When you smoke and you're on the depo-provera shot, why is it even worse?

What is worse?: Do you mean that there are some side effects that are worse in smokers who use depo-provera? I'm not aware of this. Depo Provera (medroxyprogesterone) does cause a decrease in bone density, though there is research to show that this decline in bone density resolves when people go off the medication. Smoking also is related to loss of bone density and the two together are worse than either alone.

Blood clots: Smoking tobacco products increases the clotting of our blood, and the chances of getting deep vein thrombosis (blood clots in veins of the legs), which can damage circulation, and more seriously, break off and go to the lungs, causing pulmonary embolus and potentially death. Many doctors will not prescribe them to people who smoke, and recommend other birth control methods. Please stop smoking.