ORIGINAL RESEARCH ARTICLE DMPA Use Above the Age of 35 in Thai Women Surasak Taneepanichskul,* Damrong Reinprayoon,* and Sukhit Phaosavadi* A prospective study of depot-medroxyprogesterone acetate (DMPA) use in women aged above 35 years was conducted in Bangkok, Thailand. The objectives of the study were to evaluate efficacy, continuation rate, and side effects of DMPA use in these women. A total of 60 women were enrolled in a one-year clinical trial. Their mean age was 38 years. Most of them had completed primary school. No accidental pregnancies occurred throughout the 1-year use in this study. The continuation rate was 20%. Irregular bleeding was the major cause of termination. The major side effect was also irregular bleeding. Nevertheless, DMPA in older women is a safe and effective contracep- tive. DMPA is a contraceptive akterbatuve fir women aged above 35 with contraindications to combination oral contraceptives. CONTRACEPTION 2000;61:281–282 © 2000 Elsevier Science Inc. All rights reserved. KEY WORDS: DMPA, older women Introduction T he contraceptive methods applicable in women above 35 years should be subjected to special consideration. During this period, fer- tility decreases due to a decrease in sexual activity, number of ovulatory cycles and an increase in abor- tion. 1 Pregnancy above age of 35 involves an in- creased risk to both mother and fetus. 1,2 As a conse- quence, women need absolutely efficacious contraceptives. Depot-medroxyprogesterone acetate (DMPA), an injectable progestogen, is an effective contraceptive used in many parts of the world. 3 How- ever, there have been few studies on DMPA use in older reproductive-aged women. 4 The purpose of this study was to evaluate efficacy, continuation rate and side effects of DMPA use in women above 35 years during an one-year follow-up period. Materials and Methods The study was conducted at the Family Planning Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok. A cohort of 60 healthy women aged be- tween 36 and 45 years was enrolled in the study. Criteria for entry into the study included multiparity, normal medical history, no contraindication against DMPA use, normal physical and pelvic examination, normal Pap smear, no prior use of hormonal contra- ceptive, and no recent history of pregnancy or breast- feeding. All subjects voluntarily chose DMPA after counseling and received 150 mg of DMPA within 5 days after the onset of menstruation. The interval between injections was 12 weeks. At the outset, history-taking, physical, and pelvic examination were performed including Pap smear, blood pressure, and body weight measurements. Women were scheduled for follow-up visits every 12 weeks for DMPA injec- tion. At the follow-up visits, physical examination with blood pressure and body weight measurements were routinely performed. Subjective complaints were recorded on questionnaire forms. The period of follow-up was one year. All data were collected, coded, and analyzed by the investigators. The SPSS/ PC ++ (Chicago, IL) for Windows ® statistical package program was used to analyze the data with a personal computer. Statistical values employed are mean, standard deviation, Student’s t-test, and a 95% confi- dence interval (CI). The level considered significant was at 0.05. Results DMPA was used by 60 women above 35 years of age for a total of 468 women-months. The characteristics of the subjects are summarized in Table 1. Of the 60 women who received the initial injection of DMPA, 48 discontinued for various reasons during the study and 12 women were continuing to use DMPA at the 1-year follow-up. The 12-month continuation rate for these women was 20%. The reasons for discontinuing DMPA use are shown in Table 2. The most common side effect was irregular bleeding; details are depicted *Department of Obstetrics and Gynaecology, Faculty of Medicine, Chula- longkorn University, Bangkok 10330, Thailand Name and address for correspondence: Dr. Surasak Taneepanichskul, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chula- longkorn University, Bangkok 10330, Thailand. Tel: 66-256-4241; Fax: 66-254- 9292 Submitted for publication November 8, 1999 Revised January 18, 2000 Accepted for publication February 10, 2000 © 2000 Elsevier Science Inc. All rights reserved. ISSN 0010-7824/00/$20.00 655 Avenue of the Americas, New York, NY 10010 PII S0010-7824(00)00102-5