Advantages and disadvantages of depot medroxyprogesterone contraception

Advantages and disadvantages of depot medroxyprogesterone contraception are listed in Advantages and disadvantages of depot medroxyprogesterone contraception. Also consider other factors affecting choice of contraceptive method.

Table 1. Advantages and disadvantages of depot medroxyprogesterone contraception

Advantages

very effective (96% with typical use; 99.8% with perfect use)

minimal user involvement—beneficial if compliance may be difficult (eg in adolescence)

medium duration

cost-effective

discreet; useful if coercion to avoid contraception is a consideration

suitable for Quick Start

safe to use immediately postpartum and during breastfeeding

few contraindications and precautions; may be an alternative when estrogen is contraindicated

no drug interactions

induces amenorrhoea in 50 to 70% of users after 1 year

improves dysmenorrhoea

available on the PBS

Disadvantages

altered bleeding patterns

delayed return to fertility after stopping [NB1]

relatively low continuation rate (27 to 56% at 1 year)

weight gain; around 20% of users gain 10% or more of their body weight within a year of use. Obese adolescents may have a particular increase in risk

loss of bone mineral density [NB2], so not a first-line option in adolescents or in perimenopausal individuals

other adverse effects [NB3]:

  • headaches
  • mood changes [NB4]
  • breast tenderness
  • loss of libido
  • acne
Note:

PBS = Pharmaceutical Benefits Scheme

NB1: Fertility may take up to 18 months to return after stopping depot medroxyprogesterone (median time to ovulation is 6 months; around 95% ovulate within 12 months). Do not investigate until 12 months after the last injection unless other causes of amenorrhoea are suspected (eg polycystic ovary syndrome, galactorrhoea) or the individual wants to conceive.

NB2: Consider dual energy X-ray absorptiometry (DXA) in individuals with other risk factors for osteoporosis; this may influence the decision to continue with DMPA.

NB3: These adverse effects have been reported by users of all forms of progestogen-only contraception, but evidence is insufficient to prove a causal effect. Many resolve within 3 months of starting the contraceptive.

NB4: An association between first prescription of an antidepressant and contraceptive use has been seen, but a causal link is not proven.