Depo Provera. Position paper on clinical use, effectiveness and side effects.

This study presents a review of current clinical evidence on the usefulness of Depo Provera (medroxyprogesterone acetate DMPA) a long-term method of reversible contraception. It is taken as an intramuscular long-acting agent (150 mg every 12 calendar weeks). The user failure rate approaches the method failure rate which varies considerably with age. In terms of metabolic effects it did not show changes in cholesterol or triglycerides and had no significant effect on hemostasis which impairs the oral glucose tolerance test (OGTT) glucose response and increases insulin response. There were no significant adverse effects on long term growth and development in DMPA exposed children and no delays in return to fertility. For cancers controlled surveillance of DMPA users found no overall increased risk of ovarian liver or cervical cancer and even found a prolonged protective effect in reducing the risk of endometrial cancer. However increased risk of breast cancer in recent users was observed; this could be due to enhanced detection of breast tumors of women using DMPA. The main DMPA disadvantages are menstrual disturbance and weight gain after 1 year. Bone mineral density (BMD) is found to be significantly lower. DMPA patients sociodemographic characteristics and behavior placed then at higher risk for adverse pregnancy outcome in low infant birth weight and also possibly in polysyndactyl and chromosomal defects. Thus for injectable progestogen the data is again less conclusive. Risks may be similar to POP (progestogen-only contraceptive pill) but did not reach significance in the meta-analysis.