Depo during pregnancy in one study had an 80% greater chance of dying in the first year of life.^[17]

Sexually transmitted infections (STIs) — also known as sexually transmissible diseases(STDs), venereal diseases (VD), or infrequently, social disease — are diseases or infections that have a significant probability of transmission between humans by means of sexual contact, vaginal intercourse, oral sex, or anal sex. ... Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ... Fertility is a measure of reproduction: the number of children born per couple, person or population. ... The combined oral contraceptive pill, often referred to as the Pill, is a combination of an estrogen (oestrogen) and a progestin (progestogen), taken by mouth to inhibit normal fertility. ...

Black box warning

While it has long been known that Depo-Provera causes bone loss, it has recently been discovered that the osteoporotic effects of the injection grow worse the longer Depo-Provera is administered, may remain long after the injections are stopped, and may be irreversible. For this reason, on November 17, 2004 the United States Food and Drug Administration and Pfizer agreed to put a "black box warning" on Depo-Provera's label.^[18] However, the World Health Organization (WHO) advises that the use of Depo Provera should not be restricted.^[19][20] Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... 17 November is also the name of a Marxist group in Greece, coinciding with the anniversary of the Athens Polytechnic uprising. ... 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food (humans and animal), dietary supplements, drugs (human and animal), cosmetics, medical devices (human and animal) and radiation emitting devices (including non-medical devices), biologics, and... In the United States, a black box warning is a type of warning that appears on prescription drugs that may cause serious side effects. ... The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ...

It is unclear whether the bone density loss associated with Depo-Provera use is reversible, and if so, how completely. Three studies have suggested that bone loss is reversible after the discontinuation of Depo-Provera, although one notes that bone loss was not reversible in long-term users of Depo-Provera.^[21][22][23] Other studies have suggested that the effect of Depo-Provera use on post-menopausal bone density is minimal,^[24] perhaps because Depo users experience less bone loss at menopause.^[25] However, as of 2006, no study has directly examined fracture risk in post-menopausal women who have used Depo-Provera; therefore, the risk is unknown. Pfizer and the FDA recommend that Depo-Provera not be used for longer than 2 years, unless there is no viable alternative method of contraception, due to concerns over bone loss.^[18]

Side effects

In the largest clinical trial of Depo-Provera, the most frequently reported adverse reactions (which may or may not be related to the use of Depo-Provera) were: menstrual irregularities (bleeding or amenorrhea or both), abdominal pain or discomfort, weight changes, headache, asthenia (weakness or fatigue), and nervousness. Other, less frequently reported adverse reactions are listed in the patient and physician label information for Depo-Provera.^[16][26] Amenorrhoea (BE) or amenorrhea (AmE) is the absence of a menstrual period in a woman of reproductive age. ... Asthenia is a medical term denoting weakness, lack of energy and strength. ...

Related studies

• A study of 819 women in one city found an association between using Depo-Provera and higher incidence of chlamydia and gonorrhea.^[27] A second prospective study in 948 Kenyan women found that Depo Provera use was associated with higher rates of chlamydial infection, but lower rates of trichomoniasis and pelvic inflammatory disease, when compared to women using no contraception.^[28]

• Primate studies of medroxyprogesterone have suggested that it may increase the risk of transmission of simian immunodeficiency virus (SIV), an animal model of HIV.^[29][30] At least one study in humans has suggested an increased rate of HIV infection in Depo Provera users,^[31] while a number of other studies have found no such association.^[32][33][34] A large prospective clinical trial addressing the issue of Depo Provera and HIV susceptibility is currently ongoing.^[35]

Chlamydia is a common term for infection with any bacteria belonging to the phylum Chlamydiae. ... Gonorrhoea (USA spelling: gonorrhea, slang term the clap) is among the most common curable sexually transmitted diseases in the world caused by the Gram-negative bacterium called Neisseria gonorrhoeae. ... Trichomoniasis, sometimes referred to as trich or the ping pong disease, is a common sexually transmitted disease that affects 2 to 3 million Americans yearly. ... Pelvic inflammatory disease (or disorder) (PID) is a generic term for infection of the female uterus, fallopian tubes, and/or ovaries. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. ...

