Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously

Segall-Gutierrez, Penina; Taylor, DeShawn; Liu, Xinwen; Stanzcyk, Frank; Azen, Stanley; Mishell, Daniel R.

doi:10.1016/j.contraception.2010.01.021

« Previous Next »Contraception
Volume 81, Issue 6 , Pages 487-495, June 2010

Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously

Penina Segall-Gutierrez
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Corresponding author. LAC+USC Medical Center, Los Angeles, CA 90033, USA. Tel.: +1 323 226 5408; fax: +1 323 226 3424.
DeShawn Taylor
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Xinwen Liu
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Frank Stanzcyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Stanley Azen
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Daniel R. Mishell Jr
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA

Received 12 August 2009; received in revised form 8 December 2009; accepted 26 January 2010. published online 11 March 2010.

Abstract

Background

Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the extremely obese population (BMI ≥40 kg/m²). The purpose of this 26-week prospective experimental study was to determine incidence of ovulation and follicular development among women with Class 1, 2 and 3 obesity after receiving DMPA-SC.

Methods

Five normal-weight, five Class 1-2 obese, and five Class 3 obese women received subcutaneous injections of 104 mg DMPA-SC at baseline and 12 weeks later. Weekly progesterone levels, bimonthly estradiol (E₂), and monthly medroxyprogesterone acetate (MPA) levels were measured by immunoassay methods for a total of 26 weeks in each subject.

Results

Ovulation did not occur in any subject more than 1 week after the first injection. There was large intersubject and intrasubject variability in E₂ levels, and fluctuating E₂ levels were more frequent among obese women than normal-weight women. Median MPA levels remained above the level needed to prevent ovulation but, compared with normal-weight subjects, were lower among Class 1-2 obese and lowest among Class 3 obese subjects.

Conclusion

Fluctuating E₂ levels reflective of follicular development occurred more often among Class 1, 2 and 3 obese women than normal-weight women after DMPA-SC injections. Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation. Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women.

Keywords: Depomedroxyprgesterone acetate, Contraception, Injection, Obese, Class 3 obese, Follicular development, Ovulation