Singata-Madliki, M., Hofmeyr, G. J., & Lawrie, T. A. (2016). The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial. The journal of family planning and reproductive health care, 42(3), 171-176. https://doi.org/10.1136/jfprhc-2015-101334
Singata-Madliki M, Hofmeyr GJ, Lawrie TA. The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial. J Fam Plann Reprod Health Care. 2016;42(3):171-176. doi:10.1136/jfprhc-2015-101334
Singata-Madliki, M., et al. "The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial." The journal of family planning and reproductive health care, vol. 42, no. 3, 2016, pp. 171-176.
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Deputy Director, Effective Care Research Unit (ECRU), Eastern Cape Department of Health, East London Hospital Complex, Universities of the Witwatersrand and Fort Hare, East London, South Africa05fnafm06
Linked to ROR, the Research Organization Registry
Abstract
Background
Depot medroxyprogesterone acetate (DMPA) is the most commonly used hormonal contraceptive method in South Africa. It is frequently administered in the immediate postnatal period, yet it is unclear whether it affects the risk of postnatal depression (PND).
Aim
To determine whether DMPA increases the risk of PND compared with the copper-containing intrauterine device (IUD) when administered after delivery.
Design and Setting
A single-blind randomised controlled trial conducted at two teaching hospitals in East London, South Africa.
Methods
Eligible, consenting women (N=242) requiring postnatal contraception were randomised to receive DMPA or an IUD within 48 hours of childbirth and interviewed at 1 and 3 months postpartum. Depression was measured using the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Resumption of sexual intercourse, menstrual symptoms and breastfeeding rates were also assessed.
Results
One-month EPDS depression scores were statistically significantly higher in the DMPA arm compared with IUD arm (p=0.04). Three-month BDI-II scores were significantly higher in the DMPA arm than in the IUD arm (p=0.002) and, according to the BDI-II but not the EPDS, more women in the DMPA arm had major depression at this time-point (8 vs 2; p=0.05). There were no statistically significant differences in other outcome measures except that fewer women had resumed sexual activity by 1 month postpartum in the DMPA arm (13% vs 26%; p=0.02).
Conclusions
The possibility that immediate postnatal DMPA use is associated with depression cannot be excluded. These findings justify further research with longer follow-up.
Singata-Madliki M et al., 2021·Int J Gynaecol Obstet·Free full text on PubMed Central
To compare the effects of depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel (LNG) implant, and copper intrauterine device (IUD) on mood and sexual function. At the Effective Care Research Unit in South Africa, women already randomized in the ECHO Trial to the three methods were asked to participate in this study. Participants were interviewed at 3 and 12 months after enrollment using the Beck Depression Inventory and Arizona Sexual Experiences Scale, and at 12 months using the WHO-5 Wellbeing Index and the Patient Global Impression scale. A total of 605 women participated. There was little difference in depression at 3 months across the three study groups. Contrary to our hypothesis, at 12 months, depression was lowest among DMPA-IM users (16/167, 9.6%) and highest among IUD users (28/158, 17.7%) (p = 0.032). There was little difference in sexual function at any time-point. More women in the DMPA-IM group felt "very much better" on the PGI scale than in the IUD and LNG implant groups (p = 0.003). Depression may be less likely with DMPA-IM than with the other methods 1 year after initiation. Major differences in sexual functioning are unlikely. Unhappiness related to not using DMPA-IM, the most popular method in our setting, may have skewed results. PACTR201706001651380.
Depot medroxyprogesterone acetate (DMPA) is commonly prescribed to women immediately postpartum due to its efficacy, convenience and lack of estrogen. It is unclear whether administering a progestin injection can affect the course of postpartum depression (PPD), which some suspect to be influenced by hormonal changes. In this retrospective study, the objective was to determine whether DMPA administered immediately postpartum influences the development of PPD. A retrospective review of a total of 404 charts was conducted of clinic patients who were scheduled for 6-week postpartum visits at a major medical center, where all patients are routinely asked to complete the Edinburgh Postnatal Depression Scale (EPDS). The average scores on the EPDS at these visits were compared between patients who had received DMPA prior to postpartum discharge from the hospital and patients who had not received any hormonal contraception by using an unpaired t test. In addition, the proportions of women diagnosed with PPD via the scale were compared via contingency tables. Fifty-five women who had received immediate DMPA were compared with 192 women with no hormonal contraception after delivery. The groups were similar in parity, race, mode of delivery and weight, but women receiving DMPA were significantly younger (24.2 vs. 26.2 years, p=.03). Mean EPDS scores at 6 weeks postpartum were not statistically significant between the groups (5.02 vs. 6.17, p=.16). Six patients (10.9%) who received immediate DMPA were diagnosed with PPD based on EPDS scores greater than or equal to 13, while 27 (14.1%) in the comparison group had PPD (p=.88). Administration of DMPA in the immediate postpartum period does not appear to predispose women to PPD.
