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  • Title: Use of depot medroxyprogesterone acetate contraception in adolescents.
    Author: Davis AJ.
    Journal: J Reprod Med; 1996 May; 41(5 Suppl):407-13. PubMed ID: 8725703.
    Abstract:
    More than 1 million teen pregnancies occur each year in the United States. DMPA offers several distinct advantages over other contraceptive methods in adolescents. The duration of effectiveness and convenience of DMPA are appealing to teens. Most teens who are current users view amenorrhea as a positive feature of DMPA. Although most young women are able to tolerate the irregular bleeding, some find the cycle disruption concerning. Satisfaction rates among adolescent DMPA users is high. This literature review looks at the experience of US adolescent females with the injectable contraceptive depot medroxyprogesterone acetate (DMPA). The fact that unwanted teenage pregnancies in the US exceed a million each year indicates that sexually active teens in the US are poor contraceptors and could benefit from DMPA injections. The published reports indicate that adolescents who choose DMPA are satisfied with the method, especially since it does not require a daily activity. The most common reasons cited by those who discontinued use were bleeding problems and weight gain/appetite increase. Adolescents tend to choose (or be offered) DMPA after experiencing an unplanned pregnancy. They choose the method because of its convenience and longterm protection and because they had problems with previous methods. Clinicians may be concerned that teenagers will fail to return for reinjections, but the need for regular follow-up has not been cited by teenagers as a problem. A review of real or perceived side effects in adolescents indicates that adolescents tolerate amenorrhea very well, although prospective surveys indicate that adolescents have concerns about menstrual alterations caused by contraception. Studies of weight gain with DMPA use in adolescents are inconclusive, but it is possible that increased appetite may occur. Depression and fatigue are difficult to study in adolescents who may experience the symptoms because of other factors in their lives. Studies need to be undertaken to determine the longterm effects on bone mineral density and lipid metabolism in adolescents using DMPA. In order to overcome the barriers to DMPA use in teenagers, health care providers must be educated about the benefits of the method and must be able to use interactive counseling techniques which include devising a plan for follow-up and providing information on preventing sexually transmitted diseases.
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