Vaginal estrogen supplementation during Depo-Provera initiation: a randomized controlled trial.
BACKGROUND
Irregular bleeding is often cited as the reason for discontinuation of depot-medroxyprogesterone acetate (DMPA) after the first injection. Estrogen supplementation during DMPA initiation may decrease bleeding and improve continuation.


METHODS
This prospective, randomized, controlled trial evaluated estrogen supplementation during DMPA initiation. Women initiating DMPA were randomized to receive an estradiol vaginal ring for 3 months versus DMPA alone. Bleeding diaries and questionnaires at three and 6 months assessed bleeding, continuation and ring acceptability.


RESULTS
Seventy-one participants enrolled; 49 completed the first follow-up period. The median number of bleeding or spotting days was 16 in the estrogen ring group (n=26) versus 28 in the DMPA alone group (n=23) (p=.19). Seventy-seven percent of the intervention group received a second injection compared with 70% in the DMPA alone group (p=.56). For each additional day of bleeding and/or spotting reported, women were 3% less likely to receive a second injection (OR 0.97, 95% CI 0.94-0.99). Acceptability of the vaginal ring was high among those in the intervention group.


CONCLUSIONS
Vaginal estrogen supplementation during DMPA initiation is acceptable to women and may decrease total bleeding.
Dempsey
Angela
A
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA. dempsear@musc.edu
Roca
Claudia
C
Westhoff
Carolyn
C
D000282:Administration, Intravaginal; D000328:Adult; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D017060:Patient Satisfaction; D011446:Prospective Studies
D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004967:Estrogens; D017258:Medroxyprogesterone Acetate