title: Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously.
abstract: BACKGROUND
  Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the extremely obese population (BMI >or=40 kg/m(2)). The purpose of this 26-week prospective experimental study was to determine incidence of ovulation and follicular development among women with Class 1, 2 and 3 obesity after receiving DMPA-SC.
  
  
  METHODS
  Five normal-weight, five Class 1-2 obese, and five Class 3 obese women received subcutaneous injections of 104 mg DMPA-SC at baseline and 12 weeks later. Weekly progesterone levels, bimonthly estradiol (E(2)), and monthly medroxyprogesterone acetate (MPA) levels were measured by immunoassay methods for a total of 26 weeks in each subject.
  
  
  RESULTS
  Ovulation did not occur in any subject more than 1 week after the first injection. There was large intersubject and intrasubject variability in E(2) levels, and fluctuating E(2) levels were more frequent among obese women than normal-weight women. Median MPA levels remained above the level needed to prevent ovulation but, compared with normal-weight subjects, were lower among Class 1-2 obese and lowest among Class 3 obese subjects.
  
  
  CONCLUSIONS
  Fluctuating E(2) levels reflective of follicular development occurred more often among Class 1, 2 and 3 obese women than normal-weight women after DMPA-SC injections. Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation. Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women.
authors.affiliation: Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. psegall@usc.edu
authors.forename: Penina
authors.initials: P
authors.lastname: Segall-Gutierrez
authors.forename: DeShawn
authors.initials: D
authors.lastname: Taylor
authors.forename: Xinwen
authors.initials: X
authors.lastname: Liu
authors.forename: Frank
authors.initials: F
authors.lastname: Stanzcyk
authors.forename: Stanley
authors.initials: S
authors.lastname: Azen
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Mishell
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000097:blood; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D007118:Immunoassay; D007279:Injections, Subcutaneous; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000097:blood; D009765:Obesity / Q000097:blood / Q000503:physiopathology; D009767:Obesity, Morbid / Q000097:blood / Q000503:physiopathology*; D006080:Ovarian Follicle / Q000187:drug effects* / Q000502:physiology; D010060:Ovulation / Q000097:blood / Q000187:drug effects*; D034445:Ovulation Inhibition / Q000097:blood / Q000187:drug effects; D011374:Progesterone / Q000097:blood; D011372:Progestins / Q000008:administration & dosage* / Q000097:blood; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D011372:Progestins; D011374:Progesterone; D004958:Estradiol; D017258:Medroxyprogesterone Acetate