Initiating intramuscular depot medroxyprogesterone acetate 24–48 hours after mifepristone administration does not affect success of early medical abortion

Lang, Christina; Chen, Zhong Eric; Johnstone, Anne; Cameron, Sharon

doi:10.1136/bmjsrh-2017-101928

Cited by 4 publications

(5 citation statements)

References 16 publications

(17 reference statements)

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“…Although insertion of a POC implant at the time of mifepristone administration does not impair the efficacy of early medical abortion, administration of DMPA with mifepristone increased the risk of failed medical abortion (ongoing pregnancy) compared with DMPA administration delayed until after the abortion (3.5% vs 0.9%) . A recent study suggested that giving DMPA at the time of misoprostol administration had no effect on ongoing pregnancy rates . A recent randomized controlled trial demonstrated an increased risk of partial expulsion with fast‐track (≤3 days) insertion of the LNG‐IUS compared with insertion 2‐4 weeks after misoprostol administration (expulsion rates 12‐28 vs. 2%‐4%) .…”

Section: Methodsmentioning

confidence: 99%

“…33 A recent study suggested that giving DMPA at the time of misoprostol administration had no effect on ongoing pregnancy rates. 34 A recent randomized controlled trial demonstrated an increased risk of partial expulsion with fast-track (≤3 days) insertion of the LNG-IUS compared with insertion 2-4 weeks after misoprostol administration (expulsion rates 12-28 vs. 2%-4%). 30,35 However, use of LNG-IUS was higher and pregnancy rates were lower at 1 year if the device had been inserted immediately.…”

Section: Contraception After Induced Abortionmentioning

confidence: 99%

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Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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Section: Methodsmentioning

confidence: 99%

Section: Contraception After Induced Abortionmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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“…1 ). A total of 16 studies met inclusion criteria: 9 focused on medical abortion and 7 on surgical abortion ( Tables 2 and 3 ) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . We did not identify any studies of hormonal contraception use following spontaneous or septic abortion that met our inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…A fair-quality retrospective cohort study included 5122 people at ≤63 days who either initiated a hormonal method (DMPA, COC, POP, or implant) at the time of misoprostol or had no hormonal method. The 2-week follow-up involved a home low-sensitivity UPT [31] . For all 4 methods, there were no differences in continuing pregnancy rates compared with no hormonal method.…”

Section: Hormonal Contraception Vs Nonhormonal or No Contraceptionmentioning

confidence: 99%

Systemic hormonal contraception initiation after abortion: A systematic review and meta-analysis

et al. 2021

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Background: Immediate contraceptive initiation, including start of a method before abortion completion, is a convenient option for women seeking abortion care. Objectives: To evaluate the effect of systemic hormonal contraception initiation on medical abortion effectiveness and the safety of hormonal contraceptive methods following abortion. Data sources: PubMed, Popline, Cochrane Library, and Clinicaltrials.gov. Study eligibility criteria: Studies that assessed medical abortion effectiveness after systemic hormonal contraception initiation and the safety of hormonal contraception initiation after abortion. Participants: Pregnant persons undergoing or who had recently undergone an abortion. Interventions: Initiation of systemic hormonal contraception post abortion or on the day of the first pill of the medical abortion. Study appraisal and synthesis methods: We assessed study quality using the US Preventive Services Task Force evidence grading system. We created narrative summaries and calculated pooled relative risks when appropriate. Results: We identified 16 studies for inclusion, 7 randomized controlled trials, and 9 cohorts. Nine studies assessed medical abortion effectiveness with hormonal contraception initiation and generally found no decreased risk of abortion success or increased risk of additional treatment. One fair-quality study reported a small increase in ongoing pregnancy rate with immediate depot medroxyprogesterone (DMPA) compared with delayed DMPA initiation (3.6% vs 0.9%, risk difference 2.7%, 90% confidence interval 0.4-5.6). We identified no bleeding-related safety concerns following hormonal contraception initiation after medical or surgical abortion. Pooled results were too imprecise to draw firm conclusions. Limitations: Included studies were poor or fair quality and primarily in high-income or upper-middleincome settings. Conclusions: Abortion effectiveness did not differ between immediate vs delayed initiation of most systemic hormonal contraceptive methods after a first trimester medical abortion. However, immediate DMPA initiation did show increased ongoing pregnancy. Bleeding effects with hormonal contraception initiation postabortion appeared minimal. Implications: Initiating a hormonal contraceptive method after an abortion and as early as the same day as the first pill of the medical abortion is an option if contraception is desired. The slight increase in ongoing pregnancy with immediate DMPA initiation highlights the importance of information provision during contraceptive counseling.

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“…Because mifepristone is a progesterone antagonist, there has been some concern that offering progestin-only methods (like progestin-only implants or injectables) at the time medication abortion drugs are taken might interfere with the effectiveness of medication abortion. This analysis from Lang and colleagues1 provides information from a large number of women who received a progestin-only injectable (depo medroxyprogesterone acetate, DMPA) at the time they received misoprostol (the second drug in the regimen, taken 24–48 hours after mifepristone). The findings are an important addition to the literature and add to the existing data that support providing contraception based on women’s choice and convenience.…”

mentioning

confidence: 99%

Contraception after medication abortion should be determined by convenience and choice

Blanchard

2018

BMJ Sex Reprod Health

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Initiating intramuscular depot medroxyprogesterone acetate 24–48 hours after mifepristone administration does not affect success of early medical abortion

Cited by 4 publications

References 16 publications

Contraception after pregnancy

Contraception after pregnancy

Systemic hormonal contraception initiation after abortion: A systematic review and meta-analysis

Contraception after medication abortion should be determined by convenience and choice

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