Long-term depot medroxyprogesterone acetate (Depo-Provera) use in inner-city adolescents

Abstract

Purpose: To determine Depo-Provera continuation rates and reasons for its discontinuation among adolescents.

Study design: Medical record reviews and telephone interviews with 159 adolescents who initiated Depo-Provera use between 1 December 1992 and 31 December 1995 at two clinics in New York City. Depo-Provera continuation was measured using lifetable analysis.

Results: The mean age was 17.7 +/- 1.5 years, with a median of 1 pregnancy (range 0-11). Mean follow-up was 23.4 +/- 10.7 months. Depo-Provera continuation rates were 71% at 3 months, 48% at 6 months, and 27% at 12 months, and were not affected by age, race, pregnancy or contraceptive history, clinic, or foster care status. Forty-three subjects (37% of discontinuers) restarted Depo-Provera during the study period, with a mean time to restart of 8.4 months after the last Depo-Provera injection. Side effects were the main reported reason for Depo-Provera discontinuation, primarily menstrual irregularities (26%) and weight gain (18%). Seventy percent of those discontinuing Depo-Provera owing to irregular bleeding did so after only one injection. For 23%, the single reason for discontinuation was appointment noncompliance. Restart rates were lowest among those who reported irregular bleeding (15%), weight gain (9%), and hair loss (10%), and highest among those discontinuing owing to missed appointments (87%) (p < 0.05). Pregnancies occurred in 19% of Depo-Provera discontinuers.

Conclusion: Although Depo-Provera continuation rates among adolescents are low, over a third of discontinuers may restart the method. Aggressive management of side effects and assistance with appointment follow-up may improve long-term use. High pregnancy rates warrant close follow-up after Depo-Provera discontinuation.

PIP: Depo-Provera continuation rates and reasons for discontinuation among low-income US adolescents were investigated through a review of the records of the 159 teens who initiated use of this method at two inner-city clinics in New York City, New York (US), during 1992-95. At both study sites, Depo-Provera was available as a family planning option without parental consent. Mean age of acceptors was 17.7 years, with a median of one prior pregnancy. Almost all were unmarried, Black or Hispanic, and Medicaid recipients. At follow-up (mean duration, 23.4 months), only 21 teens (13%) were still using Depo-Provera; 115 (72%) had discontinued use and the remaining 23 had been lost to follow-up. The median duration of Depo-Provera use was 6.9 months. Continuation rates were 71% at 3 months, 48% at 6 months, 27% at 12 months, and 15% at 18 months. Side effects, especially menstrual irregularities (25%) and weight gain (19%), were the main reason for Depo-Provera discontinuation. 70% of those discontinuing the method for irregular bleeding did so after only one injection. Another 23% discontinued because of problems keeping appointments. Methods adopted after Depo-Provera discontinuation included oral contraceptives (31%) and condoms (21%); pregnancies occurred in 19% of discontinuers. 43 teens (37% of discontinuers) restarted Depo-Provera during the study period, after a mean interval of 8.4 months following the last injection. Restart rates were highest among those discontinuing due to missed appointments (87%) and lowest among those reporting irregular bleeding (15%), weight gain (9%), or hair loss (10%). Recommended, to improve Depo-Provera compliance among adolescents, are strategies to motivate attendance at follow-up appointments and manage method-related side effects.