Tieng Pardthaisong

The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation

Children exposed to the injectable contraceptive Depo-Provera (DMPA) during pregnancy (N = 1,207), and/or during breastfeeding (N = 1,215) were exposures during pregnancy or breastfeeding. Weights and heights were measured for all children, and information on signs of puberty obtained for children aged ten and over. Cross-sectional weights and heights by age of DMPA-exposed children were similar to those for controls. Children with DMPA exposure during pregnancy and lactation had an increased risk of suboptimal growth in height, defined as less than two Z scores on NCHS standards (RR = 1.4, 95% CI 1.2-1.8). However, after adjustment for socioeconomic factors by multiple logistic regression, there was no increased risk of impaired growth among the DMPA-exposed children (RR = 1.1, 95% CI 0.8 - 1.6). With the exception of a delay in onset of reported pubic hair growth among DMPA-exposed girls, there were no significant effects on attainment of puberty. We conclude that use of DMPA during pregnancy or breastfeeding does not adversely affect the long-term growth and development of children.

Return of fertility after use of the injectable contraceptive Depo Provera: up-dated data analysis.

796 Thai women who stopped using the long-acting injectable contraceptive depot medroxyprogesterone acetate (DMPA, Depo Povera), 437 women who stopped using oral contraceptives and 125 women who had an IUD removed to have a planned pregnancy, were followed up to ascertain the delay to conception after the end of contraception and to determine the proportion of women who did not conceive in the 4 years after discontinuation. The median delay to conception was 5.5 months plus the estimated duration of the effect of the last injection of DMPA, 3 months for oral contraceptives and 4.5 months after discontinuing the IUD. The proportion of women who did not conceive within 9 months after discontinuation of DMPA is similar to that of ex-IUD users, and by 3 years to that of the ex-pill sample. There is no evidence to suggest that prolonged use of DMPA increases the delay to conception. The return of fertility among never pregnant ex-users resembled that of ever pregnant ex-users. There were comparable proportons of live births among ex-DMPA users and ex-pill users and both of these showed higher proportions of live-births than ex-IUD users. There was no evidence to suggest that previous use of DMPA had any significant adverse effect on the outcome of pregnancy of the subsequent births. This study did not show any association between infertility and the previous use of DMPA or other contraceptives.

Depot-medroxyprogesterone acetate as a contraceptive agent: Return of fertility after discontinuation of use

Abstract Between April, 1965 and December, 1972 there were 19,204 women who accepted depot-medroxyprogesterone acetate as a 3-month contraceptive agent. Of this total, 135 women were known to have discontinued use in order to become pregnant. A life-table return-of-fertility rate of 82 percent at the end of 14 months was found, suggesting that return of fertility is not as great a problem as had been anticipated.

Incidence of breast nodules in women receiving multiple doses of medroxyprogesterone acetate

1527 women age 16-49 were examined to determine whether a dependent relationship exists between the occurrence of breast nodules and the use of depo medroxyprogesterone acetate (DMPA). They represented a cross section of new and returning contraceptive patients at 3 family planning centers in Chiang Mai Thailand. They had received from 0 (controls) to 25 3-month contraceptive injections of 150 mg of DMPA. All except the controls had received an oral estrogen supplement of stilbesterol (.5 mg) of ethinyl estradiol (.02 mg) for 7-10 days every month. No obvious relation between DMPA use and the occurrence of breast nodules was seen. Though 1 of the authors has observed 18889.8 women-years of usage of DMPA injection accompanied by oral estrogen supplement to the best of his knowledge breast nodule formation has never been a patient complaint.

Use-effectiveness of six-month injections of DMPA as a contraceptive

The use of depot-type injections of the contraceptive medroxyprogesterone acetate (DMPA) was studied in 1132 women for up to 5 1/2 years. Continuation rates, reasons for discontinuation, method failure rates, and bleeding patterns were considered. The women received a dose of 400 mg DMPA in aqueous suspension (injected into the deltoid muscle) every six months. In addition, each patient received an oral dose of .04 mg ethynl estradiol for 10 days each lunar month. Of the original acceptors, 36.4 percent used the method for the full 5 1/2 years. The major reasons for discontinuation of DMPA injections were bleeding problems (including amenorrhea) and such other medical reasons as palpitation, abdominal pain, headache, weakness, and dizziness. A total of 26 women became accidently pregnant while using DMPA during the 5 1/2 years. Advantages of DMPA injections were the simplicity, safety, and effectiveness of the method, and the psychological appeal of an injectable contraceptive.

Return of menstruation and fertility in Thai women after contraceptive injections.

121 Thai women treated with injections of medroxyprogesterone acetate (DMPA) at 3- or 6-month intervals supplemented with oral estrogens at monthly intervals and who discontinued medication after 6 months or more were studied to determine the effect of contraceptive injections on the return of menstruation and fertility. Spontaneous menstruation returned in 113 women within 6 months. The effect of the n umber of injections period of usage or total dose of DMPA on the time required for the return of menstruation was without correlation. 17 of the 121 discontinued medication in order to conceive; 12 became pregnant within 10 months and 3 within 27 months. It was concluded that contraceptive injections are a highly effective contraceptive method compatible with the return of normal reproductive function.

Acceptability of an Injectable Contraceptive in a Rural Population of Thail

Initial acceptability of contraception by hormone injection was high in the rural population studied. 2,967 rural women accepted contraception by a once‐in‐three months injection of Depo‐Provera in a mobile family planning clinic program offering pills and injections. Injection patients represented 46.9% of all new acceptors; the continuation rate was 48.4% at the end of 18 months and the continuation of rural injection users was slightly higher than that of urban users of the same method in the first 15 months.