Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial.
To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months.



In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months.



From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P=.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment.



Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.



ClinicalTrials.gov, https://clinicaltrials.gov, NCT01902485.
Gynuity Health Projects, New York, New York; the Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Secretariat of Health, Mexico City, Mexico; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Planned Parenthood of the Pacific Southwest, San Diego, California; Planned Parenthood of Southern New England, New Haven, Connecticut; Planned Parenthood Northern California, San Rafael, California; the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and Johns Hopkins University, Baltimore, Maryland.
Elizabeth G
EG
Raymond
Mark A
MA
Weaver
Karmen S
KS
Louie
Yi-Ling
YL
Tan
Manuel
M
Bousiéguez
Ana Gabriela
AG
Aranguré-Peraza
Elba M
EM
Lugo-Hernández
Patricio
P
Sanhueza
Alisa B
AB
Goldberg
Kelly R
KR
Culwell
Clair
C
Kaplan
Lisa
L
Memmel
Sarita
S
Sonalkar
Roxanne
R
Jamshidi
Beverly
B
Winikoff
D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D015735:Mifepristone / Q000008:administration & dosage*; D017060:Patient Satisfaction; D011247:Pregnancy; D018873:Pregnancy Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000021:Abortifacient Agents, Steroidal; D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D015735:Mifepristone; D017258:Medroxyprogesterone Acetate