Which of the following are side effects of depot medroxyprogesterone acetate (DMPA)? Select all that apply.
Weight gain
Immediate return to fertility
Potential bone density loss
Increased milk supply
Irregular bleeding
Correct Answer : A,C,E
Depot medroxyprogesterone acetate (DMPA) is a progestin-only injectable contraceptive administered every 12 weeks. It suppresses ovulation, thickens cervical mucus, and thins the endometrium. Common side effects include weight gain, irregular bleeding, and bone mineral density loss due to hypoestrogenic effects. DMPA delays return to fertility by 9 to 10 months on average. It is safe during lactation, but does not increase milk supply. Normal bone mineral density (BMD) T-score is ≥−1.0; prolonged DMPA use may reduce BMD, especially in adolescents.
Rationale for correct answers
1. Weight gain is a documented side effect of DMPA, with average increases of 2–4 kg in the first year. It is attributed to increased appetite and fluid retention.
3. DMPA can reduce bone mineral density due to suppression of estrogen. This effect is reversible upon discontinuation but is significant in long-term use, especially in adolescents.
5. Irregular bleeding is common, especially in the first 6–12 months. It results from endometrial thinning and unpredictable shedding. Amenorrhea may develop with continued use.
Rationale for incorrect answers
2. DMPA does not result in immediate return to fertility. Ovulation may be delayed for 9–10 months after the last injection. This is due to prolonged suppression of the hypothalamic-pituitary-ovarian axis.
4. DMPA is compatible with breastfeeding but does not increase milk supply. It does not contain estrogen, which can suppress lactation, but its progestin component does not stimulate milk production.
Take home points
- DMPA causes weight gain, irregular bleeding, and potential bone density loss.
- Fertility return is delayed after discontinuation.
- Safe during lactation but does not enhance milk supply.
- Long-term use requires monitoring of bone health.
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Related Questions
Correct Answer is C
Explanation
Combined oral contraceptives (COCs)prevent pregnancy primarily by suppressing ovulation, thickening cervical mucus, and altering endometrial receptivity. They contain synthetic estrogenand progestin, which inhibit the hypothalamic-pituitary-ovarian axis. Estrogen suppresses follicle-stimulating hormone (FSH), while progestin inhibits luteinizing hormone (LH) surge, preventing ovulation. Normal FSH levels range from 3–20 IU/L and LH from 5–25 IU/L mid-cycle. Progestin also thickens cervical mucus, making it hostile to sperm penetration, and alters the endometrium to reduce implantation likelihood. Side effects include nausea, breast tenderness, and thromboembolic risk. Contraindications include active thromboembolism, estrogen-sensitive cancers, and severe liver disease.
Rationale for correct answers
3.COCs primarily prevent pregnancy by thickening cervical mucus and consistently suppressing ovulation. Estrogen and progestin inhibit FSH and LH, preventing follicular development and ovulation. Progestin also thickens cervical mucus, impeding sperm entry.
Rationale for incorrect answers
1.A sterile inflammatory reaction in the uterus is the mechanism of intrauterine devices (IUDs), particularly copper IUDs. COCs do not induce uterine inflammation and act hormonally, not mechanically.
2.Physical blockage of sperm is the mechanism of barrier methods like condoms or diaphragms. COCs do not create a physical barrier but alter cervical mucus and hormonal cycles.
4.Copper ions impair sperm motility and viability, a mechanism specific to copper IUDs. COCs do not contain copper and do not alter sperm function directly through ionic interference.
Take home points
- COCs suppress ovulation and thicken cervical mucus
- They do not act via inflammation or physical barriers
- Copper IUDs impair sperm via ionic mechanisms
- Barrier methods physically block sperm entry
Correct Answer is ["A","C","D"]
Explanation
Lactational amenorrhea method (LAM)is a temporary contraceptive strategybased on exclusive breastfeeding, amenorrhea, and infant age <6 months. It relies on prolactin-mediated suppressionof the hypothalamic-pituitary-ovarian axis, inhibiting gonadotropin-releasing hormone (GnRH)and thus ovulation. For LAM to be effective, breastfeeding must be frequent, including night feeds, and the mother must remain amenorrheic. Normal prolactin levels during lactation range from 100 to 400 ng/mL; elevated levels suppress GnRH. Once menstruation resumes or supplementation begins, contraceptive efficacy declines sharply.
Rationale for correct answers
1.Exclusive or near-exclusive breastfeeding maintains high prolactin levels, which suppress ovulation. Introduction of formula or solids reduces prolactin and compromises contraceptive efficacy.
3.LAM is only effective if the infant is <6 months old. After 6 months, complementary feeding begins and ovulatory cycles may resume, reducing reliability.
4.Frequent breastfeeding, including night feeds, sustains prolactin levels. Infrequent nursing allows prolactin to drop, increasing risk of ovulation and pregnancy.
Rationale for incorrect answers
2.Resumption of menses indicates return of ovulatory cycles. LAM is no longer effective once menstruation occurs, even if breastfeeding continues.
5.Regular formula supplementation reduces breastfeeding frequency and prolactin levels. This undermines the hormonal suppression of ovulation, making LAM ineffective.
Take home points
- LAM requires exclusive breastfeeding, amenorrhea, and infant age <6 months.
- Resumption of menses or formula use invalidates LAM.
- Frequent day and night breastfeeding maintains contraceptive efficacy.
- LAM is a temporary method and must transition to other contraception after 6 months.
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