Depot Medroxyprogesterone Acetate Users Research Articles

Injectable contraception: what should the longest interval be for reinjections?

BackgroundProgestin-only injectable contraceptives continue to gain in popularity, but uncertainty remains about pregnancy risk among women late for reinjection. The World Health Organization (WHO) recommends a “grace period” of 2 weeks after the scheduled 13-week reinjection. Beyond 2 weeks, however, many providers send late clients home to await menses. Study designA prospective cohort study in Uganda, Zimbabwe and Thailand followed users of depot-medroxyprogesterone acetate (DMPA) for up to 24 months. Users were tested for pregnancy at every reinjection, allowing analysis of pregnancy risk among late comers. ResultsThe analysis consists of 2290 participants contributing 13,608 DMPA intervals. The pregnancy risks per 100 women-years for “on time” [0.6; 95% confidence interval (CI), 0.33–0.92], “2-week grace” (0.0; 95% CI, 0.0–1.88) and “4-week grace” (0.4; 95% CI, 0.01–2.29) injections were low and virtually identical. ConclusionExtending the current WHO grace period for DMPA reinjection from 2 to 4 weeks does not increase pregnancy risk and could increase contraceptive continuation.

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

Association between caffeine intake and bone mass among young women: potential effect modification by depot medroxyprogesterone acetate use

This study assessed associations between habitual caffeine intake and bone mass among young women. Analyses of the entire study population revealed no significant associations, while analyses restricted to women using depot medroxyprogesterone acetate (DMPA) showed modest inverse associations between caffeine intake and bone mineral content (BMC). Some previous investigations among postmenopausal women suggest an inverse relationship between caffeine intake and bone mass, yet studies of this association among young women are few. The association between habitual caffeine intake and bone mass was evaluated prospectively in a population-based cohort of 625 females, aged 14 to 40 years, adjusting for relevant biological and lifestyle factors. Caffeinated beverage intake was self-reported, and bone mineral content (BMC) and bone mineral density (BMD) were measured at baseline and every 6 months throughout a 24-month follow-up period using dual-energy x-ray absorptiometry. Cross-sectional analyses revealed no significant differences in mean BMC or BMD at baseline. Mean percentage and absolute changes in BMC and BMD were not associated with caffeine use. Repeated measures analyses similarly showed no significant association between caffeine intake at baseline and mean BMC or BMD measured during follow-up. However, among women using depot medroxyprogesterone acetate (DMPA), modest inverse associations between caffeine and BMC (but not BMD) were detected. Our data suggest that heavy habitual consumption of caffeinated beverages does not adversely impact bone mass among young women in general. Greater caffeine intake may be associated with lower BMC among DMPA users.

A comparative study of Cyclofem® and depot medroxyprogesterone acetate (DMPA) effects on endometrial vasculature

ObjectivesThe most common reason for discontinuation of long-acting progestogen-only contraceptives is irregular bleeding following local endometrial vascular changes. To reduce unpredictable bleeding episodes among depot medroxyprogesterone acetate (DMPA) users, the...

The effect of combined oral contraception and depot medroxyprogesterone acetate on brachial flow mediated dilatation and carotid arterial distensibility and stiffness index

