DEPO-PROVERA IN ADOLESCENTS - EFFECTS OF EARLY 2ND INJECTION OR PRIORORAL CONTRACEPTION

Purpose: To examine the effects of an early second injection or prior use of oral contraceptive pills (OCP) on side effects of Depo-Provera during the early months of use in adolescents. Methods: Thirty-six gir ls, gynecologic age 4.2 +/- 0.3 years, and body mass index (BMI) 23.2 +/- 0.8, received the currently recommended injection of 150 mg every three months. Twenty-seven girls (gynecologic age 3.9 +/- 0.5 years, B MI 24.0 +/- 0.8) received the second injection six weeks after the fir st injection. Fifteen girls (gynecologic age 5.0 +/- 0.5, BMI 25.4 +/- 1.3) switched directly from an OCP to Depo-Provera. The patients were periodically assessed by their care providers. Results: Early adminis tration of the second injection of Depo-Provera did not alter the blee ding episodes, onset of bleeding, or total days of bleeding (14.3 +/- 3.7 vs. 17.1 +/- 4.0, p = 0.62) during the three months interval follo wing injection, compared with the standard second injection interval. Moreover, an excessive BMI gain (BMI increase 0.99 +/- 0.22 vs. 0.40 /- 0.14, p = 0.03) was observed in these girls. Girls who switched dir ectly from OCP showed no difference in the rate of BMI gain when compa red to those not previously on OCP (BMI increase 0.38 +/- 0.3). Bleedi ng duration of these girls, however, was markedly reduced; the total n umber of days of bleeding was 5.7 +/- 1.9 (p = 0.0003) during the firs t three month interval, and 5.7 +/- 2.3 (p = 0.019) during the three m onth period following the second injection. This reduction did not per sist beyond the first six months. Conclusions: Early second Depo-Prove ra injection does not alter the experience of menstrual abnormalities, and predisposes to greater weight gain; OCP use prior to Depo-Provera results in a decrease in the duration of bleeding with no change in t he weight gain rate.