Early experience with the contraceptive use of depot medroxyprogesterone acetate in an inner-city clinic population

Abstract

There are few data on the experience of American women with the injectable depot medroxyprogesterone acetate (DMPA) since its recent approval by the Food and Drug Administration for contraceptive use in the United States. An exploratory study was conducted using chart reviews and telephone interviews of 261 women who initiated DMPA use between December 1992 and June 1994 at either a hospital-based (48%) or community-based (49%) clinic in New York City. Most DMPA users were single (70%), had had at least one birth (88%), had had at least one abortion (67%) and had ever practiced contraception (75% of those with available data). Life-table DMPA continuation rates were 63% at six months and 42% at 12 months and were not affected by the users' age, marital status, pregnancy history, clinic site or proximity of residence to the clinic. Among adults, the risk of DMPA discontinuation was highest during the three-month period following the second injection, while among adolescents, this risk increased throughout the duration of use. The most commonly reported reasons for method discontinuation were side effects, primarily menstrual irregularities (30%) and weight gain (24%).

PIP: An exploratory study of 261 US women who initiated use of depot medroxyprogesterone acetate (DMPA) between December 1992 and June 1994 at a hospital- or community-based clinic in New York City highlighted the importance of side effects to method discontinuation. The mean age of DMPA users was 25 years; 70% were unmarried and 84% were Medicaid recipients. At the time of first injection, 58% were using no contraceptive method. At telephone interview, the average time since first injection was 8.6 months. The continuation rate was 81% at 3 months, 63% at 6 months, 52% at 9 months, and 42% at 12 months. When these rates were adjusted to assume that the 37 women who were not locatable for follow-up had discontinued, they became 74%, 53%, 39%, and 30%, respectively. There was no variation in discontinuation rates on the basis of age, parity, marital status, insurance status, number of pregnancies or abortions, postpartum status, or residence. Among the 96 discontinuers for whom data were available, the most frequently cited reasons were abnormal bleeding (30%), weight gain (24%), and nausea (12%). The percentage of women with amenorrhea was 34% at 3 months, 43% at 6 months, 66% at 9 months, and 60% at 12 months. Among adults, the risk of discontinuation was highest in the 3 months after the second injection; in contrast, the risk of discontinuation among adolescents increased steadily during the first year of use. Given the strong association between DMPA side effects and discontinuation, clinic staff are urged to pursue interventions such as estrogen therapy for amenorrhea and nutrition and exercise counseling for weight gain.