BOSTON — Immediate initiation of depot medroxyprogesterone acetate to adolescent and young adult women seeking the contraceptive injection resulted in higher continuation rates and substantially diminished unintended pregnancy rates at 6 months, compared with the use of alternative, short-term hormonal methods meant to bridge the period between initial request and injection at a later date, Vaughn I. Rickert, Psy.D., said at the annual meeting of the Society for Adolescent Medicine.
In a study of 334 young women aged 14–26 years who asked for depot medroxyprogesterone acetate (DMPA) during a reproductive health visit at an urban family planning clinic, 101 women were randomized to receive their first DMPA (Depo-Provera) injection at the conclusion of the visit, and 233 were randomized to an alternative “quick start” bridge condition whereby they were offered their choice of either oral contraceptive pills, the transdermal patch, or the vaginal ring, said Dr. Rickert of the Mailman School of Public Health at Columbia University in New York.
Historically, the rationale for waiting to initiate hormonal contraception “was to be sure the patient was not pregnant and to keep from altering the bleeding pattern,” Dr. Rickert said. “Unfortunately, with the delayed initiation, many women don't take their first pill, and their motivation wanes.” Similarly, asking women to return to the clinic at a later date for a DMPA injection means that some won't come back for it, thus increasing the likelihood for unintended pregnancies.
The immediate contraception protocol was designed to avoid this outcome, according to Dr. Rickert. While the earlier study looked specifically at the efficacy of the approach with respect to oral contraceptives, the current study sought to determine whether immediate access to DMPA would lead to greater method continuation—and thus pregnancy prevention—over a 6-month period, compared with delaying the injection and providing alternative contraceptive options for the interim period.
All subjects in both conditions underwent a history, physical, pregnancy test, and structured interview at the initial visit. All were instructed to return to the clinic in 21 days for a repeat urine pregnancy test and, for those assigned to the alternative condition, to receive their first DMPA injection, Dr. Rickert said. In addition, the women were followed through two subsequent appointments for DMPA injections and structured interviews.
As of February 2006, 278 of the women had completed the study; 54 were between the ages of 14 and 17 years, 118 were between the ages of 18 and 21, and 106 were between 22 and 26 years.
“Continuation rates were statistically higher at 6 months in the [immediate] Depo group compared to the bridge group, meaning that more women in the Depo group received their third injection,” he said. Other factors independently associated with 6-month DMPA continuation rates included partners' awareness of DMPA use, returning for the pregnancy test visit, and history of emergency contraceptive pill use, “suggesting continuation is also affected by behaviors consistent with intentions not to become pregnant,” Dr. Rickert said.
The immediate DMPA group had significantly fewer pregnancies—2, compared with 23 in the bridge group—across the study period.
The findings support immediate administration of DMPA and suggest a potentially significant impact on continuation as well as avoidance of unintended pregnancies, Dr. Rickert concluded.
