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  5. Depo-Provera：高效避孕的利弊与全球应用

Depo-Provera：高效避孕的利弊与全球应用

文献检索行在路上发表于 2026年06月26日 16:358阅读
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Depo-Provera

Depo-Provera (depot-medroxyprogesterone acetate, DMPA) is a widely used injectable contraceptive method that is highly effective and offers various advantages, as well as certain side effects and considerations . It has a complex history regarding its approval and use, particularly in the United States .

History and Approval:

  • DMPA was approved by the U.S. Food and Drug Administration (FDA) for contraceptive use in October 1992 .
  • Prior to this, in 1978, the FDA had denied approval for the three-month injectable contraceptive for use in the United States, despite recommendations from its own scientific advisory panels, the World Health Organization, and drug regulation institutions in over 70 countries .
  • This decision sparked protests from the manufacturer and health professionals, leading to a public board of inquiry in January 1983 to review the decision . The FDA's regulation of Depo-Provera during this period involved complex interactions between scientists, doctors, patients, and women's health activists, with ideas about gender and power playing a central role .
  • The scientific literature available at the time provided no reason to deny approval, provided that studies on potential side effects continued and women made informed choices .

Mechanism of Action and Efficacy:

  • DMPA is a progestin-only contraceptive .
  • It is administered as a 150 mg deep intramuscular injection every 12 calendar weeks (84 days + 5 days) .
  • DMPA is considered a highly effective contraceptive with a very low failure rate, comparable to modern copper IUDs and superior to many other methods . Its efficacy is independent of daily action or intervention around the time of coitus .
  • Ongoing research aims to improve access through home or self-injection, task-shifting, and community-based distribution, as well as to lower the overall dose while maintaining efficacy and improve drug-delivery systems .

Advantages:

  • Convenience and Discretion: DMPA is a convenient, discrete, and low-maintenance method . It is independent of intercourse and the user's memory, requiring only 12-weekly appointments, which is a significant advantage for women with irregular lifestyles, busy schedules, or frequent travel who might struggle with daily pill adherence .
  • Estrogen Contraindications: It is ideal for patients with contraindications to estrogen use .
  • Noncontraceptive Benefits: DMPA offers many noncontraceptive benefits . It does not have appreciable effects on blood pressure or thrombosis risk in the general population, making it a suitable alternative for women who cannot use combined oral contraceptive pills for these reasons . Women suffering from focal migraine, who are advised against combined oral contraceptive pills, can also use progestogen-only contraceptives like DMPA .
  • Potential for Improved Depressive Symptoms: A multicenter prospective study evaluating women choosing Depo-Provera found that those who continued the method had lower depressive symptom scores at baseline. Among continuing users, depressive symptom scores slightly improved at 1 year, with those having the highest scores at enrollment showing improvement at follow-up .

Side Effects and Disadvantages:

  • Menstrual Disturbances: This is a main potential disadvantage . Irregular bleeding is a common side effect . All progestogen-only methods, including DMPA, can lead to menstrual disturbances . While troublesome, these disturbances rarely require operative medical intervention and can often be improved with short courses of estrogen or shorter injection intervals . Patient counseling before use is essential to minimize the effect of menstrual changes .
  • Weight Gain: Weight gain is another commonly reported side effect . This concern may lead to reluctance in initiating therapy or premature discontinuation . It has been implicated especially in girls who are already overweight .
  • Bone Mineral Density (BMD) Loss: DMPA use is associated with a decrease in BMD . This loss is largely, if not completely, reversible over time and comparable to the BMD loss associated with pregnancy and breastfeeding . While the knowledge on the impact of BMD loss on future fracture risks is incomplete, the small magnitude and reversibility of DMPA's impact suggest any increase in osteoporotic fractures is likely small . However, some research suggests adverse effects on adolescent bone health, though data demonstrating reversibility after discontinuation are reassuring . Contraception selection for women with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) must consider bone health, as oral contraceptive pills and combined hormonal contraception may slow bone mass acquisition in adolescents .
  • Thrombosis Risk:
    • Historically, DMPA was considered to have no appreciable effects on thrombosis risk compared to combined oral contraceptives .
    • However, updated evidence suggests that the risk of venous thromboembolism (VTE) might be elevated with DMPA use among women with certain thrombogenic conditions or characteristics (e.g., diabetes, postpartum) and in the general population . This evidence does not suggest an increased risk of arterial thromboembolism (ATE) with DMPA .
    • The certainty of this evidence is low or very low for all outcomes, and further study is needed, especially for women with specific thrombogenic conditions .
    • Newer U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) in 2024 reflect increased safety concerns for DMPA in women with sickle cell disease .
  • Meningioma Association: Recent evidence (within the past 2 years) suggests an association between DMPA use and meningiomas, which are tumors of the meninges . This finding has garnered media attention and led to regulatory and legal proceedings . The South African Health Products Regulatory Authority (SAHPRA) has acknowledged this association, highlighting the need for local data to assess implications and inform national contraceptive strategies .
  • Mood Disturbances: Concerns about mood disturbances are also mentioned as a factor that may lead to reluctance or premature discontinuation of DMPA .
  • Temporary Irreversibility: During its three-month duration, DMPA is temporarily irreversible, meaning any problems or anxieties from side effects may last longer than with other methods .
  • Other Side Effects: Breast tenderness is another mentioned side effect .
  • No Increased Risk of Cardiovascular Events or Cancers: Long-term experience with DMPA has established that its use does not increase the risk of cardiovascular events, breast cancer, other gynecologic malignancy, or postmenopausal fracture .