Contraindications

The WHO Medical Eligibility Criteria for Contraceptive Use and RCOG Faculty of Family Planning & Reproductive Health Care (FFPRHC) UK Medical Eligibility Criteria for Contraceptive Use list the following as conditions where use of Depo-Provera is not usually recommended or should not be used because of an unacceptable health risk or because it is not indicated:^[36][37] The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ...

Conditions where the theoretical or proven risks usually outweigh the advantages of using Depo-Provera:

• Multiple risk factors for arterial cardiovascular disease
• Current deep vein thrombosis (DVT) or pulmonary embolus (PE)
• Migraine headache with aura while using Depo-Provera
• Before evaluation of unexplained vaginal bleeding suspected of being a serious condition
• Past history of breast cancer and no evidence of current disease for 5 years
• Active liver disease: (acute viral hepatitis, severe decompensated cirrhosis, benign or malignant liver tumours)
• Conditions of concern for hypo-estrogenic effects and reduced HDL levels theoretically increasing cardiovascular risk:
  • Hypertension with vascular disease
  • Current and history of ischemic heart disease
  • History of stroke
  • Diabetes for > 20 years or with nephropathy/retinopathy/neuropathy or vascular disease

Conditions which represent an unacceptable health risk if Depo-Provera is used: Section of an artery An artery or arterial is also a class of highway. ... Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... Deep-vein thrombosis (also known as deep-venous thrombosis or DVT and colloquially as economy class syndrome) is the formation of a blood clot (thrombus) in a deep vein. ... A pulmonary embolism (thromboembolism) occurs when a blood clot, generally a venous thrombus, becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. ... Migraine is a form of headache, usually very intense and disabling. ... An aura is: in Science Aura (symptom), a symptom experienced before a migraine or seizure. ... One of the main problems involving the female reproductive organs is vaginal bleeding. ... Breast cancer is cancer of breast tissue. ... The liver is an organ in vertebrates including humans. ... In medicine (gastroenterology), hepatitis is any disease featuring inflammation of the liver. ... Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ... Hepatocellular adenoma or Hepadenoma is an uncommon benign liver tumour which is associated with the use of oral contraceptive pills with a high oestrogen content. ... Hepatocellular carcinoma (HCC, also called hepatoma) is a primary malignancy (cancer) of the liver. ... Hepatic tumors are tumors or growths on or in the liver (medical terms pertaining to the liver often start in hepato- or hepatic from the Greek word for liver, hepar). ... High-density lipoproteins (HDL) form a class of lipoproteins, varying somewhat in their size (8–11 nm in diameter), that carry cholesterol from the bodys tissues to the liver. ... For other forms of hypertension, see Hypertension (disambiguation). ... It has been suggested that this article or section be merged with Coronary heart disease. ... Ischaemic heart disease is a disease characterized by reduced blood supply to the heart. ... A stroke, also known as cerebrovascular accident (CVA),[1] is an acute neurological injury in which the blood supply to a part of the brain is interrupted. ... This article is about the disease that features high blood sugar. ... Photomicrography of nodular glomerulosclerosis in Kimmelstein-Wilson syndrome. ... Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... It has been suggested that this article or section be merged with Coronary heart disease. ...

• Current or recent breast cancer (a hormonally sensitive tumour)

Conditions where use of Depo-Provera is not indicated and should not be initiated: Breast cancer is cancer of breast tissue. ...

• Pregnancy

A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ...

Other uses

Depo-Provera is also used with male sex offenders as a form of chemical castration as it has the effect of drastically reducing sex drive in males.[1] It has been suggested that Compulsory castration in California be merged into this article or section. ...

