Long-Term Use of Contraceptive Depot Medroxyprogesterone Acetate in Young Women Impairs Arterial Endothelial Function Assessed by Cardiovascular Magnetic Resonance

Abstract

Background-Depot medroxyprogesterone acetate (DMPA) inhibits proliferation of ovarian follicles, resulting in anovulation and a decrease in circulating estrogen; the latter action is potentially disadvantageous to cardiovascular health. We therefore investigated the vascular effects of long-term contraceptive DMPA in young women. Methods and Results-Endothelium-dependent (hyperemia-induced flow-mediated dilatation [FMD]) and -independent (glyceryl trinitrate [GTN]) changes in brachial artery area were measured using cardiovascular magnetic resonance in 13 amenorrheic DMPA users (Ͼ1 year use; mean age 29Ϯ4 years) and in 10 controls (mean age 30Ϯ4 years, Pϭ0.25) with regular menstrual cycles after validation of the technique. FMD and GTN responses were measured just before repeat MPA injection and 48 hours later (nϭ12) in DMPA users and during menstruation and midcycle (nϭ9) in controls. Serum-estradiol levels (S-estradiol) were measured at both visits. FMD was reduced in DMPA users compared with controls during menstruation (1.1% versus 8.0%, respectively PϽ0.01) without differences in GTN responses. S-estradiol levels in DMPA users were significantly lower than in controls during menstruation (58 versus 96 pmol/L, PϽ0.01). High levels of circulating MPA 48 hours after injection were not linked to an additional impairment in FMD (2.0% versus 3.1%, Pϭ0.23). Estradiol levels were significantly correlated to FMD (rϭ0.43, PϽ0.01). Conclusions-Endothelium-dependent arterial function measured by cardiovascular magnetic resonance is impaired in chronic users of DMPA, and hypoestrogenism may be the mechanism of action. DMPA might adversely affect cardiovascular health, and in particular its use in women with cardiovascular disease should be additionally evaluated.

Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception

“…23,24 Although not studied extensively, there is evidence of decreased vascular function in women using DMPA for contraception. 25 The mechanism(s) by which DMPA could increase weight and fat mass while also altering fat distribution is unknown and cannot be discerned from our current study. However, the effects of DMPA or progesterone in humans and experimental animals raise interesting mechanistic possibilities.…”

Cardiovascular Magnetic Resonance

“…132 CMR assesses changes in the arterial area, which has advantages over ultrasound measurements of arterial diameter, especially in noncircular vessels. Validation studies in humans suggest that CMR has improved reproducibility, which reduces sample sizes for trials.…”

Contracepção hormonal e sistema cardiovascular

“…The depot medroxyprogesterone acetate (DMPA) inhibits ovulation and causes a decline in estradiol levels, thereby inducing hypoestrogenism 53 . So, when it is administered for a long time, it can alter the vascular function 54,55 . In addition, longitudinal and crosssectional studies noted the increase in LDL levels and reduction in HDL cholesterol among DMPA users, which are changes that are epidemiologically linked to CVD.…”