A new study confirms that DMPA immediately postpartum will not affect lactation, despite the WHO’s ‘theoretical concerns’.
Women who have depot medroxyprogesterone acetate (DMPA) injections within 48 hours of giving birth do not experience delayed lactation, new research shows.
The US researchers found that the mean time to lactogenesis II was 5.5 hours shorter for women who had DMPA compared with women in the control group – a difference that was not statistically significant, the researchers said.
The randomised study included 166 participants, including 63 who initiated DMPA before discharge from hospital and 103 controls.
The mean time to lactogenesis II was 57.8 hours in the immediate postpartum DMPA group and 64.1 hours in the control group.
“We found no evidence to indicate that immediate postpartum use of DMPA interfered with LS-II,” the researchers said in Contraception.
“Given the importance of DMPA use globally to prevent closely spaced pregnancy, these findings can be used to support policies on the use of DMPA among those intending to feed their infant human milk.”
Australian sexual health physician Dr Terri Foran said the research confirmed current clinical practice.
“It’s a small study that reinforces what most people in most parts of the world are doing anyway,” Dr Foran, a conjoint senior lecturer at the University of NSW, told TMR.
“I don’t think anybody these days really believes much any more that progesterone or progesterone-only contraceptives make any difference to things like establishing lactation, infant growth or thriving.
“It’s a nice bit of extra information that lets us know that what we’ve been doing for probably the best part of 10 years is based in good clinical practice.”
The researchers said there were “theoretical concerns” that progestin could interfere with lactogenesis stage II, which is why the World Health Organization advises against progestin-only injectables during the first six weeks after birth.
“In contrast, the US Centers for Disease Control and Prevention recommends that progestin-only injectables generally can be started immediately postpartum on the grounds that their known advantages outweigh their unknown risks.”
Dr Foran said Australia followed the UK’s Faculty of Sexual & Reproductive Healthcare guidelines on contraception and according to those guidelines, the benefits of DMPA generally outweighed the risks. The WHO’s eligibility criteria for contraception were a few years older than the UK’s, she said.
DMPA (Depo-Provera or Depo-Ralovera) was not widely used as a contraceptive method in Australia but was more popular in indigenous populations, Dr Foran said.
Needing an injection every three months “doesn’t suit everyone”, and DMPA also took a long time to be reversed, she said.
“It takes a good 12 months after your last injection before your periods kick back in again, so it’s not a great method for somebody who might be thinking about having another baby in a few years.”
Dr Foran said DMPA also “profoundly suppresses bone growth”, making it unsuitable for young women who are yet to attain their peak bone mass or for perimenopausal women who need to maintain their bones before menopause.
“It’s an excellent method of contraception for a lot of women, but there are also large groups of women that it just doesn’t suit.”
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Dr Foran said DMPA was a good choice for women who could not use contraception containing oestrogen, such as women with a history of blood clots or those whose migraines worsen with the combined contraceptive pill.
DMPA was also suitable for someone who preferred contraception that didn’t involve a surgical procedure and for people who wanted a bridging method of contraception, she said.
“If you’re not quite sure whether you want to have an IUD or … an implant, you can use this as an effective method of contraception while you’re making that decision. As a bridging method of contraception, there are few things that are better.
“Like any other method of contraception, it has its pros and cons, and whenever you’re discussing contraception with someone, it’s a really individualised choice with that particular person sitting in front of you.
“[You’re in] what I like to call the contraceptive cafeteria, a whole range of different options, and then you’re assisting that woman to go through those options, ticking some off and crossing some off the list.
“At the end of it, hopefully you can find something that ticks most of the boxes for that particular woman.”
Dr Foran said some patients were concerned by reports last year of an increased risk of meningioma in women who had DMPA injections.
“I don’t want to overplay it, because that risk is tiny. The background risk is small, this increases it a little bit, so double a tiny risk is still a tiny risk.
“But some patients have been expressing a bit of concern they might be using something that has that as an additional risk above and beyond just the contraceptive needs.”
The researchers said an estimated 49% of women in low and middle-income countries did not want another pregnancy in their first year postpartum but were not using highly or moderately effective contraception.
