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BMJ Global Health Jul 2022Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is an innovative contraceptive method aimed at meeting women's unique circumstances and needs, largely due to... (Review)
Review
Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is an innovative contraceptive method aimed at meeting women's unique circumstances and needs, largely due to its ability to be self-injected. Substantial research and advocacy investments have been made to promote roll-out of DMPA-SC across sub-Saharan Africa. To date, research on the demand for DMPA-SC as a self-injectable method has been conducted largely with healthcare providers, via qualitative research, or with highly specific subsamples that are not population based. Using three recent rounds of data from Performance Monitoring for Action, we examined population-representative trends in demand, use, and preference for self-injection among current non-users in Burkina Faso, the Democratic Republic of Congo (Kinshasa and Kongo Central regions), Kenya, and Nigeria (Lagos and Kano States). We found that while over 80.0% of women had heard of injectables across settings, few women had heard of self-injection (ranging from 13.0% in Kenya to 24.8% in Burkina Faso). Despite initial increases in DMPA-SC prevalence, DMPA-SC usage began to stagnate or even decrease in all settings in the recent three years (except in Nigeria-Kano). Few (0.0%-16.7%) current DMPA-SC users were self-injecting, and the majority instead were relying on a healthcare provider for administration of DMPA-SC. Among current contraceptive non-users wishing to use an injectable in the future, only 1.5%-11.4% preferred to self-inject. Our results show that self-injection is uncommon, and demand for self-injection is very limited across six settings, calling for further qualitative and quantitative research on women's views on DMPA-SC and self-injection and, ultimately, their contraceptive preferences and needs.
Topics: Contraceptive Agents, Female; Democratic Republic of the Congo; Female; Humans; Injections, Subcutaneous; Medroxyprogesterone Acetate; Nigeria; Self Administration
PubMed: 35835480
DOI: 10.1136/bmjgh-2022-008862 -
Proceedings of the Royal Society of... Feb 1973
Topics: Adolescent; Adult; Age Factors; Aged; Blood Pressure; Castration; Climacteric; Endometrial Hyperplasia; Estradiol; Estrogens; Estrogens, Conjugated (USP); Female; Humans; Hysterectomy; Libido; Male; Medroxyprogesterone; Menopause; Methyltestosterone; Middle Aged; Norethindrone; Osteoporosis; Progesterone
PubMed: 4351701
DOI: No ID Found -
American Family Physician Jun 2008The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include... (Review)
Review
The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis. The initial history and physical examination can narrow the diagnostic possibilities, guide any subsequent evaluation, and rule out malignancy or significant systemic disease. If the initial evaluation does not reveal a specific diagnosis, a limited laboratory and ultrasound evaluation can clarify the diagnosis, as well as rule out serious disease and reassure the patient. Few treatment modalities have demonstrated benefit for the symptoms of chronic pelvic pain. The evidence supports the use of oral medroxyprogesterone, goserelin, adhesiolysis for severe adhesions, and a multidisciplinary treatment approach for patients without a specific diagnosis. Less supporting evidence is available for oral analgesics, combined oral contraceptive pills, gonadotropin-releasing hormone agonists, intramuscular medroxyprogesterone, trigger point and botulinum A toxin injections, neuromodulative therapies, and hysterectomy.
Topics: Algorithms; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Contraceptives, Oral, Synthetic; Diagnosis, Differential; Female; Humans; Medroxyprogesterone; Pelvic Pain; Physical Examination
PubMed: 18581833
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Dec 2021Long-acting reversible contraceptives (ie, intrauterine devices and the etonogestrel subdermal implant) have become increasingly popular methods of contraception because...
Long-acting reversible contraceptives (ie, intrauterine devices and the etonogestrel subdermal implant) have become increasingly popular methods of contraception because of their convenience and safety profile. At the same time, the use of depot medroxyprogesterone acetate, one of the most prescribed contraceptives in the United States since its approval in 1992, is on the wane. The history and pros and cons of these contraceptive methods are reviewed.
Topics: Contraception; Contraceptive Agents, Female; Female; Humans; Intrauterine Devices; Medroxyprogesterone Acetate; United States
PubMed: 34857607
DOI: 10.3949/ccjm.88a.20110 -
Medicina (Kaunas, Lithuania) Oct 2022Background and objectives: Abnormal uterine bleeding is a significant clinical and gynaecological concern that necessitates its safe and effective treatment. The present... (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation of the Safety and Efficacy of Ormeloxifene, a Selective Estrogen Receptor Modulator and Medroxyprogesterone Acetate in Women with Non-Structural Abnormal Uterine Bleeding: A Randomized Clinical Trial.