Patient Counseling and Information:

  • Patient information is of paramount importance, as DMPA has historically suffered from a negative public image and misinformation .
  • Easily understood, accurate patient information leaflets are crucial to counter biased and inaccurate information often found in women's magazines .
  • Pre-use counseling is essential to address potential menstrual changes and other side effects .
  • Counseling and understanding women's concerns and experiences with DMPA are important for healthcare providers to redesign counseling strategies, improve contraceptive continuation, and enhance patient adherence .

Use in Specific Populations:

  • Adolescents: DMPA is the only contraceptive injection available in the United States and its use in teens involves specific initial workup, treatment, and follow-up . Concerns regarding potential adverse effects on adolescent bone health exist, although data on reversibility of bone loss are reassuring .
  • Women with Intellectual Disabilities: In the late twentieth century, DMPA was used as a method of menstrual suppression for institutionalized women with intellectual disabilities in the U.S., even without FDA license for this purpose . This practice, as highlighted by controversies like the 1987 congressional hearing concerning A School for Me (a Navajo-run institution), reflected perceptions of DMPA as a treatment for menstrual anxiety, a reprieve for care workers, a non-surgical alternative to sterilization, and a means to delay puberty, despite public backlash and cancer concerns .
  • Women with Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS): For women with SLE and APS, contraception selection must carefully consider thrombotic risk, bone health, and cardiovascular comorbidities . While estrogen-containing hormonal contraception is generally avoided due to pro-thrombotic risk, emerging data also suggest an association of higher dose progestins like norethindrone acetate, and injectable preparations such as DMPA, with increased VTE risk in this population . Long-acting reversible contraceptives, particularly progestin-only IUDs and subdermal implants, are often highly effective and well-tolerated for those with SLE and APS .
  • Sickle Cell Disease: Updated U.S. MEC recommendations reflect increased safety concerns for DMPA in women with sickle cell disease .
  • HIV: More research is needed on the association between DMPA and HIV .

Global Context:

  • DMPA is commonly used worldwide . Other injectables like Mesigyna and norethindrone enanthate are also widely used outside the United States . Injectable contraception, in general, is globally popular .
  • In veterinary medicine, progestin contraceptives, including medroxyprogesterone acetate, are effective in preventing pregnancy in felids (cats), but long-term use is associated with endometrial hyperplasia, endometrial cancer, and mammary cancer .

In summary, Depo-Provera is a highly effective, convenient, and discrete injectable contraceptive that offers significant advantages, especially for women who cannot use estrogen or struggle with daily adherence . However, its use requires careful consideration of potential side effects such as irregular bleeding, weight gain, transient bone mineral density loss, and emerging concerns regarding venous thromboembolism risk in certain populations, and a potential association with meningiomas . Comprehensive patient counseling and accurate information are vital for informed decision-making and adherence .

