The effect of depo-medroxyprogesterone acetate on pituitary and ovarian function, and the return of fertility following its discontinuation: A review

doi:10.1016/0010-7824(74)90073-0

Contraception

Volume 10, Issue 2, August 1974, Pages 181-202

https://doi.org/10.1016/0010-7824(74)90073-0 Get rights and content

Abstract

Data from published and unpublished studies utilizing Depo-Provera^®^∗ for contraception is presented to demonstrate that there are no significant deleterious effects produced by the drug in the hypothalamus, pituitary, or ovary. The prolonged amenorrhea and anovulation is due to prolonged pharmacologic levels of Provera in the circulation due to slow absorption from the injection site. The return of reproductive function occurs promptly upon disappearance of Provera from the circulation. Pregnancy rates after discontinuation of Depo-Provera contraception are not different from other methods except for a prolongation of about 8 months and are independent of the number of injections received.

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Concern that contraception affects future fertility: How common is this concern among young people and does it stop them from using contraception?
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This study examines the concern that contraception affects future fertility among community college students and its association with contraceptive use.
We used baseline data from a randomized controlled trial with 2060 community college students assigned female at birth. We used mixed-effects multivariate logistic regression adjusted for clustered data to assess sociodemographic factors associated with concerns about contraception affecting future fertility and to test the association between this concern and contraceptive use.
Most participants (69%) worried about contraception affecting their future fertility. Multivariable results indicated that first-generation college students (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.01–1.55) and non-English speakers at home (aOR, 1.30; 95% CI, 1.04–1.64) were more concerned. Racial and ethnic differences were significant, with Black non-Hispanic (aOR, 2.83; 95% CI, 1.70–4.70), Asian/Pacific Islander non-Hispanic (aOR, 2.12; 95% CI, 1.43–3.14), and Hispanic (aOR, 1.54; 95% CI, 1.17–2.02) participants more likely to be concerned than White non-Hispanic counterparts. Participants who received contraceptive services in the past year had lower odds of this concern (aOR, 0.72; 95% CI 0.59–0.88). Furthermore, participants with this concern had lower odds of using contraception (aOR, 0.67; 95% CI, 0.49–0.91), especially hormonal contraception (aOR, 0.77; 95% CI, 0.61–0.97).
Most students feared contraception’s impact on fertility, and this fear was associated with not using contraception. Disparities in this concern may be tied to discrimination, reproductive coercion, and limited reproductive health care access. Addressing concerns about contraception affecting future fertility is crucial to person-centered contraceptive counseling.
This study examines the concern that contraception affects future fertility among sexually active female community college students and its impact on contraceptive use. Most participants expressed concerns about contraception affecting future fertility. Addressing future fertility concerns in patient-centered contraceptive counseling is crucial for reaching young people.
Continuing Medical Education Guideline on contraception and reproductive health
2022, FMC Formacion Medica Continuada en Atencion Primaria
Pharmacokinetic, biologic and epidemiologic differences in MPA- and NET-based progestin-only injectable contraceptives relative to the potential impact on HIV acquisition in women
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Access to safe and effective contraceptive choices is a reproductive right and contributes tremendously to improvements in maternal and child health. Progestin-only injectables, particularly intramuscularly injected depot medroxyprogesterone acetate (DMPA-IM), have received increased attention given findings suggesting a potential association with increased HIV risk. For women at high risk of HIV, the World Health Organization's Medical eligibility criteria for contraceptive use currently aggregate recommendations for all progestin-only injectables, including DMPA-IM, subcutaneously injected DMPA (DMPA-SC) and intramuscularly injected norethindrone/ norethisterone enanthate (NET-EN), except in the case of some drug interactions. We considered whether published data indicate differences or similarities between these injectables relevant to risk of acquiring HIV. In vitro data confirm different biological activities of these distinct progestins, including that MPA, and not NET, binds and activates the glucocorticoid receptor resulting in different biological effects relevant to immune function. Limited clinical data suggest changes in immunologic activity following DMPA-IM and NET-EN initiation, but interstudy variation and study design differences diminish ability to determine clinical relevance and the degree to which DMPA-IM and NET-EN could act differentially. The highest-quality epidemiologic studies suggest a potential 40% increase in HIV incidence in users of DMPA-IM relative to women not using hormonal contraception but no significant increase in risk in users of NET-EN. In our opinion, most of the available biologic activity and epidemiologic data indicate that DMPA and NET-EN are likely to act differently, and data remain too limited to evaluate differences between DMPA-IM and DMPA-SC.
No. 345-Primary Dysmenorrhea Consensus Guideline
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This guideline reviews the investigation and treatment of primary dysmenorrhea.
Health care providers.
Women and adolescents experiencing menstrual pain for which no underlying cause has been identified.
Published clinical trials, population studies, and review articles cited in PubMed or the Cochrane database from January 2005 to March 2016.
Seven clinical questions were generated by the authors and reviewed by the SOGC Clinical Practice-Gynaecology Committee. The available literature was searched. Guideline No. 169 was reviewed and rewritten in order to incorporate current evidence. Recommendations addressing the identified clinical questions were formulated and evaluated using the ranking of the Canadian Task Force on Preventive Health Care.
Primary dysmenorrhea is common and frequently undertreated. Effective therapy is widely available at minimal cost. Treatment has the potential to improve quality of life and to decrease time lost from school or work.
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SOGC.
- 1.
  Dysmenorrhea is highly prevalent and commonly undertreated (III).
- 2.
  Non-steroidal anti-inflammatory drugs are more effective than placebo but have more gastrointestinal side effects. All currently available non-steroidal anti-inflammatory drugs are of comparable efficacy and safety (I).
- 3.
  Suppression of ovulation is associated with decreased menstrual pain (II-1).
- 4.
