Arch Gynecol Obstet (2008) 278:1–12 DOI 10.1007/s00404-007-0497-z 123 REVIEW ARTICLE Depot-medroxyprogesterone acetate: an update Sayed Bakry · Zaher O. Merhi · Trudy J. Scalise · Mohamad S. Mahmoud · Ahmed Fadiel · Frederick Naftolin Received: 18 July 2007 / Accepted: 16 October 2007 / Published online: 10 May 2008  Springer-Verlag 2008 Abstract Objective Depo-Provera ® is a contraceptive approved by the US Food and Drug Administration (FDA) since 1992 and used worldwide by more than 90 million women. Aim of study Despite the fact that progestins are endoge- nous hormones that are secreted by the body, its excess might lead to detrimental health eVects. Whether progestins as contraceptives are friends or foes is a questionable mat- ter. In this manuscript, we drive the attention to both usage and side eVects Depo-Provera. Results Depot-medroxyprogesterone acetate (DMPA) is a highly eVective, convenient non-daily hormonal contracep- tive option that has been available worldwide for many years. The experience with DMPA provides a large body of long-term data regarding the eYcacy and safety of this con- traceptive method; this long-term experience has estab- lished that the use of DMPA does not increase the risk of cardiovascular events, breast cancer, other gynecologic malignancy, or postmenopausal fracture; however, patients are often more concerned about the relatively immediate eVects of contraceptives such as potential changes in men- strual cycle, body weight, and mood disturbances. Conclusion Concerns about such issues may lead to reluctance to initiate therapy or premature discontinuation. Counseling and understanding of women’s concerns and experiences using Depo-Provera is important and could help health care providers redesign counseling strategies to improve contraceptive continuation and improve patient adherence. Keywords Depo-Provera · Risk of cardiovascular events · Osteoporosis · Gynecologic malignancy · Body weight gain Introduction According to any dictionary, contraception (kon”tru- sep’shun) is deWned as the deliberate prevention of concep- tion or impregnation by any contraceptive method such as drugs, techniques, or devices. People have been practicing birth control for thousands of years, the evidence of which exists in some of our earliest written records, including the Book of Genesis. In 1850 B.C. Egypt, vaginal pessaries (devices inserted into the vagina, made from elephant or crocodile dung) were used to prevent pregnancy. In 1550 B.C. Egypt, tampons made from lint and soaked in fer- mented acacia juice were used as a means of contraception. Many of the contraceptive methods in use today have been in use for hundreds of years: the condom since the 16th century; cervical cap since the 1820s; the diaphragm and vaginal spermicidal since the late 19th century; and intra- uterine contraceptive devices (IUD’s) since early in the 20th century. S. Bakry Center for Genetic Engineering and Embryo Culture, Al Azhar University, Cairo 11884, Egypt S. Bakry (&) · T. J. Scalise · F. Naftolin Department of Obstetrics, Gynecology and Reproductive Biology, School of Medicine, New York University, New York, NY 10016, USA e-mail: sayed.bakry@med.nyu.edu Z. O. Merhi Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA M. S. Mahmoud Department of Obstetrics and Gynecology, University of Illinois, Illinois, USA A. Fadiel Yale University School of Medicine, New Haven, CT 06511, USA