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Continuation Rates and Characteristics of Long-term Users

Sylvia W. Lim, MD; Jessica Rieder, MD; Susan M. Coupey, MD; Polly E. Bijur, PhD

Arch Pediatr Adolesc Med. 1999;153:1068-1072.

Objective  To identify continuation rates of depot medroxyprogesterone acetate (Depo-Provera) and characteristics of long-term users in a population of inner-city, minority adolescents with high pregnancy rates.

Design  Retrospective medical record review.

Setting  An inner-city adolescent clinic and an adolescent pregnancy program.

Methods  A review of the medical records of 250 females aged 13 to 20 years (mean±SD, 16.8±1.1 years), 62.9% Hispanic and 34.2% African American, receiving a first depot medroxyprogesterone acetate injection for contraception between August 1993 and June 1996 was conducted using a standardized form. The mean±SD age at menarche of the subjects was 11.6±1.4 years, and the mean±SD age at first intercourse was 14.1±1.3 years; the mean number of lifetime sex partners was 2.4. Of the subjects, 73.6% had used condoms, 32.0% used oral contraceptives, and none used implants. Of the 201 subjects for whom there were data in the medical records regarding prior fertility, 172 (85.6%) had been pregnant, and 145 (72.1%) had a child. Life table analysis was used to measure depot medroxyprogesterone acetate continuation rates and to compare subgroups of adolescents.

Results  Depot medroxyprogesterone acetate continuation rates were found to be 70.3% at 6 months, 48.3% at 9 months, 31.5% at 12 months, and 12.8% at 24 months. The most common reason for depot medroxyprogesterone acetate discontinuation was missed appointments (41.7%). Subjects were followed up for a mean±SD of 1.3±0.7 years after discontinuation of depot medroxyprogesterone acetate use; 46.7% became pregnant. Among those 156 adolescents who discontinued depot medroxyprogesterone acetate use, 40.0% restarted the method at some later time. Continuation of depot medroxyprogesterone acetate use was more likely if age at first intercourse was younger than 13 years (P=.04). Continuation rates were not related to age, ethnicity, age at menarche, number of sex partners, use of other contraceptives, prior pregnancy, or having a child.

Conclusions  In this study, just less than one third of the adolescents continued depot medroxyprogesterone acetate use for 1 year or longer. This suggests that depot medroxyprogesterone acetate does not function as a long-term method for most inner-city adolescents. The only characteristic that was associated with successful continuation of depot medroxyprogesterone acetate use was young age at first intercourse, implying that experience may be the main determinant of continuation.

From the Divisions of Ambulatory Pediatrics (Dr Lim), Adolescent Medicine (Drs Rieder and Coupey), and Epidemiology (Dr Bijur), and the Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.

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