Subcutaneous DMPA vs. intramuscular DMPA: a 2-year randomized study of contraceptive efficacy and bone mineral density
Abstract
Background A formulation of depot medroxyprogesterone acetate (DMPA) has been developed that allows subcutaneous injection (104 mg/0.65 mL; DMPA-SC) and achieves highly effective contraception with a similar tolerability profile to intramuscular DMPA (150 mg/mL; DMPA-IM).Study design This randomized, evaluator-blinded study was designed to compare efficacy, safety, and user satisfaction in women receiving DMPA-SC (n=266) or DMPA-IM (n=268) for 2 years with an option to continue for a third year. The primary objectives were to evaluate bone mineral density (BMD) changes and contraceptive efficacy after 2 years.Results A total of 225 women completed the first 2 years of this study (DMPA-SC, n=116; DMPA-IM, n=109). After 2 years of DMPA use, BMD loss was marginally smaller in the DMPA-SC group than in the DMPA-IM group at both the total hip (-3.3% and -3.6%, respectively) and lumbar spine (-4.3% and -5.0%, respectively). In those women who received DMPA during the third year, there were no statistically significant differences in BMD loss between DMPA-SC and DMPA-IM groups at the end of Year 3. Recovery of BMD was observed in the small subpopulation of women who had discontinued DMPA-SC or DMPA-IM after the second year. The 2-year treatment-failure cumulative pregnancy rate was 0% in the DMPA-SC group and 0.8% (95% confidence interval, 0.00-2.37%) in the DMPA-IM group (life-table method). Adverse events were similar in the two groups except that injection site reactions were more common in the DMPA-SC group.Conclusion DMPA-SC is an effective and well-tolerated contraceptive option, providing comparable efficacy and BMD safety to DMPA-IM.
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The negative impact of DMPA on bone mineral density is reversible toward or to baseline values within two years after discontinuation.
“reversibility of the negative impact of DMPA on BMD toward or to baseline values within two years after discontinuation has been demonstrated in numerous studies [59,61,65,68].”
From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [68]
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Self-citationPostpartum Care and Contraception in Obese Women
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Self-citationRecent advances in hormonal contraception
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Variability and quantification of serum medroxyprogesterone acetate levels
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DMPA: battered and bruised but still needed and used in the USA
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Obesity and contraception: controversy?
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Changing US trends in contraceptive choices
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Long-Acting Reversible Contraception in Adolescents
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Depot Medroxyprogesterone Acetate
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Progestin Injectable Contraceptives
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Sayana Press and a case of likely lipoatrophy
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Knochengesundheit in der Jugendgynäkologie
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Self-citation
- Authors
- Kaunitz, A. M., Darney, P. D., Ross, D., Wolter, K. D., & Speroff, L.
- Affiliations
- University of Florida (US)
- San Francisco General Hospital (US)
- Pfizer (United States) (US)
- Oregon Health & Science University (US)
- ORCID
- Kaunitz, Andrew M.
- Venue
- Contraception
- Publisher
- Elsevier BV
- Published
- 2009-07
- Volume
- 80
- Issue
- 1
- Pages
- 7-17
- ISSN
- 0010-7824 (ISSN-L)
- OpenAlex
- W2142599245
- Cited by
- 123
- References
- 38
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 7 · 2020: 9 · 2019: 7 · 2018: 8 · 2017: 4 · 2016: 14 · 2015: 10 · 2014: 9 · 2013: 7 · 2012: 4
- FWCI
- 7.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Contraception (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- depot medroxyprogesterone acetate, subcutaneous injection, intramuscular injection, contraceptive efficacy, bone mineral density, bone loss, pregnancy rate, injection site reactions, long-acting reversible contraception, user satisfaction
- MeSH terms
- Adolescent, Adult, Contraceptive Agents, Female, Delayed-Action Preparations, Estradiol, Female, Humans, Injections, Intramuscular, Injections, Subcutaneous, Metrorrhagia, Pregnancy, Bone Density, Patient Satisfaction, Medroxyprogesterone Acetate, Young Adult
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