To compare the brachial flow-mediated dilation (FMD), carotid distensibility and stiffness index among young healthy women users of combined oral contraception (COC), depot medroxyprogesterone acetate (DMPA) and non users of hormonal contraception (NU). Cross-sectional study. The patients were enrolled from July 2006 to April 2007: 100 young healthy women aged from 18 to 30 years, 50 NU and 50 users of hormonal contraception for at least 6 months: 25 users of COC (cyclic use of ethinylestradiol 30 μg + levonorgestrel 150 μg) and 25 users of DMPA (150 mg intramuscular every 11 to 13 weeks). All patients were evaluated in a single morning appointment after overnight fast. The clinical parameters were age, body mass index (BMI), waist, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR). The ultrasonographic evaluation included the measurement of carotid intima-media thickness (IMT), right common carotid artery diastolic and systolic diameter (to calculate carotid distensibility and stiffness index), brachial artery diameter before and after 60 seconds of a five minutes 200 mmHg forearm compression (for FMD), uterine volume and the mean volume of both ovaries (only the contralateral ovary was considered when a corpus luteum was observed). One way ANOVA and Tukey post test were used to compare means. Means and standard deviations from the three groups are shown in the table. A significant difference was only observed in FMD (6.4 ± 2.2% vs. 8.7 ± 3.4%, COC vs. NU, P<0.01; 6.2 ± 2.1% vs. 8.7 ± 3.4%, DMPA vs. NU, P<0.01), uterine volume (52.5 ± 17.3cm3 vs. 66.1 ± 18.1cm3, DMPA vs. NU, P<0.01) and ovarian volume (5.3 ± 1.9 cm3 vs. 6.7 ± 2.2 cm3, COC vs. NU, P<0.05). TableDifferences among NU, COC and DMPA groupsNUCOCDMPAAge (years)23.4 ± 3.623.7 ± 3.222.9 ± 2.8BMI (kg/m2)22.7 ± 2.922.5 ± 2.822.9 ± 2.7SBP (mmHg)110.5 ± 8.2112.5 ± 5.9112.1 ± 7.0DBP (mmHg)75.4 ± 6.774.1 ± 6.874.0 ± 6.5HR (bpm)67.4 ± 9.572.6 ± 9.570.2 ± 8.0IMT (mm)0.41 ± 0.090.43 ± 0.090.44 ± 0.09Carotid Distensibility (%mmHg−1)0.36 ± 0.090.34 ± 0.090.35 ± 0.09Stiffness Index3.25 ± 0.893.49 ± 1.063.32 ± 0.78FMD (%)8.74 ± 3.43a,b6.45 ± 2.21a6.2 ± 2.08bUterine Volume (cm3)66.1 ± 18.1c62.5 ± 20.152.5 ± 17.3cOvarian Volume (cm3)6.7 ± 2.2d5.3 ± 1.9d5.8 ± 1.4Data are given as mean ± SD; a = b = c = P<0.01; d = P<0.05. Open table in a new tab Data are given as mean ± SD; a = b = c = P<0.01; d = P<0.05. Both COC and DMPA impaired DMF while carotid distensibility and stiffness index were similar among the groups.

Usefulness of FSH measurements for determining menopause in long-term users of depot medroxyprogesterone acetate over 40 years of age

Objective To assess the usefulness of follicle-stimulating hormone (FSH) measurements for determining menopause in 40–55-year-old users of depot medroxyprogesterone acetate (DMPA). Study Design FSH levels were measured in 355 blood samples from 82 amenorrheic women during an 18-month period. Blood was collected every 90 days immediately prior to DMPA administration. Results Using FSH values >35 mIU/mL as being in the post menopausal range, 32 women (39.0%) presented at least one FSH measurement in the postmenopausal range and 14 of them (43.7%) had more than one elevated FSH measurement and were considered postmenopausal. In five users (15.6%), only the last FSH measurement was within the postmenopausal range, and in 13 women (40.6%), FSH returned to normal values following one measurement that was within the postmenopausal range. Conclusions The menopausal status in DMPA users in amenorrhea should be determined based on at least two consecutive high FSH evaluations, since, as shown here, 40.6% of the women with high FSH had a low FSH in the subsequent determination. FSH measurements should be done only in women ≥50 years old because there is a greater possibility of being in postmenopause. However, we do not recommend the interruption of DMPA use prior to the quantification of FSH.

Pharmacy and clinic partnerships to expand access to injectable contraception

To explore the potential of pharmacist-administered contraceptive injections and feasibility and acceptability among patients, pharmacists, and clinicians. Throughout California, 27 pharmacists practicing in 26 community independent and chain pharmacies partnered with 19 clinics/physician offices. In spring 2003, Pharmacy Access Partnership launched a 2-year demonstration program in which established users of depot medroxyprogesterone acetate (e.g., Depo-Provera-Pfizer) hormonal contraception at participating clinics were given the option of returning to their regular clinic for reinjection or going to a participating pharmacist trained in injection technique and contraceptive management. Program feasibility and acceptability by patients, pharmacists, and clinicians were evaluated to offer insights into the potential of pharmacistadministered depot medroxyprogesterone injections. Intake forms collected during pharmacy reinjection visits, data from interviews with pharmacists and clinicians, and evaluations with patients. To determine whether contraceptive reinjection at a pharmacy is feasible and acceptable for patients, pharmacists, and clinicians and to determine the characteristics of women most likely to use the service. A total of 69 women received 143 depot medroxyprogesterone injections during the project. Patients were ethnically and racially diverse and spanned a wide age range (19-45 years). Women 20 years of age or older used pharmacists' services more frequently than did younger patients, perhaps because they were more familiar with the injections and they more often worked, therefore needing the expanded hours offered by the community pharmacy setting. Experiences of two pharmacies with successful programs are described. The pharmacy option for reinjection is most viable for women who can comfortably manage their injection cycle, prefer not to have to schedule a clinic appointment quarterly, and do not require the ongoing attention and appointment supervision available from the clinic. To be successful, program promotion requires provider support, integration, and involvement at the clinic level.

