Depot medroxyprogesterone acetate contraception in women with medical problems
Frederiksen, M.C.
Journal of Reproductive Medicine 41(5 Suppl): 414-418
1996
ISSN/ISBN: 0024-7758 PMID: 8725704 Document Number: 297891
The contraceptive implant depot medroxyprogesterone acetate (DMPA) may offer advantages to women with medical problems which contraindicate the use of estrogen. In such women, the risks of pregnancy must be weighted against the risk posed by a contraceptive method. While young women with well-controlled hypertension can use DMPA or the combined oral contraceptive, patients with uncontrolled hypertension or other risk factors may be better managed with DMPA. DMPA is also an appropriate choice for many women with cardiac disorders which can be associated with an extremely high risk of adverse pregnancy outcomes. Because it is not associated with increased thrombotic risk, DMPA is also safe in women over 35 years old who smoke. The contraceptive is likewise indicated in women with a history of thromboembolic disease (despite package labeling which was based on trials of high doses of DMPA as a cancer treatment). DMPA also is safe in women with sickle cell disease and actually has been shown to reduce the incidence of sickle cell crisis. Evidence also suggests that DMPA injections in anticoagulated women do not increase the incidence of hematoma formation. DMPA will not protect women with underlying predisposing causes of thrombosis from experiencing a thrombotic event. Whereas the contraceptive efficacy of hormonal contraception may be reduced in epileptic women using hepatic enzyme induction agents, DMPA has been reported to reduce seizure frequency with few contraceptive failures in such women. In diabetic women with peripheral vascular disease and in women with systemic lupus erythematosus, DMPA, unlike contraceptives with estrogen, avoids the enhanced risk of thrombosis. Because the best pregnancy outcome in women with medical problems occurs when the pregnancy is planned, such women should use the most effective contraceptive methods available to them.