Long-term use of contraceptive depot medroxyprogesterone acetate in young women impairs arterial endothelial function assessed by cardiovascular magnetic resonance.
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.


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 (>1 year use; mean age 29+/-4 years) and in 10 controls (mean age 30+/-4 years, P=0.25) with regular menstrual cycles after validation of the technique. FMD and GTN responses were measured just before repeat MPA injection and 48 hours later (n=12) in DMPA users and during menstruation and midcycle (n=9) 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 P<0.01) without differences in GTN responses. S-estradiol levels in DMPA users were significantly lower than in controls during menstruation (58 versus 96 pmol/L, P<0.01). High levels of circulating MPA 48 hours after injection were not linked to an additional impairment in FMD (2.0% versus 3.1%, P=0.23). Estradiol levels were significantly correlated to FMD (r=0.43, P<0.01).


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.
Sorensen
Morten B
MB
Cardiovascular MR Unit, Royal Brompton Hospital, London, UK.
Collins
Peter
P
Ong
Paul J L
PJ
Webb
Carolyn M
CM
Hayward
Christopher S
CS
Asbury
Elizabeth A
EA
Gatehouse
Peter D
PD
Elkington
Andrew G
AG
Yang
Guang Z
GZ
Kubba
Ali
A
Pennell
Dudley J
DJ
D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced / Q000150:complications; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D005996:Nitroglycerin; D012016:Reference Values; D015203:Reproducibility of Results; D013995:Time; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000139:chemically induced* / Q000150:complications / Q000503:physiopathology; D014666:Vasomotor System / Q000187:drug effects* / Q000503:physiopathology
D003692:Delayed-Action Preparations; D004958:Estradiol; D017258:Medroxyprogesterone Acetate; D005996:Nitroglycerin