Contraception with injectable long-acting preparation depo-provera
Prilepskaia, V.N.; Kondrikov, N.I.; Tagieva, T.T.
Akusherstvo i Ginekologiia 3: 7-10
1995
ISSN/ISBN: 0300-9092 PMID: 7653732 Document Number: 295946
The selection of contraception for women over the age of 35 presents significant problems. The popular IUD is often contraindicated on account of producing pathological cervical and/or uterine changes. In such women the suitable contraceptives are pure gestagen pills and injectables (Depo-Provera and norethindrone enanthate). Depo-Provera contains the active ingredient medroxyprogesterone acetate (DMPA), which imitates the activity of endogenic progesterone and increases the activity of 17-hydroxyprogesterone 6- or 7-fold. Its mechanism of action on the uterine epithelium consists of antiestrogenic and antiandrogenic activity. In 1995 approximately 3.5 million women were using DMPA. Its contraceptive effectiveness amounts to 0-1.2 pregnancies per 100 women in the course of 1 year. In a 1987 multi-centered trial it was observed that the use of 250 and 500 mg of DMPA every 9 months produced a higher incidence of pregnancy than the use of 150 mg every 3 months. The causes of discontinuation of DMPA use are irregular bleeding (10.5%), reduction of libido (1.6%), and weight gain (1.4%). A 1984 clinical study of 3905 women showed that 54% of them had no untoward effects while using DMPA. The frequency of development of amenorrhea with DMPA use varies from 8% to 72%. Its hematological parameters are good and some studies showed that DMPA does not increase the risk of development of cancer of the endometrium, ovaries, and cervix. A 1991 study suggests that the relative risk of breast cancer may increase after 4 years of use of DMPA in women under 35, however, according to a 1994 study, above this age the risk is minimal. DMPA use lowers the risk of endometrial cancer, and this protective effect lasts for 8 years after cessation of use. Higher doses of DMPA treat endometrial cancer. After halting DMPA use the average time for conception to occur is 5.5 months. DMPA use in the first trimester does not produce adverse effects on the newborn or on lactation.