Original research articleEffect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate
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
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Present address: U.I.M. en Biologı́a del Desarrollo-Hospital Pediátrico C.M.N. S XXI – IMSS.