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"98d DMPA cycle" source needed; N so farFrom: Tessler (tessler@frontiernet.net)Tue Feb 17 21:16:49 1998
What was an academic pursuit has become more pressing. Tomorrow I expect to hear arguments from at least one of my colleagues that the risks of pregnancy >91d after DMPA are higher than we thought, and that we need to reconsider the "two weeks of abstinence then pregnancy test" protocol for late reinjection. I think our protocol's fine. With a new sense of urgency, I drove down to the "big city" and got a copy of Dr. Kaunitz's article in Contemporary OB/GYN, as well as his 1994 AJOG article, hoping to find some statistical evidence to support the status quo. When I returned, I found that Dr. Sanchez-Ramos had kindly passed on some citations supporting the 98 day reinjection schedule. While Dr. Kaunitz's Contemporary OBGYN review did not have a citation for the 98 day assertion, his AJOG article did, referring only to Fotherby, cited below by Dr. Sanchez-Ramos. Fortherby et al. measured plasma estradiol and progesterone as indicators of resumption of follicular and luteal activity. Only five (5) women were tested after a 150 mg DMPA dose. The ranges in these women were 66 to over 167 days for resumption of luteal function, and 104 to over 167 days for resumption of follicular function. The authors noted that these results were preliminary, and referred to a 90 day cycle for reinjection as the standard. Fotherby et al. led me to Kirton, K.T. and Cornette, J.C. (1974). Return of ovulatory cyclicity following an intramuscular injection of medroxyprogesterone acetate. Contraception, 10, 39-45. Three (3) women were included in this study, which showed that DMPA 150 mg "inhibited formation of a functional corpus luteum for a prolonged (>= 200 d) period of time." I also found Ortiz, A. et al.'s Serum medroxyprogesterone acetate (MPA) concentrations and ovarian function following intramuscular injection of Depo-MPA. (...I lost the source...I believe this article was in Contraception volume 2 or 1970). This study also followed three (3) women after a single DMPA injection until hormone levels demonstrated the first ovulatory cycle, which happened between seven and nine months after injection. The trail ended there, and a Medline search on {medroxyprogesterone and (fertility or ovulation)} yielded no additional studies. DMPA's manufacturer says they only have data on the 91 day schedule. So, I found some preliminary evidence to support a 98 day reinjection schedule; however, these three studies taken together looked at only eleven women. What I can't locate, and what I believe Dr. Kaunitz, Dr. Sanchez-Ramos, or others of you supporting the regimen must have read at some point, is a study with enough statistical power to suggest that 98 days is a viable schedule for reliable pregnancy prevention in the overwhelming majority of women. If anyone has a recollection of a partial title or possible source of such a study, I'd appreciate any leads that might help me locate it. Patti Tessler, RN, Family Nurse Practitioner Orange County, New York, USA tessler@frontiernet.net
Dr. Sanchez-Ramos wrote:
>The "crazy assertion that one may inject DMPA 98 days after the last
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