The place in therapy of subcutaneous depot medroxyprogesterone acetate (DMPA‑SC) is likely to be as an alternative choice of administration method and route for DMPA.
A recent review of this product from the Faculty of Sexual and Reproductive Healthcare (FSRH) commented that DMPA–SC may be a preferable form of administration compared with intramuscular DMPA in women at risk of haematoma due to bleeding disorders or anticoagulation. The FSRH review also noted that it also has potential for self-administration, although it is not licensed for this indication.
The Sayana Press summary of product characteristics states that, because loss of bone mineral density (BMD) may occur in females of all ages who use DMPA‑SC long term, a risk/benefit assessment should be considered, which also takes into consideration the decrease in BMD that occurs during pregnancy and lactation. In particular, in women with significant lifestyle or medical risk factors for osteoporosis, other methods of contraception should be considered before using DMPA‑SC. Significant risk factors for osteoporosis include:
Alcohol abuse and/or tobacco use
Chronic use of drugs that can reduce bone mass, such as anticonvulsants or corticosteroids
Low BMI or eating disorder, such as anorexia nervosa or bulimia
Previous low trauma fracture
Family history of osteoporosis
In adolescents, use of DMPA‑SC is indicated only when other contraceptive methods are considered unsuitable or unacceptable, because of unknown long-term effects of bone loss associated with DMPA‑SC in the critical period of bone accretion.
The available data for usage of DMPA are based on prescribing analysis of the formulation for intramuscular administration. According to manufacturer estimates and extrapolation from prescribing data, about 227,000 woman-years of use was prescribed in primary care (such as GP practices) in England in 2012 (Pfizer, personal communication, 2013). In addition, in 2012/13, 83,900 women attending NHS contraceptive clinics in England (family planning clinics and clinics run by voluntary organisations such as Brook Advisory Centres) used injectable contraception (Health and Social Care Information Centre data); it might be that some women obtained their contraception from both sources.