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Administration of depot medroxyprogesterone acetate on the day of mifepristone for medical abortion: a pilot study

      Abstract

      Objective

      We sought to evaluate satisfaction with timing of administration and continuation rates of depot medroxyprogesterone (DMPA) when given on the initial visit for first-trimester medical abortion.

      Study design

      In this pilot study, we administered DMPA within 15 min of mifepristone administration. Participants were followed up in the clinic 7 days after enrollment and were contacted at 14 days, 28 days and 3, 6, 9 and 12 months by telephone. We assessed satisfaction with contraception timing, DMPA continuation, bleeding patterns and abortion completion.

      Results

      Twenty women were enrolled. At 7-day follow-up, 18 of 19 contacted participants (94.7%) were satisfied with timing of DMPA administration. Ten of 19 participants (52.6%) discontinued DMPA after the first injection. At 1 year, 3 participants out of 19 were continuing DMPA (15.7%). The median number of bleeding days after abortion was 19. Three participants had medical abortion failure. In the first year after abortion, there were four known repeat pregnancies.

      Conclusions

      The timing of initiation of DMPA on the initial visit for medical abortion is satisfactory to women, but its influence on medical abortion efficacy requires further study. Continuation rates for DMPA were low in our sample.

      Implications

      This pilot study provides groundwork for future larger studies to assess initiation of the injectable contraceptive DMPA on the day of mifepristone for medical abortion, but low continuation rates of DMPA in our sample emphasize the importance of access to intrauterine devices and implants after abortion.

      Keywords

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      References

        • Clark W.H.
        • Gold M.
        • Grossman D.
        • Winikoff B.
        Can mifepristone medical abortion be simplified? A review of the evidence and questions for future research.
        Contraception. 2007; 75 ([Review]): 245-250
        • Perriera L.K.
        • Reeves M.F.
        • Chen B.A.
        • Hohmann H.L.
        • Hayes J.
        • Creinin M.D.
        Feasibility of telephone follow-up after medical abortion.
        Contraception. 2010; 81: 143-149
        • Grossman D.
        • Berdichevsky K.
        • Larrea F.
        • Beltran J.
        Accuracy of a semi-quantitative urine pregnancy test compared to serum beta-hCG measurement: a possible screening tool for ongoing pregnancy after medication abortion.
        Contraception. 2007; 76 ([Comparative Study Evaluation Studies]): 101-104
        • Dayananda I.
        • Maurer R.
        • Fortin J.M.
        • Goldberg A.B.
        Does follow-up with serum HCG simplify medical abortion? A randomized controlled trial.
        Contraception. 2011; 84 ([Abstract]): 305
        • Sonalkar S.
        • Hou M.Y.
        • Borgatta L.
        Administration of the etonogestrel contraceptive implant on the day of mifepristone for medical abortion: a pilot study.
        Contraception. 2013; 88 ([Clinical Trial Research Support, Non-U.S. Gov't]): 671-673
        • Spitz I.M.
        • Bardin C.W.
        Clinical pharmacology of RU 486 — an antiprogestin and antiglucocorticoid.
        Contraception. 1993; 48: 403-444
        • Mishell Jr., D.R.
        Pharmacokinetics of depot medroxyprogesterone acetate contraception.
        J Reprod Med. 1996; 41: 381-390
        • Pullen M.A.
        • Laping N.
        • Edwards R.
        • Bray J.
        Determination of conformational changes in the progesterone receptor using ELISA-like assays.
        Steroids. 2006; 71: 792-798
        • Hubacher D.
        • Lopez L.
        • Steiner M.J.
        • Dorflinger L.
        Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons.
        Contraception. 2009; 80: 113-118
        • Tang O.S.
        • Lee S.W.
        • Ho P.C.
        A prospective randomized study on the measured blood loss in medical termination of early pregnancy by three different misoprostol regimens after pretreatment with mifepristone.
        Hum Reprod. 2002; 17 ([Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't]): 2865-2868
        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • Petrosky E.
        • Madden T.
        • Eisenberg D.
        • et al.
        Continuation and satisfaction of reversible contraception.
        Obstet Gynecol. 2011; 117: 1105-1113
        • Westfall J.M.
        • Main D.S.
        • Barnard L.
        Continuation rates among injectable contraceptive users.
        Fam Plan Perspect. 1996; 28: 275-277
        • Goldberg A.B.
        • Cardenas L.H.
        • Hubbard A.E.
        • Darney P.D.
        Post-abortion depot medroxyprogesterone acetate continuation rates: a randomized trial of cyclic estradiol.
        Contraception. 2002; 66 ([Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.]): 215-220
        • Raymond E.G.
        • Shannon C.
        • Weaver M.A.
        • Winikoff B.
        First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.
        Contraception. 2013; 87: 26-37