Protocol supports immediate start of DMPA at first visit: don't wait until next menses.(Gynecology)

LA JOLLA, CALIF. -- Most current depot medroxyprogesterone acetate protocols mandate that women who are not within 7 days of the onset of menses should return during their next menses to initiate contraception with the injectable, while using condoms or abstaining from sexual intercourse in the interim.

But results from a recent study suggest that women prefer to receive an immediate monthly injection of depot medroxyprogesterone acetate (DMPA) during their initial visit and to schedule a time for another DMPA injection about 4 weeks later, Chelsea Morroni reported at the annual meeting of the Association of Reproductive Health Professionals.

"Waiting until next menses to initiate DMPA while using condoms and/or abstinence for contraception is not acceptable to patients," said Ms. Morroni, who conducted the research while working toward a doctorate in public health at Columbia University.

She called the conventional approach to DMPA initiation "problematic" for two key reasons. First, "women avoid visiting clinics to initiate methods when they're bleeding," Ms. Morroni said. "Thus, women presenting outside of menses are going to be ineligible for initial injection."

Another problem is the requirement that a woman make a second visit to the clinic to initiate the method. "Consequently, a woman who has presented to the clinic seeking a method may remain at risk of unintended pregnancy because condoms or abstinence are unacceptable or ineffective for her," she said.

At Columbia University's family planning clinic, patients ineligible for initial DMPA injection due to menstrual cycle day are offered three options: use condoms and/or abstinence and return with the next menses to initiate DMPA (conventional protocol); initiate immediately one cycle of oral contraceptives and return 4 weeks later to initiate DMPA; or initiate immediately the monthly injection and return 4 weeks later for another DMPA injection.

In 2002, Ms. Morroni and her associates conducted a prospective observational study of women who visited the family planning clinic, to assess their bridging preferences as well as their short-term pregnancy risk. Women requesting DMPA who were beyond day 7 ...