  Amenorrhea induced by any means is beneficial for the treatment of dysmenorrhea (II-2).
- 5.
  Hysterectomy is effective treatment (II-2).
- 6.
  There is some evidence to support laparoscopic nerve ablation in selected cases (II-1).
- 7.
  Endometrial ablation is likely to reduce symptoms of dysmenorrhea when it occurs in the presence of menorrhagia (I).
- 1.
  Both primary and secondary dysmenorrhea are likely to respond to the same medical therapy. Therefore, initiation of treatment should not depend on establishing a precise diagnosis (II-1A).
- 2.
  Health care providers should include specific questions regarding menstrual pain when obtaining a woman's medical history (III-B).
- 3.
  A pelvic examination is not necessary prior to initiating therapy (III-D).
- 4.
  A pelvic examination is indicated in patients not responding to conventional therapy and when organic pathology is suspected (III-B).
- 5.
  Non-steroidal anti-inflammatory drugs, administered with regular dosing regimens, should be considered first-line treatment for most women (I-A).
- 6.
  Hormonal therapies should be offered to women and girls who are not currently planning pregnancy unless contraindications exist (I-A).
- 7.
  Continuous or extended use combined hormonal contraceptives are recommended (I-A).
- 8.
  Regular exercise is likely to improve symptoms of dysmenorrhea and should be recommended (II-1A).
- 9.
  Local heat in the form of heated pads or patches should be recommended as a complementary treatment for dysmenorrhea (I-A).
- 10.
  High-frequency transcutaneous electrical nerve stimulation should be considered as a complementary treatment or in women unable or unwilling to use conventional therapy (II-1B).
- 11.
  Acupoint stimulation should be considered for women wishing to use complementary or alternative therapies (II-1B).
- 12.
  Ginger is recommended for women wishing to use complementary or alternative therapies (I-A).
- 13.
  Preoperative investigations should include a detailed history and physical examination, ultrasound, and possibly magnetic resonance imaging to discover secondary causes for dysmenorrhea and to direct appropriate therapy (III-A).
- 14.
  Surgical intervention should only be considered if a concerted trial of medical therapy has not been successful (III-A).
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Citation Excerpt :
They can also be considered in patients for whom estrogen is contraindicated. It should not be a first-line agent, however, for a patient who is hoping to pursue pregnancy quickly after discontinuation of the method because of a potential for delayed response of fertility after therapy.28 Depot Provera can be used for the treatment of menstrual disorders such as dysmenorrhea, and amenorrhea rates may approach 71%.29
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2017, Journal of Obstetrics and Gynaecology Canada
Analyser l’évaluation et le traitement de la dysménorrhée primaire.
Fournisseurs de soins de santé.
Les femmes et les adolescentes aux prises avec des douleurs menstruelles de cause inconnue.
Essais cliniques publiés, études sur la population et articles de synthèse cités dans PubMed et dans la base de données Cochrane entre janvier 2005 et mars 2016.
Les auteurs ont défini sept questions cliniques, qui ont été évaluées par le comité de pratique clinique – gynécologie de la SOGC. La littérature publiée a été étudiée. La directive clinique n^o 169 a été revue et retravaillée pour intégrer les données probantes actuelles. Les recommandations portant sur les sept questions cliniques ont été formulées et évaluées au moyen des critères décrits par le Groupe d’étude canadien sur les soins de santé préventifs.
La dysménorrhée primaire est un trouble fréquent, souvent insuffisamment traité. Des traitements efficaces sont largement accessibles et peu coûteux. Le traitement offre la possibilité d’améliorer la qualité de vie des patientes et de réduire la perte de temps de travail ou d’études.
La présente directive clinique est une révision et une mise à jour de la directive n^o 169, publiée en décembre 2005.
SOGC.
- 1.
  La dysménorrhée a une prévalence élevée et est souvent insuffisamment traitée (III).
- 2.
  Les anti-inflammatoires non stéroïdiens sont plus efficaces que les placebos, mais ils entraînent plus d’effets secondaires gastro-intestinaux. Les anti-inflammatoires non stéroïdiens actuellement en vente ont sensiblement tous le même profil d’innocuité et d’efficacité (I).
- 3.
  L’inhibition de l’ovulation est associée à une diminution de la douleur menstruelle (II-1).
- 4.
  L’aménorrhée, peu importe la façon dont elle est induite, est bénéfique dans le traitement de la dysménorrhée (II-2).
- 5.
  L’hystérectomie est un traitement efficace (II-2).
- 6.
  Des données probantes appuient la neurectomie par laparoscopie dans certains cas (II-1).
- 7.
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- 1.
  Les dysménorrhées primaire et secondaire peuvent toutes deux répondre au même traitement médical. Il n’est donc pas néces-saire d’établir un diagnostic précis avant d’entreprendre un traitement (II-1A).
- 2.
  Les fournisseurs de soins de santé devraient poser des questions précises sur la douleur menstruelle au moment de la prise des antécédents médicaux de leurs patientes (III-B).
- 3.
  L’examen pelvien n’est pas nécessaire avant d’entreprendre un traitement (III-D).
- 4.
  L’examen pelvien est indiqué chez toutes les patientes qui ne répondent pas au traitement conventionnel de la dysménorrhée et chez celles où la présence d’une pathologie organique est soupçonnée (III-B).
- 5.
  L’administration d’anti-inflammatoires non stéroïdiens de façon régulière devrait être envisagée comme traitement de première intention chez la plupart des femmes (I-A).
- 6.
  À moins de contre-indications, l’hormonothérapie devrait être offerte aux femmes et aux adolescentes qui ne cherchent pas actuellement à tomber enceintes (I-A).
- 7.
  L’administration continue ou prolongée de contraceptifs hormonaux combinés est recommandée (I-A).
- 8.
  La pratique régulière d’exercices physiques peut atténuer les symptômes de dysménorrhée; c’est pourquoi elle devrait être recommandée (II-1A).
- 9.
  L’application locale de chaleur par des timbres ou des coussins chauffants devrait être recommandée comme traitement complémentaire de la dysménorrhée (I-A).
- 10.
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- 11.
  La stimulation de points d’acupuncture devrait être envisagée chez les femmes désirant avoir recours à des traitements complémentaires ou non conventionnels (II-1B).
- 12.
  La consommation de gingembre est recommandée chez les femmes désirant avoir recours à des traitements complémentaires ou non conventionnels (I-A).
- 13.
  Toute évaluation préopératoire devrait comprendre des antécédents médicaux détaillés, un examen physique approfondi, une échographie et possiblement une imagerie par résonance magnétique pour déterminer les causes secondaires de la dysménorrhée et orienter l’approche de traitement (III-A).
- 14.
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View all citing articles on Scopus

