ADOLESCENTS REASONS FOR AND EXPERIENCE AFTER DISCONTINUATION OF THE LONG-ACTING CONTRACEPTIVES DEPO-PROVERA AND NORPLANT

Purpose: The objectives of this study were to examine the reasons for discontinuation of the long-acting contraceptives Depo-Provera and Nor plant in adolescents, and to assess the adolescents' experience after discontinuation of the methods. Methods: A total of 35 adolescents [gy necologic age 4.7 +/- 0.3 years, and body mass index (BMI) 24.2 +/- 0. 6] who discontinued Depo-Provera, and 31 adolescents (gynecologic age 3.4 +/- 0.3 years, BMI 24.1 +/- 0.9) who discontinued Norplant(R) were periodically assessed during use of the methods and up to 12 months a fter discontinuation. Results: The most common reasons for discontinua tion of both Norplant (after 21.8 +/- 1.6 months of use) and Depo-Prov era (9.2 +/- 0.9 months of use) were irregular menstrual bleeding (64% ), weight gain (41%), and increased headaches (30%). Resumption of men strual regularity and dysmenorrhea was noted sooner after discontinuat ion of Norplant, compared with Depo-Provera. The increase in BMI noted at discontinuation of Depo-Provera (1.1, P = .0005) and Norplant (1.3 , P = .03) persisted up to 6 months after discontinuation of either me thod (0.6, P = .01 post-Depo-Provera discontinuation; and 0.9, P = 0.0 2 post-Norplant discontinuation). Only 62% of the adolescents reported no break in contraceptive practice. The condom was the most popular m ethod (37%) after discontinuation of Depo-Provera, and oral contracept ive (39%) after discontinuation of Norplant. The cumulative conception proportion reached 0.93 at 12 months after discontinuation of Norplan t, and was significantly higher (P = .01) compared with the cumulative proportion of conception after discontinuation of Depo-Provera (P = . 50). Conclusions: Health care providers should aggressively manage phy sical problems associated with Depo-Provera and Norplant use, and expe dite the transition to a new contraceptive method to minimize the high pregnancy rate observed after discontinuation of these methods in ado lescents.