Controversy over Approval of Depo-Provera in the United States

There was a long, controversial history regarding the approval of Depo-Provera by the U.S. Food and Drug Administration. The original manufacturer, Upjohn, applied repeatedly for approval. FDA advisory committees unanimously recommended approval in 1973, 1975 and 1992, as did the FDA's professional medical staff, but the FDA repeatedly denied approval. Ultimately, on October 29, 1992, the FDA approved Depo Provera, which had by then been used by over 30 million women since 1969 and was approved and being used by nearly 9 million women in more than 90 countries, including the United Kingdom, France, Germany, Sweden, Thailand, New Zealand and Indonesia.^[38] Points in the controversy included: The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food (humans and animal), dietary supplements, drugs (human and animal), cosmetics, medical devices (human and animal) and radiation emitting devices (including non-medical devices), biologics, and... The Upjohn Company was a pharmaceutical manufacturing firm founded in 1886 by Dr. William E. Upjohn in Kalamazoo, Michigan. ... October 29 is the 302nd day of the year (303rd in leap years) in the Gregorian calendar. ... 1992 (MCMXCII) was a leap year starting on Wednesday. ...

• Animal testing for carcinogenicity. Depo Provera caused breast cancer tumors in dogs. Critics of the study claimed that dogs are more sensitive to artificial progesterone, and that the doses were too high to extrapolate to humans. The FDA pointed out that all substances carcinogenic to humans are carcinogenic to animals as well, and that if a substance is not carcinogenic it does not register as a carcinogen at high doses. Levels of Depo Provera which caused malignant mammary tumors in dogs were equivalent to 25 times the amount of the normal luteal phase progesterone level for dogs. (Which is lower than the pregnancy level of progesterone for dogs, and is species-specific.)[2]
  Depo Provera caused endometrial cancer in monkeys—2 of 12 monkeys tested, the first ever recorded cases of endometrial cancer in rhesus monkeys.^[39] However, subsequent studies have shown that in humans, Depo Provera actually reduces the risk of endometrial cancer by approximately 80%.^[9][10][11]
  Speaking in comparative terms regarding animal studies of carcinogenicity for drugs, a member of the FDA's Bureau of Drugs testified at an agency Depo hearing, "...Animal data for this drug is more worrisome than any other drug we know of that is to be given to well people."

• Cervical cancer in Upjohn/NCI studies. Cervical cancer was found to be increased as high as 9-fold in the first human studies recorded by the manufacturer and the National Cancer Institute.^[40] However, numerous larger subsequent studies have shown that Depo Provera use does not increase the risk of cervical cancer.^{[41][42][43][44][45]}

• Coercion and lack of informed consent. Testing/use of Depo was focused almost exclusively on women in developing countries and poor women of color in the US,^[46] raising serious questions about coercion and lack of informed consent, particularly for the illiterate^[47] and for the mentally retarded, who in some reported cases were given Depo long-term for reasons of "menstrual hygiene", in spite of the fact that they were not sexually active.^[48]

• Atlanta/Grady Study. Upjohn studied the effect of Depo for 11 years in Atlanta, mostly on black women who were receiving public assistance, but did not file any of the required follow-up reports with the FDA. Investigators who eventually visited noted that the studies were disorganized. "They found that data collection was questionable, consent forms and protocol were absent; that those women whose consent had been obtained at all were not told of possible side effects. Women whose known medical conditions indicated that use of Depo would endanger their health were given the shot. Several of the women in the study died; some of cancer, but some for other reasons, such as suicide due to depression. Over half the 13,000 women in the study were lost to followup due to sloppy record keeping." Consequently, no data from this study was usable.^[46]

• WHO Review. In 1992, the WHO presented a review of Depo in four developing countries to the FDA. The National Women's Health Network and other women's organizations testified at the hearing that the WHO was not objective, as the WHO had already distributed Depo Provera in developing countries. Depo was approved for use in US on the basis of the WHO review of previously submitted evidence from countries such as Thailand, evidence which the FDA had deemed insufficient and too poorly designed for assessment of cancer risk at a prior hearing.[3]The Alan Guttmacher Institute has speculated that US approval of Depo may increase its availability and acceptability in developing countries.[4]^[49]

In pathology, a carcinogen is any substance or agent that promotes cancer. ... The luteal phase is the latter phase of the estrous cycle in animals. ... Binomial name Macaca mulatta Zimmermann, 1780 The Rhesus Macaque (Macaca mulatta), often called the Rhesus Monkey, is one of the best known species of Old World monkeys. ... The National Cancer Institute (NCI) is part of the United States Federal governments National Institutes of Health. ... A developing country is a country with low average income compared to the world average. ... The National Womens Health Network is a non-profit womens health advocacy organization located in Washington, D.C.. It was founded in 1975 by Barbara Seaman, Alice Wolfson, Belita Cowan, Mary Howell, M.D., and Phyllis Chesler, Ph. ...

