Medroxyprogesterone acetate depot

Table 46-1 illustrates the pathophysiology of amenorrhea relative to the organ system(s) involved, as well as the specific condition that results in amenorrhea. Amenorrhea is also a normal side effect that may result from the use of low-dose oral contraceptives (OCs), extended-cycle OC pill use, or depot medroxyprogesterone acetate use.5 Many women may experience delayed return of menses after discontinuation of OCs. Postpill amenorrhea usually is a self-limited condition. Further evaluation for other unrecognized conditions, such as polycystic ovary syndrome (PCOS), should be considered if spontaneous resolution of the amenorrhea does not occur within 3 to 6 months following discontinuation of the OCs.6,7... 

Drug-induced osteoporosis may result from systemic corticosteroids (prednisone doses greater than 7.5 mg/day), thyroid hormone replacement, some antiepileptic drugs (e.g., phenytoin, phenobarbital), depot medroxyprogesterone acetate, and other agents. 

CHCs, even those with less than 35 meg estrogen, can cause small increases in blood pressure (6 to 8 mm Hg) in both normotensive and hypertensive women. In women with hypertension, OCs have been associated with an increased risk of MI and stroke. Use of CHCs is acceptable in women younger than 35 years with well-controlled and monitored hypertension. Hypertensive women with end-organ disease or who smoke should not use CHCs. Progestin-only pills and depot medroxyprogesterone acetate (DMPA) are choices for women with hypertension. 

Depot medroxyprogesterone acetate (DEPOT PROVERA) 150 mg given once... 

Subgroups of users of depot medroxyprogesterone acetate may have reduced spinal bone density, but this seems to be reversible after withdrawal, even after several years of drug exposure (4). Bone mineral density in one cross-sectional study was lower among users of depot medroxyprogesterone acetate, but withdrawal was followed by complete recovery of normal bone density (4). A current study in the USA is expected to provide further data on this matter in women who have used medroxyprogesterone acetate for as long as 10 years. 

The adverse effects of norethisterone enantate when used as a 2-monthly injectable contraceptive have been compared in various populations with those of depot medroxyprogesterone acetate and were found to be closely similar (5,6). 

Depot medroxyprogesterone acetate is by far the most widely used formulation of this compound the World Health Organization s assessment of it in 1983 (1) remains valid, as confirmed by later studies and reviews (2-4). By 1994 it was estimated that the drug had been used by 30 million women in more than 90 countries, and at the turn of the century it continues to be used on a large scale. 

The contraceptive efficacy of depot medroxyprogesterone acetate does not appear to be affected by interactions with other drugs some interactions are known (6), but the doses used for contraceptive purposes are sufficient to remain effective even if metabolism is increased, for example by aminoglutethimide or phenytoin. 

For women with epilepsy, depot medroxyprogesterone acetate is a particularly useful contraceptive method, because it reduces seizure frequency (11). The dosage is so high that reduced efficacy due to enzyme-inducing anti-epileptic medication is not an issue. As with other hormonal contraceptives, some women tend to have headaches and mood changes. 

A 40-year-old woman developed anaphylactic shock after receiving depot medroxyprogesterone acetate 150 mg intramuscularly (30). She was not taking any other medications, and there was no history of allergy to food or cosmetics. She responded fully to immediate resuscitation. She had another episode when she received another dose 12 weeks later. 

Many studies have shown that lactation is not adversely affected by depot medroxyprogesterone acetate and that breast-milk production may even be increased (35). Because of the low binding affinity of medroxyprogesterone to sex hormone binding globulin, the concentration of steroids in the milk is close to that in the maternal plasma, unlike the 19-nortestosterone derivatives. 

Children whose mothers used depot medroxyprogesterone acetate while breastfeeding have been followed up in Thailand for 17 years and in Chile for 4.5 years, with no documented effect on growth or development (36). In undernourished lactating women the metabolic effects seem to be more pronounced than among healthy users (17). 

Depot medroxyprogesterone acetate should not be used in women with breast cancer, genital cancer, undiagnosed uterine bleeding, or suspected pregnancy (37), but these are merely logical precautions. 

The only study of depot medroxyprogesterone acetate and HIV infection, conducted among Thai prostitutes, showed an increased risk after adjustment for other variables (38). 

Kaunitz AM. Long-acting injectable contraception with depot medroxyprogesterone acetate. Am J Obstet Gynecol 1994 170(5 Pt 2) 1543-9. 

Joshi UM, Virkar KD, Amatayakul K, Singkamani R, Bamji MS, Prema K, Whitehead TP, Belsey MA, Hall P, Parker RA. Metabolic side-effects of injectable depot-medroxyprogesterone acetate, 150 mg three-monthly, in undernourished lactating women. WHO Task Force on... 

Hyjazi Y, Maes E, Hurlet A, Masure R, Vekemans M. Acetate de medroxyprogesterone-depot effets cliniques et metaboliques (lipides, glucose, hemostase). [Depot medroxyprogesterone acetate clinical and metabolic effects (lipids, glucose, hemostasis).] J Gynecol Obstet Biol Reprod (Paris) 1985 14(1) 93-103. 

Skegg DC, Noonan EA, Paul C, Spears GF, Meirik O, Thomas DB. Depot medroxyprogesterone acetate and breast cancer. A pooled analysis of the World Health Organization and New Zealand studies. JAMA 1995 273(10) 799-804. 

Lumbiganon P. Depot-medroxyprogesterone acetate (DMPA) and cancer of the endometrium and ovary. Contraception 1994 49(3) 203-9. 

Fraser I, Hoick SE. Depot-medroxyprogesterone acetate. In Mishell D, editor. Advances in Contraceptive Technology 1982 23-124. 

Effective contraception can also be achieved by injecting 150 mg of depot medroxyprogesterone acetate (DMPA) every 3 months. After a 150 mg dose, ovulation is inhibited for at least 14 weeks. Almost all users experience episodes of unpredictable spotting and bleeding, particularly during the first year of use. Spotting and bleeding decrease with time, and amenorrhea is common. This... 

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