Comparison of two strategies for the administration of injectable depot medroxyprogesterone acetate: among women who returned to a family planning clinic at three- or six-month intervals

Abstract

Objectives: The aim of this study was to compare the clinical performance of depot medroxyprogesterone acetate (DMPA) in women who received injections every 3 months at the Family Planning Clinic, and those who received every other injection at a health care facility near their place of residence, only returning to the clinic every 6 months.

Materials and methods: The medical charts of DMPA users from 2 January 1980 through 31 December 2012 were evaluated for this study. Two cohorts of women were created and compared: those who regularly received DMPA injections every 3 months (3-month group) at the clinic and those who received alternating 3-month injections at a health care facility near their residence house, returning to the clinic every 6 months for an injection (6-month group). In addition, effectiveness rates, reasons for discontinuation, and continuation rates were evaluated.

Results: Overall, 2637 women received all injections at 3-month intervals at the clinic, and 1190 women received every other injection at a health care facility near their residence. The women in the 3-month group had higher pregnancy rates and higher discontinuation rates (with the exception of discontinuation due to the loss of libido).

Conclusion: The women who received alternating injections near their homes were more likely to continue using DMPA as a contraception method and presented lower pregnancy and discontinuation rates (for the majority of reasons), when compared to those women who returned to the clinic every 3 months.

Chinese abstract

目的: 本研究的目的是比较长效醋酸甲羟孕酮（DMPA）在两类妇女中的临床效果, 一类妇女是每3个月到计划生育门诊接受注射, 另一类是只在6个月到计划生育门诊复诊一次, 其他时间在居住地附近卫生保健机构接受注射。

材料与方法: 本研究对1980年1月2日到2012 年1月31日之间使用DMPA的妇女的医疗记录进行评估。这些妇女分为两组并比较: 一组是每3个月规律到门诊接受DMPA注射（3月组）, 另一组是每六个月回到门诊接受一次注射, 同时在居住地附近的卫生保健机构接受另外一次3个月的注射。并对有效率, 停药的原因, 和续用率进行评价。

结果: 总共2637名妇女每隔3个月到门诊接受一次注射。1190名妇女在她们住所附近的卫生保健机构接受另外的注射。3个月组的妇女有更高的妊娠率和更高的停药率（除外因性欲减退产生的停药率）。

结论: 和每3个月回到门诊一次的妇女相比, 选择在住所附近接受另外一次注射的妇女更愿意持续应用DMPA作为避孕方法, 妊娠率和停药率（由于大多数原因）都比较低。

Keywords:

• Depot-medroxyprogesterone acetate
• continuation rate
• strategies
• service provision

Disclosure statement

We declare that we have no conflicts of interest regarding this study.

Funding

This study received partial financial support from the National Research Council (CNPq) [grant #573747/2008-3].