Aftermath

• In 1995, several women's health groups asked the FDA to put a moratorium on Depo Provera, and to institute standardized informed consent forms.^[50]

• In 1994, when Depo was approved in India, India's Economic and Political Weekly reported that "The FDA finally licensed the drug in 1990 in response to concerns about the population explosion in the third world and the reluctance of third world governments to license a drug not licensed in its originating country." ^[51] Some scientists and women's groups in India continue to oppose Depo Provera.^[52] In 2002, Depo was removed from the family planning protocol in India.^{[citation needed]}

• One in five black teenagers using birth control in the US uses Depo Provera, a far higher rate of use than for white teenagers. Activists claim this is because black teenagers are disproportionately targeted for the least safe contraceptives.^[53]

• The Canadian Coalition on Depo-Provera, a coalition of women's health professional and advocacy groups, opposed the approval of Depo in Canada.^[54] Since the approval of Depo in Canada in 1997, a $700 million class-action lawsuit has been filed against Pfizer by users of Depo who developed osteoporosis. In response, Pfizer argued that it had met its obligation to disclose and discuss the risks of Depo Provera with the Canadian medical community.^[55]

In law, a class action is an equitable procedural device used in litigation for determining the rights of and remedies, if any, for large numbers of people whose cases involve common questions of law and fact. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ...

Footnotes

Pfizer, Incorporated (NYSE: PFE) (pronounced faɪzəɹ or faɪzə), is the worlds largest pharmaceutical company. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 21 is the 52nd day of the year in the Gregorian Calendar. ... The Food and Drug Administration (FDA) is an agency of the United States Department of Health and Human Services and is responsible for regulating food (humans and animal), dietary supplements, drugs (human and animal), cosmetics, medical devices (human and animal) and radiation emitting devices (including non-medical devices), biologics, and... For the Manfred Mann album, see 2006 (album). ... May 12 is the 132nd day of the year in the Gregorian Calendar (133rd in leap years). ... The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... For the Manfred Mann album, see 2006 (album). ... May 12 is the 132nd day of the year in the Gregorian Calendar (133rd in leap years). ... Pfizer, Incorporated (NYSE: PFE) (pronounced faɪzəɹ or faɪzə), is the worlds largest pharmaceutical company. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... February 21 is the 52nd day of the year in the Gregorian Calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... The Royal College of Obstetricians and Gynaecologists is a medical institution in England which is responsible for training and regulating medical practitioners who specialise in obstetrics and gynaecology. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... January 11 is the 11th day of the year in the Gregorian calendar. ... The New York Times is a newspaper published in New York City by Arthur Ochs Sulzberger Jr. ... For the Manfred Mann album, see 2006 (album). ... November 20 is the 324th day of the year (325th in leap years) in the Gregorian Calendar. ... For the Manfred Mann album, see 2006 (album). ... August 22 is the 234th day of the year in the Gregorian calendar (235th in leap years), with 131 days remaining. ... For the Manfred Mann album, see 2006 (album). ... August 22 is the 234th day of the year in the Gregorian calendar (235th in leap years), with 131 days remaining. ... For the Manfred Mann album, see 2006 (album). ... August 22 is the 234th day of the year in the Gregorian calendar (235th in leap years), with 131 days remaining. ...

External links

• Pfizer official site
• Research on Injectable contraceptives - Family Health International's fact sheet on injectables, including Depo Provera.
• ContraceptINFO: Information for Consumers about Depo-Provera