Elsevier

Contraception

Volume 72, Issue 2, August 2005, Pages 138-145
Contraception

Original research article
Comparative acceptability of combined and progestin-only injectable contraceptives in Kenya

https://doi.org/10.1016/j.contraception.2005.04.001Get rights and content

Abstract

Objective

We compared 12-month continuation rates, menstrual bleeding patterns and other aspects of acceptability between users of Cyclofem and users of Depo-Provera.

Methods

The life-table method was used to calculate quarterly continuation rates. In all, 360 Kenyan women were randomly assigned to one of the two contraceptives. User-satisfaction questionnaires were administered at 6 and 12 months or at discontinuation, whichever occurred first.

Results

The 1-year continuation rate was 75.4% for Depo-Provera users versus 56.5% for Cyclofem users (p<.001). Main reasons for discontinuation included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for Depo-Provera), menstrual changes (14.1% vs. 12.5%) and nonmenstrual problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of the Cyclofem users claimed frequency of visits as the main reason for discontinuation. In all, 70.6% of the Depo-Provera users were amenorrheic after 12 months, as were 20.8% of the Cyclofem users.

Conclusions

The 1-year continuation rate was higher for Depo-Provera than for Cyclofem. There was no important difference in discontinuation rates because of menstrual problems; the difference mainly reflected the frequency of visits required.

Introduction

Progestin-only injectable contraceptives are popular because of their relatively long duration of action (2 or 3 months), high efficacy, safety, convenience, privacy and reversibility and because they do not interfere with the spontaneity of intercourse. However, they also cause changes in menstrual bleeding patterns in most users, including amenorrhea and prolonged or irregular spotting/bleeding. Also, because progestin-only injectables are long acting, there may be a delay in the return of fertility. These factors can limit their acceptability, especially among young and low-parity women.

Injectable contraceptives containing both progestin and estrogen (combined injectables) were developed to provide better cycle control than progestin-only injectables. However, the greater frequency of injections required and the narrower window in which they must be scheduled (±3 days compared with ±2 or 4 weeks for progestin-only injectables) may be inconvenient for some users, and the monthly injections entail an increased workload for family planning providers.

In Kenya, the use of Depo-Provera, a progestin-only injectable, is well established and is one of the leading methods of contraception. As of 1998, it was used by 27% of married women of reproductive age who were using a modern family planning method [1]. In our previous study of Depo-Provera in Kenya, the 12-month continuation rate was 61%, and only 9% of discontinuations were due to menstrual changes [2]. The high acceptance of Depo-Provera in Kenya suggests that conditions are favorable for acceptance of combined injectables, which could provide an effective family planning option for Kenyan women concerned about menstrual changes or the time required to return to fertility.

The primary objective of this study was to compare 12-month continuation rates and menstrual bleeding patterns between users of Depo-Provera and users of Cyclofem, the combined injectable most widely used outside Kenya. A secondary objective was to compare menstrual bleeding patterns and other measures of acceptability for both methods.

Section snippets

Study design, dosing and population

The study was conducted at three sites: (1) a young adults' clinic in Nairobi; (2) a family planning clinic at Riruta (on the outskirts of Nairobi); and (3) a family planning clinic at Thika (in the Central Province). The young adults' clinic serves unmarried women aged between menarche and 25 years who have already carried a pregnancy to delivery or abortion; these young adults are not considered minors in Kenya. Eligible women were recruited from among clients seeking family planning services

Results

One hundred twenty participants from each site, for a total of 360 participants, were randomly assigned to receive either Cyclofem or Depo-Provera. All participants received the method randomly assigned at their first visit and therefore were included in the statistical analysis. Three participants, one in the Cyclofem group and two in the Depo-Provera group, who later were found not to meet one of the eligibility criteria after the study was ended were also included in the statistical analysis.

Discussion

In this 1-year comparative study, the continuation rates for Depo-Provera were significantly higher than those for Cyclofem at all time points measured. At the end of the year, the continuation rate for Depo-Provera was 75.4% compared with 56.5% for Cyclofem. The 12-month continuation rate for Depo-Provera in this study is comparable with that observed in a previous nonrandomized study also conducted in Kenya [2]. The 12-month continuation rate for Cyclofem is in the range reported in Cyclofem

Acknowledgments

Support for this study was provided by Family Health International (FHI) with funds from the Andrew W. Mellon Foundation, Department of Reproductive Health and Research of the WHO and the United States Agency for International Development (USAID) cooperative agreements CCP-A-00-95-00022-02, CCP-3079-A-00-5022-00, DPE-3041-A-00-0043-00 and DPE-0537-A-00-4047-00. The views expressed in this article do not necessarily reflect those of the Andrew W. Mellon Foundation, the WHO or the USAID. The FHI

Cited by (23)

  • Levonorgestrel loaded biodegradable microparticles for injectable contraception: Preparation, characterization and modelling of drug release

    2022, International Journal of Pharmaceutics
    Citation Excerpt :

    For decades, scientists have explored the entrapment of LNG within polymeric microparticles to sustain its release when injected and provide long-term contraception. The remarkable increase in injectable contraceptive users over years and the limitations of the currently available injectable validate the efforts of developing a long-acting formulation (Contraceptive Use by Method, 2019; Baumgartner, 2007; Ruminjo, 2005). We fabricate PLLA microparticles of different LNG loadings using a spray dryer and assess their physical characteristics such as particle size distribution, crystallinity, and drug release.

  • Effect of self-administration versus provider-administered injection of subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a randomised controlled trial

    2018, The Lancet Global Health
    Citation Excerpt :

    Although self-administration greatly increased continuation rates in our trial, more than a quarter of women in this group still discontinued early. Discontinuation rates in the provider-administered group were also higher than those reported in previous studies.1,5–8 Comparing discontinuation rates across different studies is challenging as the contexts, study designs, definitions of discontinuation events, and analysis methods often differ.

  • Towards the development of a longer-acting injectable contraceptive: Past research and current trends

    2015, Contraception
    Citation Excerpt :

    Previous research has demonstrated that injectable contraceptives with a longer interval between injections lead to better adherence and continuation rates when compared to those with shorter intervals. Ruminjo et al. showed that the 1-year continuation rate was higher for a 3-month injectable depot medroxyprogesterone acetate (DMPA) than for 1-month Cyclofem; the main difference stated by study participants was logistical difficulty in making frequent clinic visits [12]. South African researchers compared DMPA 150 mg given every 3 months and DMPA 450 mg given every 6 months and demonstrated a significantly better acceptability of the 6-month regimen due, primarily, to convenience and reduced travel costs [13].

  • Obesity and menstrual disorders

    2015, Best Practice and Research: Clinical Obstetrics and Gynaecology
    Citation Excerpt :

    Studies have shown that the contraceptive efficacy of the desogestrel-only pill (Cerazette) is not altered by weight [48]. In general, the effect on the progestogen injection on menstrual blood loss is very variable, with 30–100% of women noticing a decrease in their menstrual blood loss, and around 15–20% of women achieving amenorrhoea [49]. Studies looking into efficacy in obese women are limited to the primary outcome of contraceptive failure as an outcome of effectiveness, as opposed to looking at the effect on menstruation.

  • Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons

    2009, Contraception
    Citation Excerpt :

    Several studies only reported bleeding data as complaints given during follow-up visits [12,13] or as a reason for discontinuation [5,6,14,15]. Others did not use standard definitions or used intervals other than 90 days [16–20]. In one case, we could not extract the needed data since the information only appeared in figures [21].

View all citing articles on Scopus
View full text