Elsevier

Contraception

Volume 63, Issue 3, March 2001, Pages 143-146
Contraception

Original research article
Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate

https://doi.org/10.1016/S0010-7824(01)00181-0Get rights and content

Abstract

This study purported to determine the effect of pretreatment counseling upon discontinuation of 150 mg depot-medroxyprogesterone acetate (Depo-Provera) given for contraception. A total of 350 Mexican women participated: 175 received detailed structured pretreatment counseling about the hormonal effects of the injectable vs. routine counseling upon duration of use and efficacy of the method. Study termination rates were significantly lower in the structured counseling group than in the control group. Cumulative life table discontinuation rates were 17% (30/175) and 43.4% (76/175), respectively (p <0.05). The most common reasons for terminating DMPA were menstrual changes (8.6 and 32% for counseling and control group, respectively). The findings suggest that pretreatment counseling on expected side effects increases the continuation rates of DMPA users.

Introduction

Injectable Depo-Provera (depot-medroxyprogesterone acetate, DMPA ) a microcrystalline suspension has been proven to be an effective hormonal treatment for pregnancy prevention by depressing pituitary gonadotrophic hormone release. It has been used for contraceptive purposes in more than 90 countries. Acceptability of the method is very high, but continuation rates at 12 months are 30% or below as a consequence of side effects [1], [2], [3], [4], [5], [6]. Women stop using DMPA mainly because of bleeding disturbances (irregular bleeding, spotting, and amenorrhea ) and other side effects, such as weight gain and headaches [7], [8], [9], [10], [11].

In rural areas of Yucatan, Mexico, women have cultural beliefs about amenorrhea. They generally believe that when amenorrhea is not produced by pregnancy or breastfeeding the monthly blood fluid is deposited in the uterus and has a toxic effect on the body. The purpose of this study was to determine whether counseling about possible menstrual disturbances, such as amenorrhea or other side effects that could be expected with DMPA use, affects the rate of discontinuation.

Section snippets

Materials and methods

The study was conducted at the Family Planning Clinic of the “Centro de Investigaciones Hideyo Noguchi” in Merida, Yucatan, Mexico, with new users who voluntarily chose their contraceptive methods. The study included 350 women: 175 received structured counseling (counseling group) and 175 received only routine counseling (control group). Table 1 summarizes the sociodemographic characteristics of the users at the time of admission. Patients in the clinic received information on alternative

Results

Amenorrhea was the major side effect of our women. The occurrence of amenorrhea rose sharply after the first injection, about 35% of the women experienced it in the structured counseling group and 34% in the control group. This symptom occurred in both groups during the first 6 months. The proportion of DMPA users who experienced other menstrual disturbances and/or other medical complaints such as nausea, vomiting, headache, and weight gain, were not considerable, except for the occurrence of

Discussion

Contraceptive compliance, patterns of use continuation and reasons for discontinuation are complicated issues, affected by many factors. Some studies have reported that discontinuation occurs more frequently when women have side effects and when these side effects are particularly related to the disruption of the usual menstrual bleeding pattern, such as amenorrhea, a common side effect with the use of DMPA [2], [3], [10].

Our results showed a marked difference in termination rates between the

Acknowledgments

The authors thank Dra. Susana Bassol for revising the manuscript

References (12)

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Present address: U.I.M. en Biologı́a del Desarrollo-Hospital Pediátrico C.M.N. S XXI – IMSS.

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