Background and objectives: Abnormal uterine bleeding is a significant clinical and gynaecological concern that necessitates its safe and effective treatment. The present study aims to compare the cost-effectiveness, safety, efficacy, and health-related quality of life of ormeloxifene with medroxyprogesterone acetate in women with non-structural abnormal uterine bleeding. Materials and Methods: A prospective, randomized, single-blinded clinical trial of 367 patients was carried out at a tertiary care hospital for a period of one year from 5 January 2019 to 4 January 2020. Patients were randomized into two groups for administering ormeloxifene and medroxyprogesterone acetate for a 3-month treatment duration and were evaluated by laboratorial investigations like anaemic status, bleeding duration, endometrial thickness, pictorial blood loss assessment chart (PBLAC) score, and patient’s medical and medication history. Health-related quality of life was assessed using short form survey-36 (SF-36) questionnaire scale. Cost-effectiveness was determined on the basis of the three-month treatment regimen. Results: The mean duration of bleeding reduced from 16.88 ± 6.46 to 7.76 ± 1.55 in the ormeloxifene group and from 15.91 ± 5.04 to 8.7 ± 1.91 (p < 0.001) in the medroxyprogesterone acetate. Similarly, mean haemoglobin increased from 8.56 ± 0.77 to 10.1 ± 0.087 g/dL and from 8.60 ±0.97 to 9.551 ± 0.90 g/dL (p < 0.001), and endometrial thickness showed a reduction from 8.52 ± 1.61 mm to 6.92 ± 1.68 mm and from 8.40 ± 2.09 mm to 7.85 ± 2.0 mm (p < 0.001) in the ormeloxifene and medroxyprogesterone acetate groups, respectively. PBLAC score reduced from 289.92 ± 42.39 to 128.11 ± 33.10 and from 287.38 ± 40.94 to 123.5 ± 29.57 (p < 0.001) in these groups, respectively. Health-related quality of life improved in the ormeloxifene group more than the medroxyprogesterone group, which was evidenced by SF-36 scale parameters (physical function, energy/fatigue and pain) that changed from 24.39, 12.99, 6.25 to 28.95, 18, 9 and from 25.41, 13.6, 7.1 to 27.02, 16, 8.3 in the ormeloxifene and medroxyprogesterone acetate groups, respectively. Conclusions: The study concludes that both medroxyprogesterone acetate and ormeloxifene are safe and efficacious in controlling abnormal uterine bleeding, but ormeloxifene was the better of the two in terms of cost effectiveness, reduction in pictorial blood loss assessment score, endometrial thickness, bleeding duration (days), increase in haemoglobin concentration (g/dL) and improvement in the quality of life.
Topics: Humans; Female; Medroxyprogesterone Acetate; Selective Estrogen Receptor Modulators; Quality of Life; Prospective Studies; Uterine Hemorrhage
PubMed: 36363460
DOI: 10.3390/medicina58111503 -
Bulletin of the World Health... 1993Depot-medroxyprogesterone acetate (DMPA) is a long-acting progestational contraceptive, which is administered by injection. It was developed in the mid-1960s, when it... (Review)
Review
Depot-medroxyprogesterone acetate (DMPA) is a long-acting progestational contraceptive, which is administered by injection. It was developed in the mid-1960s, when it was seen as a method that would be particularly useful for women seeking reversible contraception who had difficulty taking a pill every day. DMPA has been shown to be a highly effective contraceptive, and it has proved acceptable in a variety of settings. The drug is licensed as a contraceptive in more than 90 countries and has been widely used in a number of them, such as Thailand and New Zealand. On a worldwide basis, the licensing, acceptability, and prevalence of use have been influenced by concern that DMPA may increase the risk of cancer. Cancer of the breast has been a particular concern. This Memorandum reviews comprehensively the results of toxicological tests in animals and epidemiological studies in humans concerning the carcinogenicity of DMPA.
Topics: Animals; Delayed-Action Preparations; Drug Approval; Epidemiologic Methods; Humans; Medroxyprogesterone Acetate; Neoplasms; Patient Acceptance of Health Care
PubMed: 8313485
DOI: No ID Found -
BMC Women's Health Dec 2022Injectable contraceptives have contributed substantially to Nigeria's rise in modern family planning methods usage. They are one of the most commonly used and preferred...
BACKGROUND
Injectable contraceptives have contributed substantially to Nigeria's rise in modern family planning methods usage. They are one of the most commonly used and preferred means of contraception among women in the country. Enabling policies are required to assure contraceptive access, security, and use. This study aimed to investigate the policy environment and how it supports or limits Nigeria's introduction and scale-up of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC).
METHODS
The design of this mixed-methods study was cross-sectional. Desk reviews of policy papers, key informant interviews, and in-depth interviews were used to obtain information from respondents about the introduction of DMPA-SC in Nigeria and how existing policies influenced its scale-up. Data on DMPA-SC and other injectables were gathered from Nigeria's national electronic logistics management information system.
