title: Depomedroxyprogesterone-induced hypoestrogenism and changes in vaginal flora and epithelium.
abstract: OBJECTIVE
  To identify the effects of depomedroxyprogesterone acetate (DMPA) on vaginal microbial flora and epithelium.
  
  
  METHODS
  Women who desired DMPA for contraception were evaluated before and at 3 and 6 months after initiation of 150-mg DMPA injections every 3 months. At each visit, we assessed genital symptoms, vaginal signs, vaginal microflora, and histopathology by vaginal biopsies.
  
  
  RESULTS
  Among 38 women observed for 6 months, there was significant reduction in mean serum estradiol level (99.9 +/- 9.3 pg/mL to 26.6 +/- 1.6 pg/mL, P <.001). The number of subjects with any Lactobacillus did not change, but the number with hydrogen peroxide (H(2)O(2))-positive Lactobacillus decreased from 20% before to 12% after 6 months of DMPA (P =.005). The log concentration in colony-forming units per milliliter of vaginal fluid of H(2)O(2)-positive Lactobacillus decreased in a linear manner from 4. 0 +/- 0.6 at baseline to 2.5 +/- 0.6 after 6 months of DMPA use (P =. 006). The mean number of cell layers in the epithelium was reduced slightly from 28.1 +/- 0.7 to 25.9 +/- 0.9 (P =.05), epithelial thickness decreased from 1.02 +/- 0.04 mm to 0.89 +/- 0.05 mm (P =. 005), and the glycogen-positive thickness decreased from 0.81 +/- 0. 04 mm at baseline to 0.66 +/- 0.05 after 6 months of DMPA use (P =. 005).
  
  
  CONCLUSIONS
  Depomedroxyprogesterone acetate produced a systemic hypoestrogenic state associated with decreased H(2)O(2)-positive Lactobacillus colonization and slight thinning of the glycogen vaginal epithelial layer. Such changes possibly compromise the vaginal barrier to infection.
authors.affiliation: Departments of Obstetrics and Gynecology, University of Washington, Seattle 98195-6460, USA.
authors.forename: L
authors.initials: L
authors.lastname: Miller
authors.forename: D L
authors.initials: DL
authors.lastname: Patton
authors.forename: A
authors.initials: A
authors.lastname: Meier
authors.forename: S S
authors.initials: SS
authors.lastname: Thwin
authors.forename: T M
authors.initials: TM
authors.lastname: Hooton
authors.forename: D A
authors.initials: DA
authors.lastname: Eschenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D015169:Colony Count, Microbial; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004848:Epithelium / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D004967:Estrogens / Q000172:deficiency*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D007778:Lactobacillus / Q000187:drug effects; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D014621:Vagina / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology
chemical_list: D003271:Contraceptive Agents, Female; D004967:Estrogens; D017258:Medroxyprogesterone Acetate