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Contraception. 1997 Nov;56(5):305-12.

Depot medroxyprogesterone acetate pioneers. A retrospective study at a North Carolina Health Department.

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Office of Population Research, Princeton University, NJ 08544, USA.


This article examines the characteristics of the first group of depot medroxyprogesterone acetate (DMPA) acceptors after US Food and Drug Administration (FDA) approval of the method and evaluates their continuation rates and factors associated with discontinuation. This was a population based retrospective study based on 12 months of clinic data for 510 women who began using DMPA in 1993 at a large county health department. Cumulative 12 month life table rates were calculated for the entire group and were then stratified by selected characteristics. The 4, 8, and 12 month continuation rates were 67%, 46%, and 35%, respectively. More than half of these women discontinued because of bleeding and nonbleeding side effects (25% and 28%, respectively). Almost 20% of these women were considered discontinuers because they waited longer than 16 weeks to return for an injection. As measured in this study, continuation rates for this first group of DMPA acceptors were low. The next step is to determine if the characteristics and patterns of use of these "pioneer" acceptors are representative of more recent acceptors, and if lessons learned from this group will lead to higher continuation rates.


Depo-Provera was approved for general contraceptive use in the US in October 1992. This retrospective study examined the records of the first 510 women who initiated Depo-Provera use at a North Carolina county health department in 1993. The mean age of Depo-Provera users in this series was 23.5 years; 80% were unmarried. The mean number of living children was 1.3. At the time of injection, an appointment was set for a second injection 12 weeks later. Women were considered as continuers as long as they received an injection within 16 weeks of the last injection--the maximum duration of effectiveness. A total of 181 acceptors (36%) continued Depo-Provera use for 12 months, with an average interval between injections of 13 weeks. The 4-month and 8-month continuation rates were 67% and 46%, respectively. Of the 227 discontinuations, 64 were due to non-bleeding-related side effects such as weight gain, headache, and hair loss and 56 were because of bleeding problems. An additional 39 discontinuations were by default, i.e., acceptors waited more than 16 weeks for repeat injection and were refused. Another 102 women (20%) were lost to follow-up. If it is assumed that women lost to follow-up continued at the same rate as other women, the 12-month continuation rate rises. Discontinuation rates were significantly lower among only two sociodemographic groups: women covered by Medicaid for either all or none of the injections and women who reported bleeding side effects at their last injection. The provision of estrogen therapy to Depo-Provera users who experience irregular bleeding could increase compliance with this new method.

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