Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

Abstract

CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1). During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2). CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.

Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response

“…Further, there were no differences in pregnancy rates or adverse events, except that two cohort studies found an increase in injection site reactions with self-administration. In 2021, the U.S. SPR were updated to include self-administration of subcutaneous DMPA, stating that DMPA-SC is a user-controlled method with the potential to increase access to contraception and improve reproductive autonomy [50] . The authors of a small implementation study conducted in California found that 37% of DMPA-IM users were interested in self-administration, but only 21% successfully self-injected DMPA-SC [51] .…”

Society of Family Planning committee consensus on self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC)

“…Numerous studies show that patients can successfully initiate and continue self-administration of DMPA-SC on schedule after brief in-person, video-based, or telehealth education [1] . One randomized controlled trial confirmed similar therapeutic MPA levels in both provider-and self-administration study groups, indicating that patients outside of the clinical setting were able to appropriately administer DMPA-SC and do so within the indicated intervals [5] .…”

“…Patients who self-administered were also able to restart effectively without additional instruction if they delayed a dose beyond the grace period or temporarily discontinued use. Studies also show high patient-reported acceptability and satisfaction among those who self-administered DMPA-SC; many wished to continue self-administration and would recommend it to a friend [1] .…”

“…Depot medroxyprogesterone acetate (DMPA) is a highlyeffective, progestin-only injectable contraceptive used by approximately two percent of females ages 15 to 49 in the U.S. and is used widely internationally [1] . It is also used for non-contraceptive indications, including menstrual suppression, treatment of dysmenorrhea and endometriosis, and management of heavy menstrual bleeding.…”

“…It is also used for non-contraceptive indications, including menstrual suppression, treatment of dysmenorrhea and endometriosis, and management of heavy menstrual bleeding. Available in both intramuscular (IM) and subcutaneous (SC) formulations, DMPA requires injections approximately every 13 weeks and may be given up to 15 weeks without requiring additional contraceptive protection [1] . The intramuscular and subcutaneous formulations are dosed differently at 150 mg and 104 mg, ✩ Conflict of interest: Author Elise Berlan reports receiving research funding from Organon and Merck; is a Nexplanon Clinical Trainer for Organon and Merck; and is a Consultant to Organon and Merck.…”