Angela Dempsey1, Claudia Roca, Carolyn Westhoff. 1. Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA. dempsear@musc.edu
Abstract
BACKGROUND:Irregular bleeding is often cited as the reason for discontinuation of depot-medroxyprogesterone acetate (DMPA) after the first injection. Estrogen supplementation during DMPA initiation may decrease bleeding and improve continuation. STUDY DESIGN: This prospective, randomized, controlled trial evaluated estrogen supplementation during DMPA initiation. Women initiating DMPA were randomized to receive an estradiol vaginal ring for 3 months versus DMPA alone. Bleeding diaries and questionnaires at three and 6 months assessed bleeding, continuation and ring acceptability. RESULTS:Seventy-one participants enrolled; 49 completed the first follow-up period. The median number of bleeding or spotting days was 16 in the estrogen ring group (n=26) versus 28 in the DMPA alone group (n=23) (p=.19). Seventy-seven percent of the intervention group received a second injection compared with 70% in the DMPA alone group (p=.56). For each additional day of bleeding and/or spotting reported, women were 3% less likely to receive a second injection (OR 0.97, 95% CI 0.94-0.99). Acceptability of the vaginal ring was high among those in the intervention group. CONCLUSIONS:Vaginal estrogen supplementation during DMPA initiation is acceptable to women and may decrease total bleeding. Copyright 2010 Elsevier Inc. All rights reserved.
RCT Entities:
BACKGROUND: Irregular bleeding is often cited as the reason for discontinuation of depot-medroxyprogesterone acetate (DMPA) after the first injection. Estrogen supplementation during DMPA initiation may decrease bleeding and improve continuation. STUDY DESIGN: This prospective, randomized, controlled trial evaluated estrogen supplementation during DMPA initiation. Women initiating DMPA were randomized to receive an estradiol vaginal ring for 3 months versus DMPA alone. Bleeding diaries and questionnaires at three and 6 months assessed bleeding, continuation and ring acceptability. RESULTS: Seventy-one participants enrolled; 49 completed the first follow-up period. The median number of bleeding or spotting days was 16 in the estrogen ring group (n=26) versus 28 in the DMPA alone group (n=23) (p=.19). Seventy-seven percent of the intervention group received a second injection compared with 70% in the DMPA alone group (p=.56). For each additional day of bleeding and/or spotting reported, women were 3% less likely to receive a second injection (OR 0.97, 95% CI 0.94-0.99). Acceptability of the vaginal ring was high among those in the intervention group. CONCLUSIONS: Vaginal estrogen supplementation during DMPA initiation is acceptable to women and may decrease total bleeding. Copyright 2010 Elsevier Inc. All rights reserved.
Authors: Tessa Madden; Sarah Proehl; Jenifer E Allsworth; Gina M Secura; Jeffrey F Peipert Journal: Am J Obstet Gynecol Date: 2011-09-24 Impact factor: 8.661
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