Chronic endometritis in depot medroxyprogesterone acetate users: is Chlamydia trachomatis a cause?

Chronic endometritis in depot medroxyprogesterone acetate users: is Chlamydia trachomatis a cause?

Pharmacy and clinic partnerships to expand access to injectable contraception

ObjectivesTo explore the potential of pharmacist-administered contraceptive injections and feasibility and acceptability among patients, pharmacists, and clinicians. SettingThroughout California, 27 pharmacists practicing in 26 community independent and chain pharmacies partnered with 19 clinics/physician offices. Practice descriptionTIn spring 2003, Pharmacy Access Partnership launched a 2-year demonstration program in which established users of depot medroxyprogesterone acetate (e.g., Depo-Provera—Pfizer) hormonal contraception at participating clinics were given the option of returning to their regular clinic for reinjection or going to a participating pharmacist trained in injection technique and contraceptive management. Practice innovationProgram feasibility and acceptability by patients, pharmacists, and clinicians were evaluated to offer insights into the potential of pharmacistadministered depot medroxyprogesterone injections. InterventionIntake forms collected during pharmacy reinjection visits, data from interviews with pharmacists and clinicians, and evaluations with patients. Main outcome measuresTo determine whether contraceptive reinjection at a pharmacy is feasible and acceptable for patients, pharmacists, and clinicians and to determine the characteristics of women most likely to use the service. ResultsA total of 69 women received 143 depot medroxyprogesterone injections during the project. Patients were ethnically and racially diverse and spanned a wide age range (19–45 years). Women 20 years of age or older used pharmacists’ services more frequently than did younger patients, perhaps because they were more familiar with the injections and they more often worked, therefore needing the expanded hours offered by the community pharmacy setting. Experiences of two pharmacies with successful programs are described. ConclusionThe pharmacy option for reinjection is most viable for women who can comfortably manage their injection cycle, prefer not to have to schedule a clinic appointment quarterly, and do not require the ongoing attention and appointment supervision available from the clinic. To be successful, program promotion requires provider support, integration, and involvement at the clinic level.

Chronic endometritis in DMPA users and Chlamydia trachomatis endometritis

Objective This study was conducted to determine the prevalence of Chlamydia trachomatis (CT) in the endometrium of depot medroxyprogesterone acetate (DMPA) users with and without breakthrough bleeding (BTB) (unscheduled bleeding) and/or chronic endometritis (CE). Methods Cross-sectional study. Endometrial biopsies were performed on 20 DMPA users who were having BTB and 20 DMPA users who were amenorrheic. The paraffin-embedded tissue sections were washed with xylene and ethanol to remove the paraffin. CT was identified in the endometrial samples using the COBAS AMPLICOR™ (Roche Diagnostics, Branchburg, NJ, USA) polymerase chain reaction (PCR) identification system. Results Chronic endometritis was the most common histologic finding (10/40, 25%) and occurred more often in women experiencing BTB (35% vs. 15%) (RR 1.62, CI 0.91–2.87). No patient with CE had CT infection of the endometrium or cervix. Conclusions CT was not a cause of CE in this population of at-risk patients using DMPA. It is possible that CE in DMPA users reflects an inflammatory state, a function of an atrophic endometrium. This points to the possibility of nonsteroidal anti-inflammatory drugs as therapy for CE in this population rather than antimicrobials or hormonal medication.