References

1Injectable contraception.PubMed

Sadia Haider, Philip D Darney
Injectable contraceptive methods are safe, highly efficacious, and commonly used worldwide. Depo-Provera (depot-medroxyprogesterone acetate) is the most commonly used injectable in the United States. It is a convenient, discrete, and low-maintenance method, and is ideal for patients with contraindications to estrogen use and certain medical conditions. In addition, there are many noncontraceptive benefits to Depo-Provera use. Side effects with this method including irregular bleeding, breast tenderness, weight gain, and the impact on bone mineral density should be taken into consideration when prescribing the method. Other injectables such as Mesigyna and norethindrone enanthate are widely used outside the United States.

2Depo Provera. Position paper on clinical use, effectiveness and side effects.PubMed

A Bigrigg, M Evans, B Gbolade, et al.
Depo Provera (medroxyprogesterone acetate, DMPA) when given as 150 mg by deep intramuscular injection every 12 calendar weeks (84 days+5 days), is a highly effective contraceptive with a very low failure rate comparable to modern copper IUDs and lower than many other methods. It should be available as a first line method to all who wish to make an informed choice about reversible methods of contraception. Pre-use counselling is essential to minimise the effect of menstrual change which occurs in most patients. However there is great patient variability. Use of DMPA is independent of intercourse and also independent of the user's memory (and thus of continuing motivation), other than remembering the 12 weekly appointments. For many women this is a great advantage. Oral contraceptive methods involve remembering to take a pill each day, in the case of the progestogen only pill within the same three hours each day. This places considerable strain on women who lead irregular lifestyles, who are very busy or travel frequently. Such women often describe a constant 'fear of forgetting', especially with the POP. The main potential disadvantage of DMPA in this country are likely to be menstrual disturbance and weight gain. The combined oral contraceptive pill gives the appearance of excellent cycle control because it removes the natural cycle altogether and replaces it with an artificial one. All progestogen-only methods, whether low or high dose, lead to menstrual disturbances, so in this respect DMPA is not unique. Although troublesome, the menstrual disturbances which occur in DMPA users very rarely require operative medical intervention, and can often be improved simply by short courses of oestrogen or shorter injection intervals. Again, women need to know what can be done so that they are aware that they should seek advice early, rather than miserably waiting.for their 12 week appointment. DMPA has no appreciable effects on blood pressure or thrombosis risk. In this it has an advantage over the combined oral contraceptive pill, and provides a simple, effective alternative for women who cannot use the pill for these reasons. Similarly, it has been suggested that women who suffer from focal migraine and are therefore advised against use of the combined oral contraceptive pill can still use progestogen-only contraceptives. Although the POP is medically safe in these circumstances, in young women it is less effective, and involves strict time keeping, which will be disadvantageous for some women. Side effects, long term use and schedules of administration are also discussed. The use of local protocols to allow nurse administration is to be supported both in general practice and the clinic situation. Perhaps the most important issue surrounding the use of DMPA is that of patient information. The method has had a particularly bad public image, which naturally makes potential users anxious and subject to misinformation from poorly informed or biased sources. Also, it is temporarily irreversible during its three months duration, so the duration of any problems or anxieties resulting from side effects may be longer than for other methods. It is of paramount importance that easily understood, accurate patient information leaflets are available, since biased and inaccurate information is readily available from women's magazines, perpetuating the myths surrounding the method.

3Injectable contraception.PubMed

Geneviève Roy
Injectable contraception has many advantages and is a popular birth control method worldwide. Its efficacy is independent of a daily action or an intervention around the time of coitus. It is highly efficacious and well tolerated in general. In the United States, the available injectable contraceptive is depot medroxyprogesterone acetate (DMPA). Its use is associated with a decrease in bone mineral density (BMD) that is largely if not completely reversible over time and very comparable to the BMD loss associated with pregnancy and breastfeeding. The available knowledge on the impact of BMD loss on the risks of fractures later in life is incomplete, but in the light of the small magnitude of impact of DMPA on BMD and its reversibility, any increase in the risk of osteoporotic fractures is likely to be small. This article reviews the recent evidence on DMPA's efficacy, risks and benefits, and side effects with a focus on bone health issues.

4Use of depo-provera in teens.PubMed

F E Khoiny
Currently, depot-medroxyprogesterone acetate is the only contraceptive injection available in the United States. Its use was approved by the U.S. Food and Drug Administration in October 1992. This article describes the mechanisms of action, advantages, disadvantages, and contraindications of this very effective contraceptive agent. In addition, the initial workup, the treatment, and the follow-up of the teen receiving depot-medroxyprogesterone acetate are presented.

