Depo Provern (medroxyprogesterone acetate, DMPA) when given as 150 mg by de
ep intramuscular injection every 12 calendar weeks (84 days+5 days), is a h
ighly effective contraceptive with a very low failure rate comparable to mo
dem copper IUDs and lower than many other methods. It should be available a
s a first line method to all who wish to make an informed choice about reve
rsible methods of contraception. Pre-use counselling is essential to minimi
se the effect of menstrual change which occurs in most patients. However; t
here is great patient variability Use of DMPA is independent of intercourse
and also independent of the user's memory (and thus of continuing motivati
on), other than remembering the 12 weekly appointments. For many women this
is a great advantage. Oral contraceptive methods involve remembering to ta
ke a pill each day, in the case of the progestogen only pill within the sam
e three hours each day. This places considerable strain on women who lend i
rregular lifestyles, who ai-e very busy or travel frequently Such women oft
en describe a constant fear of forgetting', especially with the POP. The ma
in potential disadvantage of DMPA in this country are likely so be menstrua
l disturbance and weight gain. The combined oral contraceptive pill gives t
he appearance of excellent cycle control because it removes the natural cyc
le altogether and replaces it with an artificial one. All progestogen-only
methods, whether low or high dose, lend to menstrual disturbances, so in th
is respect DMPA is not unique.
Although troublesome, the menstrual disturbances which occur in DMPA users
very rarely require operative medical intervention, and can often be improv
ed simply by short courses of oestrogen or shorter injection intervals. Aga
in, women need to know what can be done so that they are aware that they sh
ould Seek advice early, rather than miserably waiting for their 12 week app
ointment.
DMPA has no appreciable effects on blood pressure or thrombosis risk. In th
is it has an advantage over the combined oral contraceptive pill, and provi
des a simple, effective alternative for women who cannot use the pill for t
hese reasons. Similarly, it has been suggested that women who suffer from f
ocal migraine and are therefore advised against use of the combined oral co
ntraceptive pill can still use progestogen-only contraceptives,(1) Although
the POP is medically safe in these circumstances, in young women it is les
s effective, and involves strict time keeping, which will be disadvantageou
s for some women.
Side effects, long term use and schedules of administration are also discus
sed. The rise of local protocols to allow nurse administration is to be sup
ported both in general practice and the clinic situation.
Perhaps the most important issue surrounding the rise of DMPA is that of pa
tient information. The method has had a particularly bad public image, whic
h naturally makes potential users anxious and subject to misinformation fro
m poorly informed or biased sources. Also, it is temporarily irreversible d
uring its three months duration, so the duration of any problems or anxieti
es resulting from side effects may be longer than for other methods. it is
of paramount importance that easily understood accurate patient information
leaflets are available, since biased and inaccurate information is readily
available from women's magazines, perpetuating the myths surrounding the m
ethod.