Not caused by DMPA:
a. Depomedroxyprogesterone acetate (DMPA) is a suspension of microcrystals of a synthetic progestin which is injected intramuscularly.
b. Pharmacological active levels are achieved within 24 hours after injection, and serum concentrations of 1 ng/mL are maintained for 3 months.
c. During the fifth or sixth month after injection, the levels decrease to 0.2 ng/ mL, and they become undetectable by 7-9 months after injection.
d. It acts by the inhibition of ovulation with the suppression of FSH and LH levels and eliminates the LH surge. This results in a relative hypoestrogenic state. Single doses of 150 mg will suppress ovulation in most women for as long as 14 weeks.
e. The contraceptive regimen consists of 1 dose every 3 months. It is an extremely effective contraceptive option.
f. Neither varying weight nor use of concurrent medications has been noted to alter efficacy.
g. Within the first year of use, the failure rate is 0.3%.
h. It does not produce the serious adverse effects of estrogen, such as thromboembolism.
i. Dysmenorrhea is decreased. Risk of endometrial and ovarian cancer is decreased.
j. Disadvantages are disruption of the menstrual cycle to eventual amenorrhea occurs in 50% of women within the first year.
k. Persistent irregular bleeding can be treated by administering the subsequent dose earlier or by adding a low-dose estrogen temporarily.
l. Because DMPA persists in the body for several months in women who have used it on a long-term basis, it can delay the return to fertility.
m. Other adverse effects, such as weight gain, depression, and menstrual irregularities, may continue for as long as one year after the last injection.