5Progestin-only contraception and thrombosis: An updated systematic review.PubMed

Naomi K Tepper, Antoinette T Nguyen, Maura K Whiteman, et al.
OBJECTIVES: Evidence is limited on whether the use of progestin-only contraception (POC) is associated with the risk of thrombosis. Our objective was to update an earlier systematic review on POC and thrombosis risk. STUDY DESIGN: We searched for articles that examined risk of venous thromboembolism (VTE) (e.g., deep venous thrombosis or pulmonary embolism) or arterial thromboembolism (ATE) (e.g., myocardial infarction or stroke) among women with thrombogenic conditions or characteristics or in the general population using POC, compared with women using nonhormonal or no contraception, published during February 1, 2016 through November 30, 2022. We also included articles from a previous systematic review, with articles published through January 2016. We assessed quality for each study and certainty of evidence for all outcomes. RESULTS: Thirty-three articles met inclusion criteria; one was good quality, 20 were fair quality, and 12 were poor quality. Seven articles were newly identified, and 26 were included in the previous review. Risk of VTE, but not ATE, was generally elevated with depot medroxyprogesterone acetate (DMPA) use among women with certain thrombogenic conditions or characteristics (e.g., diabetes or postpartum) and women in the general population. Risks of VTE and ATE were generally not elevated with use of other POC, including levonorgestrel intrauterine devices, implants, or progestin-only pills. CONCLUSIONS: Evidence suggests that risk of VTE, but not ATE, is increased with DMPA use compared with nonuse among women with certain thrombogenic conditions and women in the general population. Evidence does not suggest increased risk of VTE or ATE with use of other POC. While several studies examined thrombosis risk with POC use and thrombogenic conditions or characteristics, data are limited for individual conditions or characteristics and no evidence was identified for most conditions. The certainty of evidence is low or very low for all outcomes. IMPLICATIONS: Use of DMPA might increase the risk of VTE among women with medical conditions associated with thrombosis and among women in the general population. Evidence does not suggest an increased risk of thrombosis with other POC. Further study is needed on safety of POC use by women with thrombogenic conditions.

6Depo-Provera.PubMed

N C Sharts-Hopko

7Depot-medroxyprogesterone acetate: an update.PubMed

Sayed Bakry, Zaher O Merhi, Trudy J Scalise, et al.
OBJECTIVE: Depo-Provera is a contraceptive approved by the US Food and Drug Administration (FDA) since 1992 and used worldwide by more than 90 million women. AIM OF STUDY: Despite the fact that progestins are endogenous hormones that are secreted by the body, its excess might lead to detrimental health effects. Whether progestins as contraceptives are friends or foes is a questionable matter. In this manuscript, we drive the attention to both usage and side effects Depo-Provera. RESULTS: Depot-medroxyprogesterone acetate (DMPA) is a highly effective, convenient non-daily hormonal contraceptive option that has been available worldwide for many years. The experience with DMPA provides a large body of long-term data regarding the efficacy and safety of this contraceptive method; this long-term experience has established that the use of DMPA does not increase the risk of cardiovascular events, breast cancer, other gynecologic malignancy, or postmenopausal fracture; however, patients are often more concerned about the relatively immediate effects of contraceptives such as potential changes in menstrual cycle, body weight, and mood disturbances. CONCLUSION: Concerns about such issues may lead to reluctance to initiate therapy or premature discontinuation. Counseling and understanding of women's concerns and experiences using Depo-Provera is important and could help health care providers redesign counseling strategies to improve contraceptive continuation and improve patient adherence.

8The Food and Drug Administration and medroxyprogesterone acetate. What are the issues?PubMed

A Rosenfield, D Maine, R Rochat, et al.
In 1978, the Food and Drug Administration denied approval of the three-month injectable contraceptive depot medroxyprogesterone acetate for use in the United States. This decision goes against the advice of the FDA's own scientific advisory panels, as well as the rulings of the World Health Organization and the drug regulation institutions of more than 70 developed and developing countries. In response to protest from the manufacturer of depot medroxyprogesterone acetate and from many health professionals, the FDA took the unusual step of scheduling a public board of inquiry to review its decision in January 1983. Reviewing the scientific literature on the risks and benefits of depot medroxyprogesterone acetate, we find no reason to deny depot medroxyprogesterone acetate approval, provided that studies of its possible side effects are continued and that women use it only after having made an informed choice between this and other methods of contraception.

