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Depot medroxyprogesterone acetate for contraception
Topic Outline
- INTRODUCTION
- FORMULATIONS AND PHARMACOLOGY
- MECHANISMS OF ACTION
- EFFICACY
- ADMINISTRATION
- Medical eligibility criteria
- Women with contraindications to estrogen therapy
- Injection technique
- - Intramuscular DMPA
- - Subcutaneous DMPA
- - Self-administration of DMPA
- Timing of injections
- - Initial injection
- - Repeat injections
- DISCONTINUATION
- Return to fertility after discontinuation
- Switching from DMPA to another method
- COUNSELING
- SIDE EFFECTS
- Menstrual changes
- - Unscheduled bleeding
- - Amenorrhea
- Weight changes
- Headache
- Mood changes
- Other
- OTHER EFFECTS
- Reduction in bone mineral density
- - Counseling patients
- Beneficial effects on comorbid conditions
- Possible allergic reactions
- Decrease in cancer risk
- Cardiovascular risk
- Lack of protection from sexually transmitted infections
- - Effect on HIV acquisition and transmission
- - Effect on chlamydia and gonorrhea acquisition
- Change in glucose/insulin
- SPECIAL POPULATIONS
- Adolescents
- Perimenopausal women
- Postabortion and postpartum women
- COST
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- REFERENCES
GRAPHICS
INTRODUCTION
Depot medroxyprogesterone acetate (DMPA) is an injectable, progestin-only contraceptive that provides highly effective, private, relatively long-acting (12 weeks), reversible contraception. Use of DMPA eliminates both the need for user action daily or near the time of sexual intercourse and the need for partner cooperation.
DMPA is a good contraceptive option for the following groups of women:
- Women who do not want to take a contraceptive pill daily
- Women who have a contraindication to, or wish to avoid, an estrogen-containing contraceptive
- Women who would like to eliminate regular menses
- Adolescents who may not consistently remember to use types of contraception that require frequent administration
- Institutionalized adolescents and women who have difficulty using other forms of contraception
- Wheelchair-bound adolescents and women
Other types of progestin-only contraceptives include:
- Progestin pills (minipills) (see "Progestin-only pills (minipills) for contraception")
- Progestin implants (eg, Nexplanon, Jadelle) (see "Etonogestrel contraceptive implant")
- Intrauterine contraception (eg, Mirena, Skyla) (see "Overview of intrauterine contraception")
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Literature review current through:
Apr 2013.
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May 7, 2013.
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