Effect of mifepristone on endometrial matrix metalloproteinase expression and leukocyte abundance in new medroxyprogesterone acetate users

Purpose This double-blind, placebo-controlled study was conducted to evaluate the molecular mechanism of mifepristone controlling breakthrough bleeding (BTB) in new depot-medroxyprogesterone acetate (DMPA) users. Method A total of 50 regularly cycling women who were new starters of DMPA were randomized to receive 50 mg of mifepristone or placebo once every 14 days for six cycles. Endometrial biopsies were obtained on each patient before, during and after treatment. Endometrial matrix metalloproteinase 1 (MMP-1) and MMP-9 protein and mRNA were determined by immunohistochemistry and real-time PCR, respectively. The number of T lymphocytes (CD3-positive) and mast cells (mast tryptase-positive) was evaluated by immunohistochemistry. Results MMP-1, MMP-9, CD3-positive and mast tryptase-positive cells increased following the DMPA treatment. Addition of mifepristone to DMPA-exposed endometrium for 1 week significantly decreased stromal MMP-9 expression and numbers of CD3-positive and mast tryptase-positive cells. Conclusion The decreased rates of BTB in new users of DMPA by mifepristone are associated with decreased MMP-1 and MMP-9 expression and fewer mast and T cells.

Bone mineral density in adolescents using norethisterone enanthate, depot-medroxyprogesterone acetate or combined oral contraceptives for contraception

Purpose Most studies have shown a negative effect of depot-medroxyprogesterone acetate (DMPA) on the bone mineral density (BMD) of adolescents. There is no information available on the effect of norethisterone enanthate (NET-EN) on BMD in adolescents and the effect of combined oral contraceptives (COCs) on adolescent BMD is inconclusive. The aim of this longitudinal study was to investigate BMD in adolescent (aged 15–19 years) new users of hormonal contraception (DMPA, NET-EN and COCs). Method New users of DMPA ( n=115), NET-EN ( n=115), COCs ( n=116) and 144 nonuser controls were recruited. BMD was measured at the distal radius and midshaft of the ulna using dual X-ray absorptiometry. Results In total, 275 women were included in this interim analysis and total follow-up time was 553 person-years. There was no significant difference in radius BMD between users of different contraceptive methods at baseline (p=.40). Overall, an increase in radius BMD of 0.00522 per person-year was observed. This result was similar when adjusting for BMI in the random effects regression model (p=.88). The regression model showed that BMI was significantly associated with radius BMD, with each unit increase in BMI corresponding to an increase of 0.0029 g/cm 2 in BMD (95% CI 0.0023 to 0.0036, p<.001). Interaction between contraceptive method and follow-up time adjusted for BMI was not significant (p=.07). The increase in BMD for NET-EN users of 0.0013 g/cm 2 per person-year (95% CI −0.0017 to 0.0043) was significantly lower than that of nonusers (p=.017). For DMPA and COC users, the increase in BMD was not significantly different compared to the nonusers. This study suggests that NET-EN users had lower increase in BMD over time compared to the other user groups.

Hormonal contraception and the risk of HIV acquisition

Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18-35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases). HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69-1.42] nor DMPA (HR, 1.25; 95% CI, 0.89-1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39-5.82) and DMPA (HR, 3.97; 95% CI, 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding.

Mifepristone alters expression of endometrial steroid receptors and their cofactors in new users of medroxyprogesterone acetate

To evaluate the effect of mifepristone on the expression of endometrial steroid receptors and their co-factors in depot medroxyprogesterone acetate (DMPA) users. A prospective, randomized, placebo-controlled trial. Reproductive research center. Fifty healthy women with regular menstrual cycle. One hundred fifty milligrams of DMPA were given every 3 months. Two pills (25 mg each) of placebo or mifepristone were administered every 14 days during the DMPA therapy. Four endometrial biopsy specimens were obtained from each patient. The expression of estrogen receptor subtypes alpha and beta (ERalpha and ERbeta), progesterone receptors A and B (PRAB and PRB), and androgen receptor messenger RNA and protein was detected by real-time polymerase chain reaction and immunohistochemistry, respectively. Steroid receptor coactivator 1 (SRC-1), silencing mediator for retinoid and thyroid-hormone receptors, and cell proliferation were evaluated by immunohistochemistry. The expression of endometrial ERalpha, PRAB, PRB, and SRC-1 was increased significantly after 1 week of mifepristone, but the increase was no longer seen after 10 weeks. A positive correlation between endometrial ERalpha, PRAB, PRB, and SRC-1 production and proliferation was demonstrated. Short-term exposure of mifepristone in new starters of DMPA increases the expression of endometrial ERalpha, PRAB, PRB, and SRC-1 and promotes cell proliferation. Prolonged exposure to mifepristone does not alter the suppression of these receptors that are caused by DMPA and continues to result in endometrial atrophy.

Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities

We sought to evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities. Cross-sectional population-based observational study of all noninstitutionalized females with developmental disabilities age >/=13 who received fee-for-service Medicaid in Washington State during 2002 (n = 6,773), using administrative data. In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (95% confidence interval [CI], 1.3-4.4) for fracture compared to nonusers. Among 1,909 users of AEDs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (95% CI, 1.3-2.6) for fracture compared to nonusers. We controlled for use of drugs (DMPA or AEDs), age and race (as white or other racial and ethnic groups). Use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture. Women and girls who have developmental disabilities may be poor candidates for DMPA use owing to increased risk of fractures. Further research is indicated to 1) determine the specific risks profile of DMPA for this population, 2) explore alternative means of managing significant menstrual problems and contraceptive needs in this population, and 3) screen current and previous users of DMPA and chronic users of AEDs for osteoporosis risk, regardless of age.

Bone mineral density loss and recovery during 48 months in first-time users of depot medroxyprogesterone acetate

To compare changes in bone mineral density (BMD) during 48 months between first-time depot medroxyprogesterone acetate (MPA) users, during use and after discontinuation, to controls. Longitudinal study. Academic community. Women 18-35 years, newly initiating depot MPA (n = 178) and controls (n = 145) not using hormonal contraception. The BMD of the hip and spine, measured at 3-month intervals, by dual energy roentgen absorptiometry. Hip and spine BMD declined during 48 months of depot MPA use by 7.7% +/- 0.11% (mean +/- SE) and 6.4% +/- 0.36%, respectively. The BMD of controls declined <or=1.6% +/- 0.30%. Hip and spine BMD loss slowed to <0.6% after 48 months of depot MPA use. After discontinuation, BMD increased from 0.3% to 2.0% per year depending on length of depot MPA use and bone site. The longest depot MPA users remained 4.7% and 2.9% lower than hip and spine baseline values, respectively, 18 months after discontinuation. Depot MPA-related BMD loss is substantial but occurs mostly during the first 2 years of DMPA use. Therefore, longer use may not substantially increase the risk of osteoporosis. The prolonged recovery time suggests the need to consider timing of use in relation to menopause or other factors that may impede bone remodeling.

Bone mineral density and depot medroxyprogesterone acetate

Introduction Depot medroxyprogesterone acetate (DMPA) suppresses pituitary gonadotrophin output, thus, suppressing ovulation. Estrogen production from the ovary is also strongly inhibited, and the resulting estrogen deficiency has a detrimental impact on bone. Depot medroxyprogesterone acetate may be particularly detrimental in young women, as it may impede attainment of peak bone mass, and switching to a different contraceptive is recommended. However, the effect of sequential use of DMPA with other contraceptives in this age group has not been investigated. Methods This was a cross-sectional analysis of 218 DMPA users who were 20 years or older (mean, 31 years, ±8.9 SD) at the time of bone mineral density (BMD) estimation. The majority of women had used one or more contraceptive beside DMPA. The most commonly used alternative contraceptive was the oral combined pill (OCP). It was used by 65% of women ( n=143) and for an average duration of 6 years. A logistic regression model was used to estimate the association between potential risk factors and low bone mass. Results The prevalence of low bone mass at either hip or spine ( T≤1) was 41%. The prevalence of a T score below −2.5 was 5%, and 45% of women had already sustained one fracture. Younger age was associated with higher BMD [odds ratios (ORs), 0.054; 95% confidence interval (CI), 0.007–0.431]. However, this protective effect of age was lost once the interaction between the duration of both DMPA and OCP was introduced into the model (OR for low BMD, 1.42; 95% CI, 1.09–1.8). The use of DMPA first before ever use of OCP was particularly detrimental to BMD (OR, 3.94; 95% CI, 1.08–14.0). On the contrary, body mass index was positively associated with BMD (OR, 0.86; 95% CI, 0.8–0.9). No other demographic or anamnestic variables significantly predicted the presence of low BMD in this group of young women. This group of DMPA users appear to be at a very high risk of both low BMD and fractures, possibly independently of DMPA use. This needs to be considered when writing guidelines for risk assessment. Conclusion The use of DMPA before achievement of peak bone mass may be particularly detrimental to bone, but switching DMPA with the OCP in these women does not seem to confer specific benefit in terms of bone density. This needs to be taken into consideration when a change in contraceptive is considered purely for the sake of bone protection.