9The association between depot medroxyprogesterone acetate and meningiomas: Emerging data and their relevance to the South African context.PubMed

R J Burman, R De Waal, K Cohen, et al.
In the past 2 years, evidence suggesting an association between depot medroxyprogesterone acetate (dMPA) use and meningioma has emerged. As dMPA remains one of the most widely used contraceptive methods worldwide, this finding has led to increasing media attention, and regulatory and legal proceedings. The South African Health Products Regulatory Authority (SAHPRA) has issued a statement acknowledging the association between dMPA exposure and the development for meningiomas. However, the paucity of local data on dMPA use and the incidence of and risk factors for meningioma in both the public and private health sector make it difficult to fully assess the implications in SA. This report discusses the relevance of the association between dMPA and meningiomas in the SA context. We provide a summary of the current data on the risk of meningioma with dMPA exposure, and suggest how this should impact on recommendations for the prescribing and use of dMPA from a public health perspective. We further identify gaps in local data, and propose where efforts should be directed to collect relevant data to inform a rational national contraceptive strategy.

10Injectable contraception: updates and innovation.PubMed

Gillian Schivone, Laneta Dorflinger, Vera Halpern
PURPOSE OF REVIEW: Injectable contraception is a highly effective form of birth control that is globally popular. Recent research has focused on ways to make injectables such as depot medroxyprogesterone acetate (DMPA) more accessible and to improve the side-effect profile of injectables. This review will focus on new directions and approaches to the use of injectable contraception. RECENT FINDINGS: Research in the area of injectable contraception has focused on improving access for women through home or self-injection, and also task-shifting and community-based distribution in low-resource areas. Specific to DMPA, studies have focused on lowering the overall dose of medication while maintaining efficacy, and improving drug-delivery systems. More research into the association between DMPA and HIV is needed, and also the effects of administration of DMPA at the time of medication abortion. SUMMARY: Injectable contraceptives are an important part of the global method mix of highly effective birth control. Improving the accessibility and side effect profile of commodities such as DMPA will make injectables even more valuable for women seeking effective contraception.

11Bodies of evidence: activists, patients, and the FDA regulation of Depo-Provera.PubMed

Wendy Kline
In January 1983, the FDA held one of only two scientific "Public Boards of Inquiry" in the history of the administration to determine whether to approve Depo-Provera for use as a contraceptive in the United States. At the hearing, ideas about gender and power played a central role in negotiations between scientists, doctors, patients, and women's health activists. The nature of the Depo-Provera Public Board of Inquiry lends itself to analysis of the interaction between and among these groups, each of which had a vested interest in the outcome of the FDA decision. The stories and strategies emerging from the actors involved in the Public Board of Inquiry reveal the enormous complexity of regulating reproduction in the late twentieth century.

12Contraception in systemic lupus erythematosus and antiphospholipid antibody syndrome.PubMed

Lauren He, Wendy Marder
PURPOSE OF REVIEW: Family planning and contraception are central to disease management in people with rheumatic musculoskeletal diseases (RMD), particularly systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), in whom unplanned pregnancy can carry substantial maternal and fetal risk. This review summarizes current evidence and guideline-based recommendations regarding contraceptive choices in women with SLE and APS, with a focus on thrombotic risk, bone health, and cardiovascular considerations. RECENT FINDINGS: Estrogen-containing hormonal contraception is well established as a pro-thrombotic risk and should be avoided in those with APS, antiphospholipid antibodies (aPL), lupus nephritis, or at least moderately active SLE. Emerging data also suggest an association of certain higher dose progestins such as norethindrone acetate, and injectable preparations such as depot medroxyprogesterone acetate (DMPA), with increased venous thromboembolism (VTE) risk. Regarding bone health, oral contraceptive pills (OCPs) and combined hormonal contraception (CHC) may slow the rate of bone mass acquisition in adolescents with uncertain long-term effects on fracture risk, whereas use in adult women is associated with modestly higher bone mineral density and lower osteoporotic risk. While awareness of the importance of contraception in the rheumatology community is improving, real-world practice reveals that implementation of reproductive health guidelines is lagging. SUMMARY: For women with SLE and APS, contraception selection must account for thrombotic risk, bone health, and cardiovascular comorbidities. Long-acting reversible contraceptives, particularly progestin-only intrauterine devices (IUDs) and subdermal implants, remain highly effective and well tolerated for those with SLE and APS. Ongoing efforts to improve guideline implementation, shared decision-making, and patient and provider education are essential to reduce unplanned pregnancies and optimize reproductive outcomes in this population.