^∗: Registered trade mark for sterile aqueous suspension of medroxyprogesterone acetate, The Upjohn Company, Kalamazoo, Michigan, U.S.A.

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The effect of depo-medroxyprogesterone acetate on pituitary and ovarian function, and the return of fertility following its discontinuation: A review

Abstract

Amer. J. Obstet. Gynec.

Fertil. Steril.

Amer. J. Obstet. Gynec.

Amer. J. Obstet. Gynec.

Amer. J. Obstet. Gynec.

Amer. J. Obstet. Gynec.

Fertil. Steril.

Contraception

Contraception

Am. J. Obstet. Gynec.

Contraception

Fertil. Steril.

Contraception

Contraception

J. Chron. Dis.

Fertil. Steril.

Fertil. Steril.

J. Fertil. Steril.

Medroxyprogesterone acetate in the treatment of constitutional sexual precocity

J. Clin. Endocr.

Effects of 17α-hydroxy-6α-methylprogesterone acetate (Depo-Provera) on urinary gonadotropins and estrogens in man

Acta Endocr. (Kobenhavn)

Treatment of constitutional precocious puberty in children with medroxyprogesterone acetate

J. Pediat.

Parenteral Use of Medroxyprogesterone Acetate as an Antifertility Agent in Dogs

Factors influencing the absorption of medroxyprogesterone acetate

Steroids

6-Methyl-17-acetoxyprogesterone Injectable: Clinical Experience

Prolonged postpartum dysfunctional uterine bleeding subsequent to prenatal therapy with parenteral potent progestogens

Obstet. Gynec.

Fertility control with long-acting injectable steroids: a preliminary report

Obstet. Gynec.

Fertility Control with an Injectable Form of a Progestin-Estrogen Combination

A Long Acting Progestational Agent as a Contraceptive Method

Depo-Provera (medroxy-progesterone acetate) as a female contraceptive agent

Current studies in contraception: the use of a longacting progestogen by injection

S. Afr. Med. J.

Long-term contraceptive effect of injectable progestogens: inhibition and reestablishment of fertility

Int. J. Fertil.

Contraception with a six-monthly injection of progestogen. 1. Effects on blood pressure, body weight and uterine bleeding pattern side effects, efficacy and acceptability

Aust. New Zeal. J. Obstet. Gynaec.

Return of menstruation and fertility in Thai women after contraceptive injections

J. Biosoc. Sci.