RESULTS
The findings suggest that policies such as task-shifting and task-sharing, cost-free policies, reproductive health policies, and others created an enabling environment for the scale-up of DMPA-SC adoption in Nigeria. The inclusion of DMPA-SC on the essential medicines list and the approved patent medicines list facilitated the scale-up process by ensuring private sector participation, removing economic barriers to access, fostering greater collaboration among health worker cadres, improving intersectoral partnerships, and improving logistics and client access. Despite significant anomalies in some implementing policies, injectable contraceptive consumption data demonstrate a progressive increase in DMPA-SC use during the study period. The results also indicate that policy initiatives have a favorable impact on the use of DMPA-SC throughout the country.
CONCLUSION
The existence of policies, the active participation of stakeholders, and the political will of the Nigerian health system's leadership have all aided in the scaling-up of the DMPA-SC. Understanding how to build an enabling policy climate is critical for providing women with family planning options. These lessons from Nigeria emphasize the importance of these levers, which should be considered by teams intending to introduce innovative health products, particularly in developing countries.
Topics: Female; Humans; Medroxyprogesterone Acetate; Contraceptive Agents, Female; Nigeria; Cross-Sectional Studies; Policy
PubMed: 36544189
DOI: 10.1186/s12905-022-02109-x -
Lancet (London, England) Feb 2020
Topics: Contraception; Female; HIV Infections; Humans; Incidence; Intrauterine Devices, Copper; Levonorgestrel; Medroxyprogesterone Acetate
PubMed: 32035557
DOI: 10.1016/S0140-6736(19)33107-1 -
Archivio Italiano Di Urologia,... Sep 2015Andrology is a constantly evolving discipline, embracing social problems like pedophilia and its pharmacological treatment. With regard to chemical castration, the... (Review)
Review
Andrology is a constantly evolving discipline, embracing social problems like pedophilia and its pharmacological treatment. With regard to chemical castration, the andrologist may perform an important role as part of a team of specialists. At present, no knowledge is available regarding hormonal, chromosomal or genetic alterations involved in pedophilia. International legislation primarily aims to defend childhood, but does not provide for compulsory treatment. We reviewed international literature that, at present, only comprises a few reports on research concerning androgen deprivation. Most of these refer to the use of leuprolide acetate, rather than medroxyprogesterone and cyproterone acetate, which present a larger number of side effects. Current opinions on chemical castration for pedophilia are discordant. Some surveys confirm that therapy reduces sexual thoughts and fantasies, especially in recidivism. On the other hand, some authors report that chemical castration does not modify the pedophile's personality. In our opinion, once existing legislation has changed, andrologists could play a significant role in the selection of patients to receive androgen deprivation therapy, due in part to their knowledge about its action and side effects.
Topics: Androgen Antagonists; Andrology; Castration; Cyproterone Acetate; Evidence-Based Medicine; Humans; Leuprolide; Libido; Male; Medroxyprogesterone; Patient Selection; Pedophilia; Sexual Behavior; Treatment Outcome
PubMed: 26428645
DOI: 10.4081/aiua.2015.3.222 -
Depo-medroxyprogesterone acetate, weight gain and amenorrhea among obese adolescent and adult women.The European Journal of Contraception &... Feb 2020The aim of the study was to evaluate the correlation between obesity and the use of depot medroxyprogesterone (DMPA) with regard to weight gain and changes in bleeding...
The aim of the study was to evaluate the correlation between obesity and the use of depot medroxyprogesterone (DMPA) with regard to weight gain and changes in bleeding pattern. A retrospective chart review was conducted of women receiving 150 mg DMPA via intramuscular injection at inpatient and outpatient clinics at the University of Mississippi Medical Centre between 1 June 2012 and 31 December 2016. Body mass indices (BMI) were assessed at baseline and at the time of final injection. Data on race, medical history, age at first DMPA injection, number and timing of injections, reported side effects, indication for DMPA use and reason for discontinuation, if applicable, were collected. Of the 240 women included in the study, 3.3% were underweight, 30.8% were normal weight, 23.3% were overweight, 15% were class I obese, 9.6% were class II obese and 17.9% were class III obese; 87.9% of the population were African American. Women gained 2.40 kg (95% confidence interval 1.34-3.45) while they were on DMPA ( < .01), which after adjusting for confounding variables was inversely associated with age at initial injection ( coefficient -0.13; = .02). Amenorrhoea was the most commonly reported change in bleeding pattern. Women who started DMPA at an earlier age gained the most weight over time, independently of initial BMI. Similar rates of amenorrhoea were found among all BMI categories.
Topics: Adolescent; Adult; Age Factors; Amenorrhea; Body Mass Index; Contraceptive Agents, Female; Female; Humans; Injections, Intramuscular; Medroxyprogesterone Acetate; Obesity; Retrospective Studies; Time Factors; Weight Gain; Young Adult
PubMed: 31928370
DOI: 10.1080/13625187.2019.1709963