Vaginal estrogen supplementation during Depo-Provera initiation: a randomized controlled trial

Area of Science:

• Reproductive Health
• Contraception
• Endocrinology

Background:

• Irregular bleeding is a primary reason for discontinuing depot-medroxyprogesterone acetate (DMPA) after the first injection.
• Estrogen supplementation at DMPA initiation may mitigate bleeding issues and enhance treatment adherence.

Purpose of the Study:

• To evaluate the efficacy and acceptability of estrogen supplementation during DMPA initiation.
• To assess the impact of vaginal estrogen on bleeding patterns and continuation rates of DMPA.

Main Methods:

• A prospective, randomized controlled trial was conducted.
• Participants initiating DMPA were randomized to receive either an estradiol vaginal ring for 3 months or DMPA alone.
• Bleeding patterns, continuation rates, and ring acceptability were assessed via diaries and questionnaires.

Main Results:

• The median number of bleeding/spotting days was lower in the estrogen ring group (16 days) compared to the DMPA alone group (28 days), though not statistically significant (p=.19).
• Continuation rates for a second injection were 77% in the intervention group versus 70% in the control group (p=.56).
• Each additional day of bleeding/spotting reduced the likelihood of receiving a second injection by 3% (OR 0.97).

Conclusions:

• Vaginal estrogen supplementation is an acceptable option for women initiating DMPA.
• Estrogen supplementation shows potential in reducing overall bleeding experienced by DMPA users.