Injectable depot medroxyprogesterone acetate contraception: an update for U.S. clinicians

Injectable contraceptions appeal to women who value the efficacy, convenience, and safety provided by this reversible birth control option. Since FDA approval for contraceptive use in 1992, depot medroxyprogesterone acetate (DMPA)--already used by millions of women worldwide--has been used by several million U.S. women. Although women using this 3-month progestin-only injectable often experience irregular bleeding and spotting (initially), long-term DMPA use typically results in amenorrhea. Many users, including adolescents, choose DMPA because of its convenience--nearly 100% contraceptive effectiveness is achieved with 4 injections per year. Because DMPA does not contain estrogen, it represents an appropriate contraceptive choice for postpartum or lactating women, as well as those whose medical status precludes use of contraceptive doses of estrogen. Some examples include: women over age 35 who smoke, those with increased thromboembolism risk, women with cardiovascular or liver disease, as well as women with complex migraines. Although fertility resumes on the average 10 months following the last injection, suppression of ovulation occasionally persists for as long as 22 months. Consequently, DMPA is not an appropriate choice for women who may wish to conceive within the next two years. Since the use of DMPA lowers ovarian estradiol production, reversible loss of bone mineral density (BMD) may occur. Studies currently in progress may clarify DMPA's long-term impact, if any, on BMD. Therapeutic uses of DMPA include treatment of: dysmenorrhea, menorrhagia (including that associated with fibroid uterine tumors), endometriosis, endometrial hyperplasia, ovulatory pain, pain associated with ovarian adhesive disease, premenstrual dysphoria and perimenopausal symptoms.