Experience with Medroxyprogesterone Acetate (Depo‐Provera®) as an Injectable Contraceptive

Abstract

Depo-Provera injections appear to be a safe and effective alternative for women who cannot tolerate the estrogenic side effects associated with oral contraceptives or the pain and bleeding associated with IUDs. However, women considering the method should be fully aware of the possible risks: (a) inability to withdraw the drug promptly in the event of a serious reaction, (b) disruption of menstrual patterns, and (c) delayed return of fertility after discontinuing therapy. Some women may consider the required trip to the doctor every 3 months an additional disadvantage. For women in developing countries where anemia and nutritional problems are prevalent, Depo-Provera has additional advantages in relation to IUDs and OCs: it causes less bleeding than IUDs or OCs and, unlike oral contraceptives, it does not suppress vitamin levels (4-8). Since it requires a trip to the doctor every 3 months, it also provides a better opportunity for medical supervision and care. For postpartum women who which to breastfeed their babies, Depo-Provera has the additional advantage of causing no adverse effect on lactation (1, 2, 13, 14, 16, 18, 19, 25, 32, 36).

Fertility after intrauterine device discontinuation

“…Compared to past use of other contraceptive methods, past IUD use does not impair a woman's ability to become pregnant [7,19,23,27]. Most of these cohort studies evaluated women who had their IUDs removed electively to become pregnant.…”

“…It has been suggested [4] that the reason for the higher risk of PID in IUD users is that IUDs do not protect against PID while the use of other contraceptive methods provides some protection. As a consequence of the apparent association between IUD use and PID and the higher risk of infertility following PID [5], some physicians are reluctant to provide IUDs for women who may wish to have children.Studies evaluating conception rates for women who had their IUDs removed to become pregnant have shown that IUD use did not impair their fertility [6][7][8][9][10][11][12][13][14][15]. The primary limitation of these studies is that they only evaluated pregnancy outcomes or infertility rates for women who discontinued IUD use for reasons other than pregnancy or planned pregnancy.…”

Appropriate contraception for middle-aged women

“…In the United States, the drug has not as yet been approved by the FDA. The method is highly effective (Ellinas, 1977). Unsatisfactory aspects are breakthrough bleeding and the required visit to the doctor every 3 months.…”

The Effect of Medroxyprogesterone Acetate on Blood Pressure

“…Estrogens have usually been considered the culprit. Most authors think that progesterone, on the other hand, does not raise BP (2,4,11,13,14,17,18) and so may be used as a contraceptive agent without fear of causing hypertension. Leiman (9), however, reported significant BP changes in 24% of 1050 patients treated with medroxyprogesterone acetate (MPA) (Depo-Provera, The Upjohn Company, Kalamazoo, MI, USA) as defined by increases or decreases in systolic (20 mm Hg) and/or diastolic (10 mm Hg) BP.…”