Effect of pretreatment counseling on discontinuation rates in Chinese women given depo-medroxyprogesterone acetate for contraception

doi:10.1016/0010-7824(96)00085-6

Contraception

Volume 53, Issue 6, June 1996, Pages 357-361

https://doi.org/10.1016/0010-7824(96)00085-6 Get rights and content

Abstract

The study examined the effect of pretreatment counseling upon discontinuation of 150 mg depo-medroxyprogesterone acetate (Depo-Provera^® (DMPA)), given for contraception. A total of 421 chinese women participated, 204 receiving detailed structured pretreatment and ongoing counseling on the hormonal effects and probable side effects of DMPA and 217 receiving only routine counseling. The primary study endpoint was termination rate; secondary endpoints were frequency of medical events and reasons for termination.

Study termination rates were significantly lower in the intensive structured counseling group than in the routine counseling group. At one year, the total cumulative termination rates were 11% ( $23204$ ) and 42% ( $92217$ ), respectively (p < 0.0001). The most common reasons for terminating DMPA were menstrual changes. No pregnancy, serious or unexpected medical events were reported, nor were statistically or clinically significant changes in vital signs observed. We conclude that pretreatment counseling on expected side effects increases the acceptability of DMPA.

References (10)

KT Kirton et al.
Return of ovulatory cyclicity following an intramuscular injection of medroxyprogesterone acetate (Provera)
Contraception
(1974)
IS Fraser
A survey of different approaches to management of menstrual disturbances in women using injectable contraceptives
Contraception
(1983)
EM Belsey
Vaginal bleeding patterns among women using one natural and eight hormonal methods of contraception
Contraception
(1988)
DR Mishell
Long-acting contraceptive steroids. Postcoital contraceptives and antiprogestints
E Wilson
Injectable contraception
The Practitioner
(1988)

There are more references available in the full text version of this article.

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Counseling about combined hormonal contraceptive methods often does not include information about all available methods, or comprehensive information about side effects, benefits, or logistics of use. As this counseling can impact patient's satisfaction with and continuation of their chosen method of contraception, future work should focus on designing interventions to improve providers' ability to meet patients' needs.
Short acting hormonal contraception is widely used, but counseling for these methods often neglects key features. Comprehensive counseling about all methods and their individual features can improve contraceptive selection and use.
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Although over 70% of respondents indicated that the provider had asked or informed her about experiences with side effects, these aspects of information given were rated relatively lower in quality compared to other item responses and domains. Correspondingly, many women (~60%) reported side effects, especially irregular bleeding, as the main reason they discontinued DMPA-SC, which is consistent with other studies in Nigeria on the influence of side effects on continuing a variety of different methods, as well as studies of DMPA-related side effects and continuation [33,34,45]. However, it should be noted that women in our study were only surveyed after two injections spanning up to 6 months of protection against pregnancy; this short follow-up time frame may not have been sufficient for many women to experience side effects associated with long-term use of DMPA, such as amenorrhea [46].
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From March to August, 2016, we conducted phone interviews with a convenience sample of women obtaining DMPA-SC from selected providers to survey them about their experience obtaining an initial dose of DMPA-SC. Study coordinators contacted women again about 3 months later after when they were due for reinjection. We used logistic regressions to examine the likelihood of having obtained a subsequent dose of DMPA-SC at follow-up as predicted by sociodemographic characteristics, a quality of counseling indicator based on responses to a 14-item scale, and reports of side effects experienced.
Of the 541 DMPA-SC users who completed the first survey, 311 were reached again via phone after 3 months to conduct a second survey. Multivariate results for sociodemographic predictors of continued DMPA-SC use show that those with some college education or more (OR=2.79; 95% CI: 1.09–7.14), and those with four or more children (OR=2.89; 95% CI: 1.09 0 7.67) were more likely to obtain another dose. Our summary quality measure showed that women overall rated the quality of their initial counseling session high. Logistic regressions indicated that higher quality during the initial counseling session is related to the likelihood of getting another dose of DMPA-SC (OR=2.04; 95% CI: 1.12–3.47) whereas experiencing more bleeding reduced the likelihood of continuation after 3 months (OR=0.15; 95% CI: 0.07–0.34).
Among urban Nigerian women, both counseling quality and experiencing side effects were important factors in predicting continued use of DMPA-SC after 3 months. These findings are consistent with previous studies of DMPA and injectable contraception continuation.
New contraceptive methods that are designed for increased access and ease of use, combined with high quality provision, have potential to increase contraceptive use in settings with low levels of contraceptive prevalence. Higher quality counseling can help encourage women's continuation of a new injectable contraceptive method at 3 months.
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Original research articleEffect of pretreatment counseling on discontinuation rates in Chinese women given depo-medroxyprogesterone acetate for contraception

Abstract

Contraception

Contraception

Contraception

Long-acting contraceptive steroids. Postcoital contraceptives and antiprogestints

Injectable contraception

The Practitioner

Original research article
Effect of pretreatment counseling on discontinuation rates in Chinese women given depo-medroxyprogesterone acetate for contraception