The Contraceptive Use of Depot Medroxyprogesterone Acetate

Abstract Background Subcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use. Methods We searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions. We included randomized trials comparing self- versus provider-administered subcutaneous depot medroxyprogesterone acetate. Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes. Results We identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10–1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs. clinic-based provider). Conclusions Self-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence.

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Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054590 ◽

2020 ◽

pp. sextrans-2020-054590

Author(s):

Jennifer Deese ◽

Neena Philip ◽

Margaret Lind ◽

Khatija Ahmed ◽

Joanne Batting ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Medroxyprogesterone Acetate ◽

Contraceptive Use ◽

Intrauterine Device ◽

Secondary Analysis ◽

Final Visit ◽

Sexually Transmitted ◽

Depot Medroxyprogesterone Acetate ◽

Copper Iud ◽

Copper Intrauterine Device

ObjectivesReproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce STI prevalence and comorbidities. We compared the risk of STI among women randomised to three contraceptive methods.MethodsWe conducted a secondary analysis to assess the risk of chlamydia and gonorrhoea in a clinical trial evaluating HIV risk among 7829 women aged 16–35 randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) or a levonorgestrel (LNG) implant. We estimated chlamydia and gonorrhoea prevalences by contraceptive group and prevalence ratios (PR) using log-binomial regression.ResultsAt baseline, chlamydia and gonorrhoea prevalences were 18% and 5%, respectively. Final visit chlamydia prevalence did not differ significantly between DMPA-IM and copper IUD groups or between copper IUD and LNG implant groups. The DMPA-IM group had significantly lower risk of chlamydia compared with the LNG implant group (PR 0.83, 95% CI 0.72 to 0.95). Final visit gonorrhoea prevalence differed significantly only between the DMPA-IM and the copper IUD groups (PR 0.67, 95% CI 0.52 to 0.87).ConclusionsThe findings suggest that chlamydia and gonorrhoea risk may vary with contraceptive method use. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use.

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

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm7020a2 ◽

2021 ◽

Vol 70 (20) ◽

pp. 739-743

Author(s):

Kathryn M. Curtis ◽

Antoinette Nguyen ◽

Jennifer A. Reeves ◽

Elizabeth A. Clark ◽

Suzanne G. Folger ◽

...

Keyword(s):

Medroxyprogesterone Acetate ◽

Contraceptive Use ◽

Self Administration ◽

Depot Medroxyprogesterone Acetate ◽

Practice Recommendations

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Self-Administered Subcutaneous Medroxyprogesterone Acetate for Improving Contraceptive Outcomes: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-246858/v1 ◽

2021 ◽

Author(s):

Ashraf Fawzy Nabhan ◽

Amal Elshabrawy ◽

Farida ElShafeey ◽

Luna Marion Mehrain ◽

Rita Kabra

Keyword(s):

Confidence Intervals ◽

Risk Ratio ◽

Medroxyprogesterone Acetate ◽

Randomized Trials ◽

Contraceptive Use ◽

Risk Of Bias ◽

Controlled Trials ◽

Cochrane Central Register ◽

Self Administration ◽

Depot Medroxyprogesterone Acetate

Abstract Background: Subcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. Objectives: to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use.Search strategy: We searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions.Selection criteria: We included randomized trials comparing self- vs provider-administered subcutaneous depot medroxyprogesterone acetate.Data collection and analysis: Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes.Results: We identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10 to 1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs clinic-based provider).Conclusions: Self-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence.Registration number: CRD42018097388.

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