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Recommendations for Contraceptive Use |
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Progestin-Only Injectables |
Q.7. Should the progestin-only
injectable be discontinued because of extended amenorrhea?
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| a) No, there is no medical
reason to discontinue. Emphasis should be on counseling, including reassurance that
amenorrhea with injectable progestins is to be expected and is safe, as well as counseling
on the benefits of amenorrhea. |
a) It is reasonable to expect
amenorrhea among injectable progestin users, and the likelihood of amenorrhea increases
with increased duration of progestin-only injectable use (50% at end of first year,
two-thirds of women by end of second year of use). Women who are counseled about this
possible side-effect will be less concerned if they experience extended amenorrhea.
- Mishell DR. Long-acting contraceptive
steroids: Postcoital contraceptives and antiprogestins, in Mishell DR, Davajan V, Lobo RA
(eds). Infertility, Contraception, and Reproductive Endocrinology, 3rd edition.
Boston, Blackwell Scientific Publications, 1991, pp 872-894.
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| b) The question of whether
progestin-only injectables may be related to osteoporosis is under study. In theory, this
may be a particular concern for older women with prolonged amenorrhea. (See Q.4. concerning amenorrhea due to DMPA before age 16.) |
b) Extended amenorrhea resulting
from the use of injectable progestins is due to endometrial atrophy. There is no risk of
endometrial hyperplasia. In fact, DMPA is protective against endometrial cancer.
- Speroff L, Glass RH, Kase NG. Clinical
Gynecologic Endocrinology and Infertility, 4th edition. Baltimore,
Williams & Wilkins, 1989, p 201 and 227.
- Herbst AL, Mishell DR, Stenchever MA,
Droegemueller W. Comprehensive Gynecology. St. Louis, Mosby-Year Book, 1992, pp
1082-1083.
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