Combination injectable contraceptives for contraception

In trials of combined injectable contraceptives versus progestogen-only contraceptives, the former had lower rates of early discontinuation due to amenorrhea or other bleeding disturbances, but had higher rates of discontinuation due to other reasons. Overall, combined injectable contraceptives appear to be more acceptable than progestogen-only injectables.

RHL Commentary by Biran Affandi

EVIDENCE SUMMARY

This review aimed to assess the contraceptive efficacy, bleeding patterns, discontinuation, user preferences, and side-effects of combination injectable contraceptives. The included trials had compared combination injectables with either progestogen-only methods or the intrauterine device (IUD).

The 25 mg depot-medroxyprogesterone acetate (DMPA) + 5 mg estradiol cypionate (E2C) and 50 mg norethisterone enantate (NET-EN) + 5 mg estradiol valerate (E2V) combinations had higher rates of cyclical (regular) bleeding, less amenorrhoea and fewer infrequent bleeding pattern than only150 mg DMPA and 200 mg NET-EN, respectively. Women using 150 mg DMPA were more likely to discontinue for amenorrhoea or bleeding problems. In contrast, women using 25 mg DMPA + 5 mg E2C were more likely discontinue early for 'other medical' reasons. Women using the 50 mg NET-EN + 5 mg E2V combination had higher rates of cyclical (regular) bleeding and lower rates of infrequent bleeding patterns compared with progestogen-only contraceptive, 200 mg NET-EN.

Life-table analysis found no difference in the overall discontinuation rates between the combination injectables 25 mg DMPA + 5 mg E2C and 50 mg NET-EN + 5 mg E2V.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References

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This document should be cited as: Biran Affandi. Combination injectable contraceptives for contraception: RHL commentary (last revised: 20 February 2006). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com