Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Contraception. 2010 Jun;81(6):487-95. doi: 10.1016/j.contraception.2010.01.021. Epub 2010 Mar 9.
Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the extremely obese population (BMI >or=40 kg/m(2)). The purpose of this 26-week prospective experimental study was to determine incidence of ovulation and follicular development among women with Class 1, 2 and 3 obesity after receiving DMPA-SC.
Five normal-weight, five Class 1-2 obese, and five Class 3 obese women received subcutaneous injections of 104 mg DMPA-SC at baseline and 12 weeks later. Weekly progesterone levels, bimonthly estradiol (E(2)), and monthly medroxyprogesterone acetate (MPA) levels were measured by immunoassay methods for a total of 26 weeks in each subject.
Ovulation did not occur in any subject more than 1 week after the first injection. There was large intersubject and intrasubject variability in E(2) levels, and fluctuating E(2) levels were more frequent among obese women than normal-weight women. Median MPA levels remained above the level needed to prevent ovulation but, compared with normal-weight subjects, were lower among Class 1-2 obese and lowest among Class 3 obese subjects.
Fluctuating E(2) levels reflective of follicular development occurred more often among Class 1, 2 and 3 obese women than normal-weight women after DMPA-SC injections. Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation. Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women.
尚未对皮下注射去甲孕二烯酮（DMPA-SC）在极肥胖人群（BMI≥40kg/m²）中进行研究。本 26 周前瞻性实验研究的目的是确定 DMPA-SC 给药后 1 类、2 类和 3 类肥胖女性的排卵和卵泡发育发生率。
5 名正常体重、5 名 1-2 类肥胖和 5 名 3 类肥胖女性在基线和 12 周后接受 104mg 皮下 DMPA-SC 注射。对每位女性共 26 周每周测定孕酮水平、每 2 个月测定雌二醇（E₂）和每月测定甲羟孕酮（MPA）水平，采用免疫分析法。
首次注射后 1 周以上无任何女性排卵。E₂水平的个体间和个体内差异很大，肥胖女性的 E₂水平波动更为频繁。中位 MPA 水平保持在预防排卵所需水平之上，但与正常体重女性相比，1-2 类肥胖女性的 MPA 水平更低，3 类肥胖女性的 MPA 水平最低。
与正常体重女性相比，DMPA-SC 注射后，1 类、2 类和 3 类肥胖女性的 E₂水平波动更频繁，反映出卵泡发育。3 类肥胖女性的中位 MPA 水平最低，但仍保持在抑制排卵所需水平之上。进一步的研究应更全面地探讨 DMPA-SC 在极肥胖女性中的药代动力学。
