Management of Clinical Side Effects of Depot Medroxyprogesterone Acetate

The document discusses the management of side effects associated with the use of depot medroxyprogesterone acetate (DMPA), a popular contraceptive method among adolescents. The three main side effects addressed are menstrual changes, weight gain, and hair loss. Menstrual changes, particularly irregular bleeding, are the primary reason for DMPA discontinuation. The authors suggest that providing anticipatory guidance about these changes can improve continuation rates, noting that over 50% of users will experience amenorrhea by the end of the first year. Weight gain is the second most common reason for discontinuation, with studies showing conflicting results regarding its significance. The authors emphasize the importance of discussing potential weight gain before starting DMPA and providing dietary and exercise guidance. Hair loss or thinning is also a concern, but there is limited data on its incidence. The authors recommend a comprehensive history and consideration of other causes when evaluating patients with hair loss. Overall, the document concludes that addressing concerns about side effects through counseling and reassurance can improve adolescents' compliance with DMPA.