13Controversies in contraception.PubMed

Sarah A B Pitts, S J Emans
PURPOSE OF REVIEW: New research is constantly being published regarding hormonal contraceptives and bone health, migraine headaches, thrombosis risk, hypertension, weight gain, and obesity, as well as emergency contraception. At times, these studies can be clarifying, but they can also raise new controversies and questions. It is important for providers to be aware of the emerging issues regarding contraceptive care for adolescent patients. RECENT FINDINGS: Research suggests that Depo-Provera (depot medroxyprogesterone acetate; Pfizer, New York City, New York, USA) and, perhaps, low-dose oral contraceptive pills can have adverse effects on adolescent bone health, although the data demonstrating reversibility of bone loss after discontinuation of these contraceptives are reassuring. Additionally, estrogen-containing contraceptives pose risks for patients, including the onset of or exacerbation of migraine headaches, venous thromboembolism, and hypertension. Depo-Provera has been implicated in weight gain, especially in girls who are already overweight. Obesity may decrease the efficacy of some hormonal contraceptives. Finally, the mechanism of action of emergency contraception is still unknown, although studies continue to suggest that it has primarily preovulatory, not postovulatory, effects. SUMMARY: Adolescent health providers need to be aware of the new research and controversies in contraceptive care in order to counsel and care for patients effectively.

14Contraception in felids.PubMed

Linda Munson
Contraceptives are used for reversible reproductive control in genetically valuable wild felids, as permanent reproductive control in generic wild felids, and as an economically practicable means to control feral cats. The progestin contraceptives, megestrol acetate, melengesterol acetate, medroxyprogesterone acetate, and levonorgestrol (administered orally, in implants, or as depot injections), are effective in preventing pregnancy. However, long-term use is associated with endometrial hyperplasia, endometrial cancer, and mammary cancer. Gonadotropin releasing hormone analogs or luteinizing hormone vaccines that achieve contraception by suppressing ovarian or testicular function, do not have the adverse health effects of progestins. However, reliable reversibility has not been demonstrated, and male secondary sex characteristics may be suppressed. Bisdiamines also inhibit spermatogenesis and lower circulating testosterone concentrations in treated male cats. Porcine zona pellucida vaccines are ineffective contraceptives in felids and may cause serious health problems when combined with some adjuvants. Because of the limited availability of non-progestin contraceptives and side effects associated with some agents, widespread application of contraception to felids has been curtailed. More non-steroidal methods of contraception should be tested in the future to provide alternatives for controlling reproduction in felids. Furthermore, all empirical information on contraceptive safety and efficacy should be assembled in a database to provide the knowledge needed by veterinarians and managers to determine benefits/risks of currently available contraceptives in felids, both domestic and wild.

15Early experience with the contraceptive use of depot medroxyprogesterone acetate in an inner-city clinic population.PubMed

M Polaneczky, M Guarnaccia, J Alon, et al.
There are few data on the experience of American women with the injectable depot medroxyprogesterone acetate (DMPA) since its recent approval by the Food and Drug Administration for contraceptive use in the United States. An exploratory study was conducted using chart reviews and telephone interviews of 261 women who initiated DMPA use between December 1992 and June 1994 at either a hospital-based (48%) or community-based (49%) clinic in New York City. Most DMPA users were single (70%), had had at least one birth (88%), had had at least one abortion (67%) and had ever practiced contraception (75% of those with available data). Life-table DMPA continuation rates were 63% at six months and 42% at 12 months and were not affected by the users' age, marital status, pregnancy history, clinic site or proximity of residence to the clinic. Among adults, the risk of DMPA discontinuation was highest during the three-month period following the second injection, while among adolescents, this risk increased throughout the duration of use. The most commonly reported reasons for method discontinuation were side effects, primarily menstrual irregularities (30%) and weight gain (24%).

