Title : Depot medroxyprogesterone acetate (DMPA): Special Issues
Progestogen-only injectable contraceptives include
• DMPA 150 mg 3 monthly
• Nethisterone enanthate 200 mg 2 monthly
• DMPA-SC = 104 mg 3 monthly
DPMA most commonly used is highly effective Contraceptive with first year effectiveness in perfect and typical use as 99.7% and 97% respectively.
DMPA is safe in women of any age, any parity , unmarried, immediate post abortion , smokers, breastfeeding (6 weeks after child birth), women at risk of STI/ HIV or HIV infected , whether or not on ART.
Women can start DMPA without a pelvic and breast examination / blood tests , cervical cancer screening however, desirable to have BP measurements before initiation . A woman can start DMPA within 7 days after the start of her menstrual bleeding and also start at any other time if it reasonably certain that she is not pregnant but will need to maintain abstinence or use additional contraceptive protection for the next 7 days.
DMPA is contraindicated in women -breastfeeding less than six weeks postpartum, Hypertensives (BP 160/100 mm Hg or more) and with Unexplained vaginal bleeding etc .
MPA: Return to Fertility
One injection is effective for 3-4 months ,hence given i/m every 3 months .Return of fertility takes 7-10 months from date of last injection .
• No massage or hot fomentation to the injection site.
• Repeat injection can be given up to 2 weeks early and up to 4 weeks late without backup
• If more than 4 weeks late repeat DMPA given only if certain that not pregnant with backup method for 7 days.
• DMPA can be used safely in adolescence: advantages generally outweigh the theoretical safety concerns regarding fracture risk
• DMPA, a good contraceptive option for older women (>35 Years)
-Reduces vasomotor symptoms and effectively treats abnormal uterine bleeding and prevents endometrial hyperplasia
- Reduces risk of endometrial and ovarian cancers
-Use should be reviewed every 2 years to assess the benefits and risks
• Recommended during lactation at 6 weeks post partum -No adverse effect on quantity, quality / composition
• Once breast feeding is established and woman not breast feeding - can be started earlier than 6 weeks
• MPA failure: rare but No Risk of Exposure to Fetus in Utero
Advice to discontinue MPA and can continue with pregnancy, if desired
Non Contraceptive Benefits of MPA
• May decrease menstrual cramps, reduce pre-menstrual syndrome/tension and menorrhagia, symptoms of endometriosis, benign breast disease and ovarian cyst and sickle-cell crises
• Prevents/improves anaemia
• Protects against endometrial & ovarian cancer, ectopic pregnancy ,fibroids
• Reduces the incidence of symptomatic PID
Limitations of MPA
• Does not protect against STI/RTI/HIV
• Once taken its action cannot be stopped immediately
• Causes changes in the menstrual cycle and bleeding
• Has to be repeated every three months
• Return of fertility takes 7-10 months
• Little increased risk of CVD associated with use