The study examined the effect of pretreatment counseling upon discontinuation of 150 mg depo-medroxyprogesterone acetate (Depo-Provera (DMPA)), given for contraception. A total of 421 Chinese women participated, 204 receiving detailed structured pretreatment and ongoing counseling on the hormonal effects and probable side effects of DMPA and 217 receiving only routine counseling. The primary study endpoint was termination rate; secondary endpoints were frequency of medical events and reasons for termination. Study termination rates were significantly lower in the intensive structured counseling group than in the routine counseling group. At one year, the total cumulative termination rates were 11% (23/204) and 42% (92/217), respectively (p < 0.0001). The most common reasons for terminating DMPA were menstrual changes. No pregnancy, serious or unexpected medical events were reported, nor were statistically or clinically significant changes in vital signs observed. We conclude that pretreatment counseling on expected side effects increases the acceptability of DMPA.
PIP: In China, 214 women aged 18-40 years at two family planning clinics in Sichuan province received structured counseling on the effects they could expect with use of the contraceptive injectable delivering depot-medroxyprogesterone acetate (DMPA) and DMPA's mode of action. They also viewed an educational video on DMPA and received an information booklet on DMPA. 217 women aged 19-37 years at two other family planning clinics in the same province received routine counseling. They were only told that they were in a study to study the efficacy of DMPA. No other information on DMPA was provided unless asked. Researchers aimed to determine whether or not structured counseling would affect the rate of DMPA discontinuation. They followed the women for 12 months. Overall, the women who received structured counseling had a much lower discontinuation rate than those who received routine counseling (p 0.0001). For example, three months after receiving the first DMPA dose, 3% of women in the structured counseling group did not return for the next DMPA dose compared to 25% of those in the routine counseling group. At 12 months, these figures were 11% and 42%, respectively. Regardless of the group, menstrual irregularities were the leading reasons for DMPA termination and were much more common as a reason in the routine counseling group than the structured counseling group (19.24% vs. 5.43%; p 0.0001). They were also the most commonly reported medical event for both groups (39.7% for structured counseling group and 26.3% for routine counseling group). Among breast feeding mothers, menstrual irregularities were less likely to be a reason for DMPA termination in the structured counseling group than the routine counseling group (14% vs. 37%). Increased body weight and changes in blood pressure were not found. No pregnancy or serious or unexpected side effects occurred. These findings suggest that structured counseling increases the acceptability of DMPA and that DMPA is safe and effective.