Studies have demonstrated an association between hormonal contraception use with subsequent depression and antidepressant use. This association has not been assessed among postpartum women. This study is a secondary analysis of insurance records from 75,528 postpartum women enrolled in the US military medical system, who delivered between October 2012 and September 2014. Our analyses excluded women who used antidepressants or had a diagnosis of depression in the 24months prior to delivery. We assessed the relationship of hormonal contraception use with subsequent antidepressant use or diagnosis with depression in the first 12months postpartum using Cox proportional hazards regression, with a time dependent covariate measuring exposure to hormonal contraception. Antidepressants were prescribed to 7.8% of women and 5.0% were diagnosed with depression. In multivariable analysis adjusting for demographics, both antidepressant use and diagnosis with depression were associated with: younger age, lower socioeconomic status, and a history of military service. Compared to women with no hormonal contraceptive use, use of etonogestrel containing contraception was associated with a higher risk of antidepressant use (Implant: adjHR:1.22(95%CI:1.06-1.41), p<0.001; Ring:1.45(1.16-1.80), p=0.001). Use of norethindrone-only pills was associated with a lower risk of antidepressant use (0.58(0.52-0.64), p<0.001) and depression diagnosis (0.56(0.49-0.64), p<0.001). Use of a levonorgestrel intrauterine system was associated with a lower risk of depression diagnoses (0.65(0.52-0.82), p<0.001). The risk of major depression diagnosis and antidepressant use in the postpartum period varies with the type of hormonal contraception used. Further research is required to describe the mechanisms of these relationships.
Comparative Studies · Contraception Versus Fertility Awareness
Hagh Mohammadi-Pasand S et al., 2020·Nursing Practice Today·Free to read
Background & Intrauterine device and depo-medroxyprogesterone acetate are among the most effective reversible contraception in the world, still few consensuses exist about sexual and mood changes of these two conventional methods. The present study has compared the sexual satisfaction and depression level in these two methods.
Methods & A cross-sectional study was conducted between August 2017 and January 2018, in 300 married women aged 19-50 year, in Tehran, Iran. One hundred and fifty IUD users and 150 DMPA consumers, 12-18 months after starting the current method, recruited to the study from 34 health centers of Tehran University of Medical Sciences by convenience sampling. Two standard questionnaires of Index of sexual satisfaction (ISS) and Patient Health Questionnaire (PHQ) were used for assessing sexual satisfaction and depression, respectively. Chi-square and independent t-test were used for the homogeneity of the two groups. The linear logistic regression analysis was conducted to estimate the strength of associations.
There was not any significant difference between two groups in demographic characteristics such as age, marriage duration, education level, number of children and breastfeeding condition (P>0.05). Significantly higher sexual satisfaction (P<0.001) and lower depression level (P<0.001) reported in IUD users than DMPA consumers in the t-test. A multivariate regression confirmed that sexual satisfaction increased 6.4 scores in the IUD group in comparison to DMPA users (P= 0.003, B= -6.4), and with increase 1 year to duration of the marriage, sexual satisfaction increase 0.33 score. For depression, the only significant variable was the contraceptive methods, and depression level increase 1.24 scores in DMPA users than IUD consumers. (P=0.006, B= - 1.24). Although in univariate analysis, some variables showed effects on sexual satisfaction and depression, multivariate regression results did not confirm any significant relationships.
Both sexual satisfaction and mood level was higher among IUD users. This paper reconfirmed that IUD is a preferable method in women who are eligible to use both methods.
As the HIV/AIDS epidemic continues to spread in Africa and Asia, use of the injectable contraceptive steroid DMPA is widespread and has been increasing. Since studies dating back to 1992 have suggested that DMPA may increase the transmission of HIV to women, we endeavored to determine if the extant epidemiological and biological evidence is sufficient to conclude that DMPA use constitutes a definite hazard to women's health. We searched Medline using the search terms: contraceptives or contraception AND HIV and searched bibliographies of articles thus identified. We included in the meta-analysis all studies examining the association between use of DMPA (or injectable contraceptives comprising mostly DMPA) and the presence (cross-sectional studies, n = 8) or acquisition (longitudinal studies, n = 16) of HIV+ status in women, using a random effects models to estimate odds ratios (ORs; cross-sectional studies) and hazard ratios (HRs; longitudinal studies). Studies were excluded if the comparison group included women using any form of steroidal contraception. Statistically significant positive associations between DMPA use and HIV positivity were observed both in cross-sectional (OR = 1.41, 95% CI 1.15 - 1.73) and longitudinal studies (HR = 1.49, 95% CI 1.28 - 1.73). The biological plausibility of increased vulnerability to HIV infection due to progestational action (via thinning of the vaginal epithelial barrier and immunosuppression) as well as glucocorticoid agonistic immunosuppression, are discussed. The epidemiological and biological evidence now make a compelling case that DMPA adds significantly to the risk of male-to-female HIV transmission.
Postpartum › Mental Health › Postpartum Depression · Contraception › Adverse Effects › Mood and Libido · Therapeutics › Hormonal Agents › Progesterone and Progestins
G Justus Hofmeyr, Theresa A Lawrie, Mandisa Singata-Madliki
T Lawrie, M Singata-Madliki
PMID 27030698 27030698 DOI 10.1136/jfprhc-2015-101334 10.1136/jfprhc-2015-101334 Singata-Madliki et al. 2016, Singata-Madliki 2016
Cite this article
Singata-Madliki, M., Hofmeyr, G. J., & Lawrie, T. A. (2016). The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial. The journal of family planning and reproductive health care, 42(3), 171-176. https://doi.org/10.1136/jfprhc-2015-101334
Singata-Madliki M, Hofmeyr GJ, Lawrie TA. The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial. J Fam Plann Reprod Health Care. 2016;42(3):171-176. doi:10.1136/jfprhc-2015-101334
Singata-Madliki, M., et al. "The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial." The journal of family planning and reproductive health care, vol. 42, no. 3, 2016, pp. 171-176.
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