Abstract

PIP: 121 multiparous women (aged 15-37) who had received injections of 150 mg of depomedroxyprogesterone acetate (DMPA) every 3 months as a contraceptive for more than 1 year, were examined to assess possible clinical alterations due to low estrogen levels. Serum samples were taken to evaluate estradiol levels by radioimmunoassay. Clinical examination did not reveal any sign of estrogen deficiency, except a smaller uterine than expected. Serum estradiol concentrations (36-42 pg/ml) were in the range of the follicular phase estradiol levels of the normal ovulating woman. As this follicular level probably persists throughout treatment, total estrogenic stimulation of end organs was much lower than for cycling women, but greater than for post-menapausal women. Patients receiving DPMA have functioning ovaries which continue to secrete estradiol at follicular levels. Uterine atrophy and shift in maturation index during contraceptive treatment with this drug is due to the large dose of progestogen outweighing the low levels of estradiol. It is suggested that long-term studies are needed to determine the possible advantage of increasing the estrogen effect on end organs over the known adverse effects of estrogen administration.