Depot medroxyprogesterone versus Norethisterone oenanthate for long-acting progestogenic contraception.

Draper, Beverly; Morroni, Chelsea; Hoffman, Margaret; Smit, Jennifer; Beksinska, Mags; Hapgood, Janet P.; Merwe, Lize van der

doi:10.1002/14651858.cd005214.pub2

Cited by 28 publications

(24 citation statements)

References 10 publications

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“…Thus, the sensitivity of immune cells to the effect of GR-binding progestins may be significantly enhanced in the context of HIV-1 infection. In a sharp contrast to MPA, NET and LNG have low affinity to GR and do not appear to mediate transrepression of genes involved in immune regulation [4, 45, 46, 63–65]. ETG binds GR with intermediate affinity [66, 67].…”

Section: Discussionmentioning

confidence: 99%

“…NET-EN, typically administered as a 200 mg 2-monthly injectable, is manufactured and distributed at costs similar to DMPA [70]. Both injectable contraceptives have been shown to be highly effective and safe [65]. However, accumulating evidence suggests that DMPA but not NET-EN exerts immunosuppressive properties and increases HIV-1 infectivity [3–5, 14, 63].…”

Section: Discussionmentioning

confidence: 99%

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Effect of progestins on immunity: medroxyprogesterone but not norethisterone or levonorgestrel suppresses the function of T cells and pDCs

2014

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Objectives The potential effect of hormonal contraception on HIV-1 acquisition and transmission represents an important public health issue. Several observational studies have suggested an association between the use of hormonal contraception, in particular injectable depot medroxyprogesterone acetate (DMPA), and an increased risk of HIV-1 acquisition and transmission. We and others have previously demonstrated that DMPA acts as a potent inhibitor of innate and adaptive immune mechanisms. The study presented here addresses the immunomodulatory properties of several common progestins with a potential to replace DMPA. Study design To identify safe alternatives to DMPA, we tested the effect of commonly used progestins on the function of human primary T cells and plasmacytoid dendritic cells (pDCs) obtained from the blood of healthy premenopausal women. Results Medroxyprogesterone acetate (MPA) inhibited the activation of T cells and pDCs in response to T cell receptor and Toll-like receptor (TLR)-mediated activation at physiological concentrations. Etonogestrel (ETG) exerted a partial suppressive activity at high concentrations. In sharp contrast, norethisterone (NET) and levonorgestrel (LNG) did not exhibit detectable immunosuppressive activity. Conclusion Evidence indicating the immunosuppressive properties of DMPA strongly suggests that DMPA should be discontinued and replaced with other forms of long-term contraception. Since NET and LNG do not exert immunosuppressive properties at physiological concentrations, these progestins should be considered as alternative contraceptives for women at high risk of HIV-1 infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of progestins on immunity: medroxyprogesterone but not norethisterone or levonorgestrel suppresses the function of T cells and pDCs

2014

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“…IPC is considered a reliable and safe contraceptive method, with discontinuation mainly attributed to menstrual disturbances,9 but which may also be linked to depressive symptoms 10. However, it remains unclear whether the use of IPC in the immediate postnatal period is associated with an increased risk of PND.…”

Section: Introductionmentioning

confidence: 99%

The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial

Singata‐Madliki

Hofmeyr

Lawrie

2016

J Fam Plann Reprod Health Care

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Background Depot medroxyprogesterone acetate (DMPA) is the most commonly used hormonal contraceptive method in South Africa. It is frequently administered in the immediate postnatal period, yet it is unclear whether it affects the risk of postnatal depression (PND). Aim To determine whether DMPA increases the risk of PND compared with the coppercontaining intrauterine device (IUD) when administered after delivery. Design and setting A single-blind randomised controlled trial conducted at two teaching hospitals in East London, South Africa. Methods Eligible, consenting women (N=242) requiring postnatal contraception were randomised to receive DMPA or an IUD within 48 hours of childbirth and interviewed at 1 and 3 months postpartum. Depression was measured using the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Resumption of sexual intercourse, menstrual symptoms and breastfeeding rates were also assessed. Results One-month EPDS depression scores were statistically significantly higher in the DMPA arm compared with IUD arm ( p=0.04). Three-month BDI-II scores were significantly higher in the DMPA arm than in the IUD arm ( p=0.002) and, according to the BDI-II but not the EPDS, more women in the DMPA arm had major depression at this time-point (8 vs 2; p=0.05). There were no statistically significant differences in other outcome measures except that fewer women had resumed sexual activity by 1 month postpartum in the DMPA arm (13% vs 26%; p=0.02). Conclusions The possibility that immediate postnatal DMPA use is associated with depression cannot be excluded. These findings justify further research with longer follow-up. Clinical trial number PACTR201209000 419241.

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“…In contrast, only 31% of women who began DMPA received 4 injections in a 12-month period. This continuation rate is much lower than reported rates that demonstrate approximately 50% of women who initiate DMPA continue this method for at least one year (10) (21)(22)(23)(24)(25). …”

Section: Discussionmentioning

confidence: 59%

“…When we re-examined results of 14 international clinical studies conducted by the World Health Organization, we found that although the average continuation rate at one year was 51% for DMPA, the rate ranged from 25% to 67% on individual investigations (25). Similarly, some studies in US women have reported 12-month continuation rates on DMPA ranging from 21.3% to 28.6% (26)(27)(28).…”

Section: Discussionmentioning

confidence: 97%

Continuation Rates and Complications of Intrauterine Contraception in Women Diagnosed With Bipolar Disorder

Berenson

Asem

Tan

et al. 2011

Obstetrics &Amp; Gynecology

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Objective To estimate continuation rates, complications, and psychiatric hospitalizations among women with bipolar disorder using levonorgestrel-releasing or copper-containing (CuT380A) intrauterine devices (IUD), as compared with those using depot medroxyprogesterone acetate (DMPA) or sterilization for birth control. Methods Data for this cohort study were obtained from a nationwide health insurance claims database on an employed, commercially insured population. Women aged 18–44 with a prior diagnosis of bipolar disorder (n = 849), who were using the levonorgestrel intrauterine system, CuT380A, DMPA, or sterilization were evaluated. Outcomes included continuation rates over a 12-month interval, infectious and noninfectious complications, and hospitalizations for bipolar disorder or depression. Results Women using an IUD were more likely than those using DMPA to continue the method for at least 12 months (CuT380A, 86%; levonorgestrel intrauterine system, 87%). In comparison, only 31% of those who initiated DMPA received three more injections during the following year (p<0.0001). No significant differences were noted in infectious or noninfectious complications by contraceptive type. Finally, no differences were observed in the number of hospitalizations for bipolar disorder or depression among the four contraceptive groups. Conclusions More women with bipolar disorder continued using IUDs at one year than women using DMPA. The rates of complications and psychiatric hospitalizations were not different among women using an IUD, DMPA, or sterilization.

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Depot medroxyprogesterone versus Norethisterone oenanthate for long-acting progestogenic contraception.

Cited by 28 publications

References 10 publications

Effect of progestins on immunity: medroxyprogesterone but not norethisterone or levonorgestrel suppresses the function of T cells and pDCs

Effect of progestins on immunity: medroxyprogesterone but not norethisterone or levonorgestrel suppresses the function of T cells and pDCs

The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial

Continuation Rates and Complications of Intrauterine Contraception in Women Diagnosed With Bipolar Disorder

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