DMPA at initial visit cuts unintended pregnancies.(Gynecology)

BOSTON -- The immediate initiation of depot medroxyprogesterone acetate to adolescent and young adult women seeking the contraceptive injection resulted in higher continuation rates and substantially diminished unintended pregnancy rates at 6 months, compared with the use of alternative, short-term hormonal methods meant to bridge the period between initial request and injection at a later date, Vaughn I. Rickert, Psy.D., said at the annual meeting of the Society for Adolescent Medicine.

In a study of 334 young women ages 14-26 years who asked for depot medroxyprogesterone (DMPA) during a reproductive health visit at an urban family planning clinic, 101 women were randomized to receive their first DMPA (Depo Provera) injection at the conclusion of the visit, and 233 were randomized to an alternative "quick start" bridge condition whereby they were offered their choice of either oral contraceptive pills, the transdermal patch, or the vaginal ring, said Dr. Rickert of the Mailman School of Public Health at Columbia University in New York.

In a previous study, the Columbia investigators determined that patients who immediately initiated oral contraception at the time of their clinic visit (after a negative urine pregnancy test) were significantly more likely to continue the oral contraceptive than a control group of women who were provided with conventional instructions to wait until their menses began before starting oral contraception (Contraception 2002;66:141-5).

Historically, the rationale for waiting to initiate hormonal contraception "was to be sure the patient was not pregnant and to keep from altering the bleeding pattern," said Dr. Rickert. "Unfortunately, with the delayed initiation, many women don't take their first pill, and their motivation wanes." Similarly, asking women to return to the clinic at a later date for a DMPA injection means that some won't come back for it, thus increasing the likelihood for unintended pregnancies.

The immediate contraception protocol was designed to avoid this outcome, according to Dr. Rickert. While the earlier study looked specifically at the efficacy of the approach with respect to oral contraceptives, the current study sought to determine whether immediate access to DMPA would lead to greater method continuation--and thus pregnancy prevention--over a 6-month period, compared with delaying the injection and providing alternative contraceptive options for the interim period.

All of the women enrolled in the study had a negative urine pregnancy test at the time of their initial clinic visit, and none were breast-feeding or currently using other forms of hormonal contraception. In addition, none of the women had received a DMPA injection within the previous 14 weeks nor had any medical contraindications to hormonal contraception, said Dr. Rickert.

All of the ...