Depot Medroxyprogesterone Acetate Use and the Development and Progression of Uterine Leiomyoma.

Abstract

OBJECTIVE:

Investigate the association between use of depot medroxyprogesterone acetate (DMPA) (an injectable progestin-only contraceptive) and leiomyoma development.

METHODS:

We conducted a cohort study in the Detroit, Michigan, area that involved four clinic visits at 20-month intervals over 5 years (2010-2018) and used a standardized ultrasonography protocol to prospectively measure leiomyomas 0.5 cm or more in diameter. Participants were 1,693 self-identified Black women aged 23-35 years with no prior leiomyoma diagnosis and no hysterectomy. For this substudy, years since last use of DMPA was ascertained from questionnaire data at every visit. Leiomyoma incidence was defined as the first visit with an observed leiomyoma among women who were leiomyoma-free at enrollment. Depot medroxyprogesterone acetate associations were examined with Cox models. Leiomyoma growth was calculated as the change in log-volume for leiomyomas matched at successive visits and was modeled using linear mixed models accounting for clustered data. Leiomyoma loss, defined as a reduction in leiomyoma number in successive visits, was modeled using Poisson regression. All models used time-varying exposure and covariates.

RESULTS:

Of participants with at least one follow-up visit (N=1,610), 42.9% had ever used DMPA. Participants exposed to DMPA within the previous 2 years experienced reduced leiomyoma development during the subsequent observation interval compared with never users, including lower leiomyoma incidence (5.2% vs 10.7%), adjusted hazard ratio 0.6 (95% CI 0.4-1.0), 42.0% lower leiomyoma growth (95% CI -51.4 to -30.7) and 60% greater leiomyoma loss (adjusted risk ratio 1.6, 95% CI 1.1-2.2). Excess leiomyoma loss was also seen for those who used DMPA 2-4 years before the visit compared with never users, 2.1-fold increase (95% CI 1.4-3.1).

CONCLUSION:

Recent use of DMPA was associated with reduced leiomyoma development and increased leiomyoma loss. Such changes in early leiomyoma development in young women could delay symptom onset and reduce the need for invasive treatment.

• Authors: Quaker E Harmon, Stacy A Patchel, Shanshan Zhao, David M Umbach, Tracy E Cooper, Donna D Baird
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 139 Issue 5 Pg. 797-807 (05 01 2022) ISSN: 1873-233X [Electronic] United States
• PMID: 35576339 (Publication Type: Journal Article, Research Support, American Recovery and Reinvestment Act, Research Support, N.I.H., Intramural)
• Copyright: Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government. Published by Wolters Kluwer Health, Inc.

Chemical References

• Contraceptive Agents, Female
• Delayed-Action Preparations
• Medroxyprogesterone Acetate
• Medroxyprogesterone

Topics

• Cohort Studies
• Contraceptive Agents, Female (adverse effects)
• Delayed-Action Preparations
• Female
• Humans
• Incidence
• Leiomyoma (chemically induced, drug therapy, epidemiology)
• Medroxyprogesterone
• Medroxyprogesterone Acetate (adverse effects)