Depo Diaries Questionnaire

Be a Volunteer!
Help us collect Depo Stories through interviews. Please download this 'how to' information and send all collected stories to depodiaries@cwpe.org.

Many women who have taken Depo Provera have suffered changes in their health – changes that are often dismissed by their doctors and healthcare providers as minor, unimportant, or inconsequential. But changes such as weight gain, headaches, bleeding, and depression are serious concerns when they are happening to you.

We are interested in your experiences with Depo Provera (aka ‘the shot’, or Depo). In addition to a questionnaire, we are collecting your personal stories so that we can begin to document what Depo’s real effects have been. These questionnaires and stories will help us create a more accurate picture of the range and kinds of side effects women have experienced.

We hope you will fill out the questionnaire below so that we can better track the details of the use of Depo Provera. Your responses will be kept completely confidential. After the questionnaire there is room for you to write your story. If you prefer, you can send us your story via email, snail mail, or call for a phone interview.

Month/Year
State/Country
Some things you could include in your story:
  • Where did you hear about Depo?
  • How much did you know about Depo when you decided to take it?
  • Was it easy for you to ask questions of the person who prescribed it? Did you feel comfortable?
  • Did you get and read a consent form before taking it?
  • Did the person who prescribed Depo or administered the shot treat you respectfully or disrespectfully? How were you made to feel?
  • How frequently do you use a health clinic? Did you just go in to get Depo or did you go consistently?
  • Did you suffer from any negative side effects from Depo such as changes in weight, bleeding, headaches, depression?
  • If so, how long did these effects last?
  • Why did you stop using Depo?
  • Do you think Depo is a safe, good contraceptive?
  • Did you use condoms before taking Depo?
  • Did you use condoms once you had Depo?
  • Do you think it is necessary to use condoms if you are on Depo?
  • Was it difficult for you to ask your partner to use condoms because you were already on one method of birth control?