16Using updated clinical recommendations to support contraceptive decision-making: U.S. medical eligibility criteria for contraceptive use, 2024.PubMed

Kathryn M Curtis, Antoinette T Nguyen, Naomi K Tepper, et al.
OBJECTIVES: In August 2024, the U.S. Centers for Disease Control and Prevention updated U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), which provides recommendations for safe use of contraception for women with certain characteristics and medical conditions. This paper provides a summary of the evidence and context for new and updated U.S. MEC recommendations. STUDY DESIGN: The 2024 U.S. MEC was updated through a rigorous, multi-year process of determining priorities that would have high impact on clinical care, conducting systematic reviews of the evidence, and considering perspectives of health care providers and patients on how the evidence could best support updated recommendations. RESULTS: New U.S. MEC recommendations were added for chronic kidney disease, specifically for three subconditions: current nephrotic syndrome, hemodialysis, and peritoneal dialysis. Revisions were made to several existing recommendations, such as those for sickle cell disease, anticoagulant therapy use, various thrombogenic conditions, cirrhosis, liver tumors, solid organ transplantation, and intrauterine device placement in the postpartum period. Updated recommendations include those that reflect decreased safety concerns for some medical conditions (e.g., progestin-only contraception and some liver diseases) and increased safety concerns for others (e.g., combined hormonal contraception and depot medroxyprogesterone acetate for women with sickle cell disease). Recommendations for new contraceptive methods were added. CONCLUSIONS: Evidence-based clinical guidelines can be used by health care providers to support patient-centered contraceptive counseling and services and remove unnecessary barriers to accessing and using contraception. Provider tools including a mobile app are available to help with implementation of the updated recommendations. IMPLICATIONS: Keeping U.S. MEC up-to-date is critical for supporting contraceptive decision-making and improving access to contraception and reproductive health care. This includes new research to address current evidence gaps, rigorous methodology for continuous evidence identification and synthesis, state-of-the-art methods for guideline development, and a broad range of dissemination and implementation strategies.

17Depressive symptoms and Depo-Provera.PubMed

C Westhoff, C Truman, D Kalmuss, et al.
Women enrolled in a multicenter prospective study were evaluated to identify any possible relationship between depressive symptoms and the use of contraceptives. Women choosing Depo-Provera (n = 495) were evaluated before starting these contraceptives and were reinterviewed 1 year later. Women who continued the method had lower depressive symptom scores at baseline than did the women who discontinued the method or who were lost to follow-up. Among the continuing Depo-Provera users, the depressive symptom scores improved slightly at 1 year (7.4 vs 6.7). Those subjects with the highest (i.e., worst) scores at enrollment demonstrated improved scores at follow-up.

18Injectable contraception.PubMed

A M Kaunitz

19Contraceptive development and testing in the United States of America.PubMed

D A Edelman, W A Van Os
Contraceptive development, including the development of IUDs, is discussed in light of the changing regulatory role of the FDA. The paper considers how the FDA and the government affect contraceptive development. Events that led to the demise of IUD use in the United States probably will have long-lasting effects on all future contraceptive development by the pharmaceutical industry in the United States.

20These "Children Won't Become Women": Depo-Provera, Intellectual Disability, and the Indian Health Service.PubMed

Emma Wathen
Although Depo-Provera is best known as an injectable hormonal contraceptive, the drug also served as a method of menstrual suppression for institutionalized women with intellectual disabilities in the late twentieth-century United States, even after the Food and Drug Administration refused to license it for this purpose. To understand how institutionalized women came to be injected with Depo-Provera in the 1980s, this article investigates the controversy at A School for Me, a Navajo-run institution that came under fire during a 1987 congressional hearing for administering Depo-Provera to its residents. Beyond its utility as a contraceptive, many physicians and institutional administrators saw Depo-Provera as a treatment for menstrual anxiety, a reprieve for care workers, a non-surgical substitute for sterilization, and a delayer of puberty for women with intellectual disabilities. These perceived benefits explain why some physicians and administrators championed routine injections of Depo-Provera in institutional settings, despite public backlash and concerns about the drug's potential to cause cancer. Framing Depo-Provera as a form of care enabled it to be deployed as a form of control over these women's menstruation and their bodyminds. Editor's Note: This article received the American Association for the History of Medicine 2025 Shryock Medal, an award for an outstanding, unpublished essay by a single author graduate student on any topic in the history of medicine.
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