Original Articles
Long-term depot medroxyprogesterone acetate (Depo-Provera) use in inner-city adolescents

https://doi.org/10.1016/S1054-139X(98)00014-7Get rights and content

Abstract

Purpose: To determine Depo-Provera continuation rates and reasons for its discontinuation among adolescents.

Study Design: Medical record reviews and telephone interviews with 159 adolescents who initiated Depo-Provera use between 1 December 1992 and 31 December 1995 at two clinics in New York City. Depo-Provera continuation was measured using lifetable analysis.

Results: The mean age was 17.7 ± 1.5 years, with a median of 1 pregnancy (range 0–11). Mean follow-up was 23.4 ± 10.7 months. Depo-Provera continuation rates were 71% at 3 months, 48% at 6 months, and 27% at 12 months, and were not affected by age, race, pregnancy or contraceptive history, clinic, or foster care status. Forty-three subjects (37% of discontinuers) restarted Depo-Provera during the study period, with a mean time to restart of 8.4 months after the last Depo-Provera injection. Side effects were the main reported reason for Depo-Provera discontinuation, primarily menstrual irregularities (26%) and weight gain (18%). Seventy percent of those discontinuing Depo-Provera owing to irregular bleeding did so after only one injection. For 23%, the single reason for discontinuation was appointment noncompliance. Restart rates were lowest among those who reported irregular bleeding (15%), weight gain (9%), and hair loss (10%), and highest among those discontinuing owing to missed appointments (87%) (p < 0.05). Pregnancies occurred in 19% of Depo-Provera discontinuers.

Conclusion: Although Depo-Provera continuation rates among adolescents are low, over a third of discontinuers may restart the method. Aggressive management of side effects and assistance with appointment follow-up may improve long-term use. High pregnancy rates warrant close follow-up after Depo-Provera discontinuation.

Section snippets

Procedure

With institutional review board approval, we reviewed the medical records of all adolescents aged ≤19 years who initiated Depo-Provera between 1 December 1992 and 31 December 1995, at two clinics in New York City. The New York Hospital Women’s Health Clinic is an obstetrics and gynecology (Ob/Gyn) clinic serving primarily low-income women who reside in all five boroughs of New York City. Ob/Gyn residents and nurse practitioners provide care under the supervision of full-time faculty. There is

Study population

A total of 174 adolescent Depo-Provera users were identified. Two subjects who had used Depo-Provera before and 10 subjects who had initiated Depo-Provera while hospital inpatients or at outside sites were excluded, as were three subjects who initiated Depo-Provera while awaiting Norplant, leaving 159 first-time Depo-Provera users in the final study sample. Of these, 117 (73%) attended the hospital-based clinic and 42 (27%) attended the community-based clinic. Most (79%) had at some point

Discussion

This study imparts new information regarding long-term use of Depo-Provera among adolescents. Our findings confirm earlier reports that the rate of long-term Depo-Provera use among adolescents is low, with almost three quarters stopping the method within the first year of use. These findings are also similar to those for a population of adolescent mothers using Depo-Provera in Philadelphia, where 66% stopped Depo-Provera use within 1 year 22. As reported in previous studies, the majority of

Acknowledgements

This study was supported in part by a National Institutes of Health Short-Term Training Grant for Students in Health.

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