Medroxyprogesterone Acetate Side Effects and Management

Introduction to Side Effects

Weight gain at 6 months is a strong predictor of future excessive weight gain with ongoing DMPA use 1
DMPA causes reductions in bone mineral density (BMD) 1
The FDA has issued a black-box warning about the risk of decreased BMD among DMPA users 1
Substantial recovery of BMD occurs after discontinuation of DMPA 1
Calcium intake (1300 mg daily) and vitamin D (600 IU daily) supplementation are recommended for all patients on DMPA 1

Women using DMPA should be monitored for signs of thromboembolism 2
ACOG does not advise limiting DMPA use to 2 years, recognizing the risk of unwanted pregnancy if contraceptive options are limited 1

When used in transgender care, progestins like medroxyprogesterone acetate can suppress testosterone levels via central feedback 3
Not recommended by the Endocrine Society for transgender care due to risk of breast cancer, thromboembolism, and stroke 3
Medroxyprogesterone acetate suppresses circulating androgen levels and pituitary gonadotropin levels in women with PCOS 4
Can be used to prevent endometrial cancer in women with PCOS, though optimal dosing and frequency are not established 4

Counseling before initiation about expected menstrual changes improves continuation rates 1
Regular monitoring of weight and discussing lifestyle modifications may help manage weight gain 1
Consider alternative contraceptive methods if significant weight gain occurs within first 6 months 1
Regular weight-bearing exercise is recommended 1
Calcium (1300 mg daily) and vitamin D (600 IU daily) supplementation 1

Thorough pre-treatment counseling about potential side effects significantly improves continuation rates 1
Schedule follow-up visits every 11-12 weeks for adolescents (rather than every 13 weeks) to allow for missed or delayed visits 1
Failing to counsel patients about expected menstrual changes before initiating DMPA 1
Not monitoring weight changes, especially during the first 6 months of use 1
Overlooking the importance of calcium and vitamin D supplementation for bone health 1