User Experiences with Subcutaneous DMPA

Survey reveals high satisfaction among adolescents and young adults using subcutaneous DMPA.

Depot medroxyprogesterone acetate (DMPA) is a progestin-only injectable contraceptive that is used as a birth control method and in the treatment of heavy or painful menstrual periods, endometriosis, and for menstrual suppression. DMPA can be injected intramuscularly or subcutaneously, with no difference in effectiveness or side effects.

In the spring of 2020, the COVID-19 pandemic disrupted access to contraceptives and limited in-person health care visits. This led to a clinical protocol at Nationwide Children’s to improve access to subcutaneous DMPA, which can be administered at home. Because few studies have focused on adolescents and young adults using subcutaneous DMPA, researchers at Nationwide Children’s leveraged this opportunity to survey their patients’ experiences. The results were recently published in the Journal of Pediatric and Adolescent Gynecology.

The researchers identified 108 eligible patients in the electronic health record who had received a prescription for subcutaneous DMPA between November 2019 and October 2021.

“To recruit them, we first sent MyChart messages,” says Hunter Wernick, DO, an adolescent medicine physician at Nationwide Children’s and the study’s lead author. “If they didn’t have an active MyChart, we sent a letter. And then if they never responded to that letter, which was most of them, we called.” The team ended up with completed surveys from 29 patients who received at least one subcutaneous DMPA injection.

Most patients (about 93%) reported high satisfaction with subcutaneous DMPA. Of the 79.3% with previous intramuscular DMPA injection experience, nearly 70% preferred the subcutaneous injection, most often citing convenience, personal control, and injection comfort. Survey responses also indicated subcutaneous DMPA was a feasible option, and problems obtaining the prescription were uncommon. Most respondents reported administering the injection within the time window and planned to continue the method.

Dr. Wernick says the study is not without limitations, as it was conducted retrospectively and has a small sample size.

“The study tells us that the people who responded to our survey liked the subcutaneous option,” she says. “There is no way of knowing if respondents may have had different experiences compared with those who did respond.”

The researchers suggest future research that prospectively investigates subcutaneous DMPA use among adolescents over time and at multiple sites.

In the meantime, they say clinicians caring for adolescents should consider including subcutaneous DMPA as an option, especially for adolescents and young adults who value convenience and user control.

“I think it is a good option, especially if there are any difficulties in the patient getting to the clinic,” says Dr. Wernick. “Overall, subcutaneous DMPA should be included as an option with the caveat that everybody’s a little different and insurance coverage could be different for everybody.”

This article also appears in the Fall/Winter 2023 print issue. Download the full issue.

Reference:

Wernick HJ, Wentzel E, Jackson K, Schmuhl K, Valenti O, Bonny AE, Berlan E. A pilot study of adolescent and young adult experience with subcutaneous depot medroxyprogesterone acetate. Journal of Pediatric and Adolescent Gynecology. 2023 Jun 22:S1083-3188(23)00343-1.

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