Medroxyprogesterone depot contraception

Kaunitz AM. Injectable depot medroxyprogesterone acetate contraception An update for US clinicians. Int J Fertil Women s Med 1998 43 73-83. 

Depot contraception (medroxyprogesterone IM every 3 months), and implant (norgestrel 5 years). 

Lanza LL, McQuay LJ, Rothman KJ, Bone HG, Kaunitz AM, Harel Z, et al. Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture. Obstet Gynecol 2013 121(3) 593-600. 

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... 

Used as long-acting depot preparations intramuscularly administered medroxyprogesterone acetate provides contraception for up to 3 months and norethisterone enanthate up to 2 months. These preparations can be indicated when compliance can pose problems. They are not associated with thromboembolism or cardiovascular disease. Adverse reactions are abnormal and prolonged bleeding and amenorrhoea. 

Case-control study Significantly more cases of breast cancer with depot medroxyprogesterone no link with oral contraceptives (149)... 

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). 

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. 

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

Kim C, Seidel KW, Begier EA, Kwok YS. Diabetes and depot medroxyprogesterone contraception in Navajo women. Arch Intern Med 2001 161(14) 1766-71. 

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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