Depo Provera. Position paper on clinical use, effectiveness and side effects

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.