DMPA: Battered and Bruised but Still Needed and Used in the USA

Medscape Today

Anita L Nelson

Posted: 11/17/2010; Expert Rev of Obstet Gynecol. 2010;5(6):673-686. © 2010 Expert Reviews Ltd.

Abstract and Introduction

Abstract

Depot medroxyprogesterone acetate (DMPA; Depo-Provera®, Merck & Co., Inc., NJ, USA) is a very safe and effective method of birth control that can be used by virtually every woman. However, DMPA has not achieved its full potential for pregnancy protection. With correct and consistent use, the first-year pregnancy rate should be 0.3%, but in typical use, the first-year pregnancy rate is 7.4%. This gap is due to interrupted use and high discontinuation rates. Responding to patient complaints of side effects and adopting new practice protocols that enhance prompt access to DMPA may improve continuation rates and lower failure rates. Newer information about the long-term safety of DMPA on bone health and sexually transmitted disease risk may encourage more clinicians to more enthusiastically support the use of DMPA, particularly among women who would benefit from its noncontraceptive health applications.

Introduction

The 3-month injectable depot medroxyprogesterone acetate (DMPA) was registered for use as a contraceptive in 1979. It is the fifth most commonly used contraceptive method worldwide.[201] In sub-Saharan Africa, it is used by one-third of women employing contraception.[1] However, DMPA has had a tumultuous history in the USA over the last four decades. The first US FDA-approved application for DMPA was with very high doses of DMPA (1000 mg/week), followed by lower maintenance doses given for 1–3 weeks to treat endometriosis and endometrial carcinoma.[2] At the time, medroxyprogesterone acetate (MPA) was also used off-label in high doses to treat breast cancer. Response rates of 45% were attained in patients with estrogen receptor- and progesterone receptor-positive lesions. DMPA is known to turn on the metastasis suppressor gene Nm23-H1 and to reduce soft agar colonization of metastatic breast cancer cell lines by almost 50%.[3] However, as a contraceptive version of DMPA was being developed, new testing regulations were put in place by the FDA to ensure product safety in the wake of the thalidomide disaster. In animal safety testing of DMPA for contraception, female beagle dogs developed breast cancer when treated with massive doses of DMPA. Rhesus monkeys developed endometrial cancer with doses 50-times higher than the contraceptive dose.[2] The FDA denied approval in 1978 and again in 1983 owing to those health issues, coupled with deeply held concerns by some women’s advocacy groups that injectable contraceptives could be used to involuntarily control the fertility of specific groups of women.

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Depo Provera is also used for sexual castration for sexual abusers at a prison on the east coast.  That article is posted on this blog as well.  Imagine if birth control was marketed as “sexual castration” methods… How many women would be using the synthetics then?

Who do you trust?  Someone who prescribed birth control to involuntarily control fertility? That is being done to adolescent girls…as well as women in mental health institutions – because there periods are so “messy.”  Meanwhile, they are also the victims of rapes….first they are mentally/emotionally drugged and then they are on Depo and then they are abused.

Oh, yes we have problems…..

PG

Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.