USAID Guidance on Depo Study
According to a recently published study conducted by FHI researchers and colleagues, women using the injectable contraceptive depot-medroxyprogesterone acetate (DMPA) appear to have a three-fold increased risk of acquiring the sexually transmitted infections chlamydia and gonorrhea when compared to women not using a hormonal contraceptive.
The U.S. Agency for International Development (USAID), which jointly funded the study with the National Institute of Child Health and Human Development, has issued the following announcement in regard to this study:
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You should be aware of a study, published last week in the journal Sexually Transmitted Diseases, that found an association between use of depot-medroxyprogesterone acetate (DMPA or Depo-Provera) and the risk of acquiring chlamydial or gonococcal infections (a three-fold increased risk). This study was jointly funded by the U.S. Agency for International Development and the National Institute of Child Health and Human Development. It follows two recently published but less well-designed studies that found an increased risk of chlamydial, but not gonococcal, infections among DMPA users.
While of concern, in the view of GH/PRH technical staff, this new research does not call for changes in the provision or use of DMPA. Notably, there is no increased risk of infection for women who remain in monogamous relationships with uninfected partners. The research findings do underscore the continuing need to counsel DMPA users who are not in a mutually monogamous relationship with an uninfected partner that they should limit their number of sexual partners and use condoms correctly and consistently with each sexual act.
In summary, the results of the present study:
- Should be taken seriously, but do not call for change in the provision of DMPA.
- Are of no concern for DMPA users who know that they are in mutually faithful monogamous relationships with an uninfected partner and thus face no risk of acquiring a sexually transmitted infection (STI).
- Are of little concern for DMPA users who use condoms consistently and correctly, since such condom use only rarely fails to provide protection.
- Reinforce the need for all women at STI risk (including any married woman who is unsure of the faithfulness of her partner) to use latex condoms consistently and correctly. This long-accepted recommendation remains unchanged regardless of the method of contraception a woman uses.
- Provide women and their partners with important, new knowledge about making contraceptive choices that are appropriate for their individual situations and best for their overall reproductive health. Sexually active women who choose to use DMPA need to remember that this method is safe and highly effective for preventing unintended pregnancy, but that only consistent condom use and mutually monogamous relationships among uninfected individuals protect against STIs.
- Offer an opportunity for providers to emphasize contraceptive choice. If a woman decides to discontinue DMPA use, a provider should emphasize the other contraceptive options available to her.
Further details:
The study compared three groups of women: those starting oral contraceptives, those starting DMPA injections, and those who did not use hormonal contraceptives. No significant increase in risk of chlamydial or gonococcal infections was found for users of oral contraceptives containing both estrogen and progestin, although a moderate increase in risk associated with oral contraceptive use could not be ruled out.
The study had the strengths of being prospective and carefully designed to assess various sexual risk factors. However, women were not randomized to contraceptive method, and the possibility remains that women using DMPA were different in some ways from the control group, many of whom were not using contraception. Moreover, while the results were highly statistically significant, there could have been some role of chance in the finding. This is because the elevation in risk was based on a total of 12 cases of gonorrhea or chlamydia among DMPA users.
It is also important to note that 77 percent of the 819 women participating in the study conducted in Baltimore and Towson, Maryland, USA, were single. Study results may not apply to married women who comprise the large majority of women seen in family planning clinics in the developing world. However, any married woman who is unsure of the faithfulness of her partner should consider herself at risk of acquiring an STI, and that risk may be heightened if she is a DMPA user.
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Links for further information about hormonal contraception and sexually transmitted infections, including HIV, can be found below.
NICHD press release, available at:
http://www.nichd.nih.gov/new/releases/depo-provera-risk.cfmOverview of the latest research related to hormonal contraception and HIV, available at:
http://www.fhi.org/en/RH/Pubs/booksReports/hcandhiv.htmNetwork 22(3): "Hormonal Contraception and STIs", available at:
http://www.fhi.org/en/RH/Pubs/Network/v22_3/NWvol22-3concptiveSTIs.htmFor additional information about this study, please contact: news@fhi.org
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