Re: "98d DMPA cycle" source needed; N so far
From: R. Daniel Braun, M.D. (rbraun@iunet.iupui.edu)
Wed Feb 18 07:47:58 1998
I find it interesting that Fotherby found reumption of "Luteal" function as
early as 66 days, but no evidence of "Follicular" function before 104 days.
I thought a follicle was necessary to lead to Luteal function. Or is this a
typo?
Dan
-----Original Message-----
From: Tessler <tessler@frontiernet.net>
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Date: Tuesday, February 17, 1998 11:36 PM
Subject: "98d DMPA cycle" source needed; N so far
>
>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
>>injection..." can be documented by reading the article by Kaunitz AM.
>>"Long-acting injectable contraception with depot medroxyprogesterone
>>acetate" Am J Obstet Gynecol 1994;170:1543-9.
>>
>>Another reference on the same assertion: Fotherby K. Contraception
>>1980;22:527-36.
>>
>>The company may state that ovulation can occur once 91 days have passed
>>after the last dose but the data show that 98 days may be more than
>>appropriate.
>
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