Efficacy of a selective COX-2 inhibitor for controlling irregular uterine bleeding in DMPA users

Purpose This double-blind, placebo-controlled study was conducted to evaluate the efficacy of valdecoxib and placebo for controlling irregular uterine bleeding in depot-medroxyprogesterone acetate (DMPA) users. Method A total of 51 DMPA users were enrolled. All subjects in the study had abnormal bleeding and were randomly divided into two groups. One group totaling 22 received valdecoxib, 40 mg, once a day for 5 days, and placebos were given to another 24 in the same manner; 5 subjects dropped out from the study. Analysis of the number of treatment days required for stopping the bleeding episode, percentage of women whose bleeding was stopped in 7 days, total number of bleeding-free days and length of the bleeding-free interval after the initial treatment was determined in the first and the fourth weeks. Results The percentage of the subjects whose bleeding was stopped during the first week after the initial treatment and the mean value of the bleeding-free days during the 28 days of the follow-up period were significantly higher in the valdecoxib group than in the placebo group (77.3% vs. 33.3%, p<.01; and 17.8 days vs. 11.5 days, p<.05, respectively). The mean duration of treatment days required for stopping the bleeding episode in the valdecoxib-treated group was 1.7 days, and the mean duration of the bleeding-free interval in valdecoxib-treated group was 18.6 days. Conclusion Valdecoxib was more effective than placebo in the short-term control of irregular bleeding in DMPA users. The mechanism of nonsteroidal anti-inflammatory drugs (NSAIDs) for the reduction of endometrial bleeding is likely from COX-2 inhibition.

Variação de peso em usuárias de sistema intra-uterino liberador de levonorgestrel, DIU T-cobre e acetato de medroxiprogesterona no Brasil

Assess weight variations in Brazilian users of the 20 microg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) for comparison with a cohort of users of the TCu 380A intrauterine device (IUD) and a cohort of users of the injectable contraceptive, depot-medroxyprogesterone acetate (DMPA) over a period of five years. A total of 163 users of the LNG-IUS, who had the device inserted in 1998, were admitted to the study. At the time of enrollment, each woman was matched by weight (+/- 1 kg) and age (+/- 1 year) to a woman using a TCu 380A IUD and to another woman using DMPA. All women were followed up for a period of five years. Each year weight was measured and the body mass index (BMI, kg/m2) was calculated. Age of the LNG-IUS users was 27.0 +/- 6.7 years (mean +/- SD), while age of the copper IUD users was 28.0 +/- 6.6 years and that of DMPA users was 26.9 +/- 6.5 years. Weight recorded at the onset of the study was 62.9 +/- 0.8 kg, 62.8 +/- 0.8 kg, and 62.5 +/- 0.9 kg (Mean +/- SD) for users of the LNG-IUS, the copper IUD, and DMPA, respectively. The BMI of women was initially 25.0 (+/- 0.3), 26.4 (+/- 0.3), and 25.5 (+/- 0.4), (Mean +/- SD), for users of the LNG-IUS, copper IUD, and DMPA, respectively. Weight increases of 3.1 kg, 4.9 kg and 8.2 kg were observed at the end of the fifth year among users of the LNG-IUS, copper IUD, and DMPA, respectively (p = 0.009). Increase of the BMI was also observed among all groups (final BMI was 26.3 +/- 0.7, 28.5 +/- 0.8 and 28.7 +/- 1.3 for users of the LNG-IUS, copper IUD and DMPA, respectively). Multivariate analysis showed that there was a significant association between weight increase and length of use of the contraceptive method and of the DMPA. The use of a LNG-IUS during five years caused no significant weight increase and the difference in weight was of the same magnitude as that of copper IUD users.