CONTRACEPTION

In an 18-month clinical trial comparing the 2 drugs, researchers found similar efficacy, with DMPA causing less bone loss and less frequent and severe menopausal symptoms. The trial involved 274 women and measured pain across the following categories: pelvic pain, dysmenorrhea, dyspareunia, pelvic tenderness, and induration.

Clearing a woman for use

The manufacturer recommends that all women undergo an annual history and physical examination. The physical exam should include a blood pressure check; examination of the breasts, abdomen, and pelvic organs; cervical cytology; and any relevant laboratory studies.

Overall outlook

Subcutaneous DMPA offers women the same advantages as the IM formulation. Since we have long-term experience with MPA as a contraceptive agent, we know it offers many noncontraceptive benefits, safety, and excellent contraceptive efficacy.

As we gain experience specific to subcutaneous DMPA , and as data accumulate from additional trials, we will be able to further define its role as a contraceptive option.

Disclosure

Dr. Jain has disclosed that he has received grant/research support from Ferring, Organon, Pfizer, Serono, and TA P.

REFERENCES

1. Westhoff C. Depot-medroxyprogesterone acetate injection (Depo-Provera®): a highly effective contraceptive option with proven long-term safety. Contraception. 2003;68:75-87.

2. Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 17th revised edition. New York: Irvington Publishers; 1998.

3. Jain JK, Jakimiuk AJ, Bode FR, et al. Contraceptive efficacy and safety of DMPA-SC. Contraception. 2004;70:269-275.

4. Canto De Cetina TE, Canto P, Luna MO. Effect of counseling to improve compliance in Mexican women receiving depo-medroxyprogesterone acetate. Contraception. 2001;63:143-146.

5. Lei ZW, Wu SC, Garceau RJ, et al. Effect of pretreatment counseling on discontinuation rates in Chinese women given depo-medroxyprogesterone acetate for contraception. Contraception. 1996;53:357-361.

6. Depo SubQ Provera 104 [package insert]. Cambridge, Mass: Pfizer; 2005.

7. Banks E, Berrington A, Casabonne D. Overview of the relationship between use of progestogen-only contraceptives and bone mineral density. Br J Obstet Gynecol. 2001;108:1214-1221.

8. Tang OS, Tang G, Yip PSF, et al. Further evaluation on long-term depot-medroxyprogesterone acetate use and bone mineral density: a longitudinal cohort study. Contraception. 2000;62:161-164.

9. Petitti DB, Piaggio G, Mehta S, et al. Steroid hormone contraception and bone mineral density: a cross-sectional study in an international population. Obstet Gynecol. 2000;95:736-744.

10. Jain JK. Evaluation of bone mineral density in women treated with DMPA-SC 104 or DMPA-IM 150. Presented at: Annual Meeting of the American Academy of Nurse Practitioners; June 17, 2005; Fort Lauderdale, Fla.

11. Cromer BA, Blair JM, Mahan JD, et al. A prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate (DMPA), levonorgestrel (Norplant), or oral contraceptives. J Pediatr. 1996;129:671-676.

12. Scholes D, LaCroix AZ, Ichikawa LE, et al. Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Arch Pediatr Adolesc Med. 2005;159:139-144.

13. Depo-Provera [package insert]. Cambridge, Mass: Pfizer; 1999.

14. Jain JK, Dutton C, Nicosia A, et al. Pharmacokinetics, ovulation suppression and return to ovulation following a lower dose subcutaneous formulation of Depo-Provera®. Contraception. 2004;70:11-18.

15. Pelkman CL, Chow M, Heinbach RA, et al. Short-term effects of a progestational contraceptive drug on food intake, resting energy expenditure, and body weight in young women. Am J Clin Nutr. 2001;73:19-26.

CONTRACEPTIVES IN THE NEWS Plan B: Studies surprise both sides

Ian H. Thorneycroft
MD, PhD

OBG Management
Board of Editors
Professor of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, Ala

Marston C, Meltzer H, Majeed A. Impact on contraceptive practice of making emergency hormonal contraception available over the counter in Great Britain: repeated cross sectional surveys. BMJ doi;10.1136/bmj.38519.440266.8F (published July 11, 2005).

Raine TR, Harper CC, Rocca CH, Fischer R, Padian N, Klausner JD, Darney PD. Direct access to emergency contraception through pharmacies and effect of unintended pregnancy and STIs: a randomized controlled trial. JAMA. 2005;292:54–62.

Litt IF. Placing emergency contraception in the hands of women. JAMA. 2005;293:98–99.

A quick succession of events in July seemed to clear the path to a Food and Drug Administration (FDA) decision on over-the-counter sale of levonorgestrel (Plan B), the emergency contraceptive.

A week after the publication of the large study led by Marston, Plan B was placed on the FDA calendar for a Sept. 1 decision. The authors concluded that their study “supports the case for lifting the ban on over-the-counter sales of emergency hormonal contraception in the United States and other countries.”

Plan B has been a point of contention, especially after the FDA, in 2004, rejected Barr Laboratories’ application for OTC access, on the basis of lack of long-term safety data on its use in young adolescent women, without medical supervision.