Estrogen levels and genitourinary signs and symptoms during DMPA use

E.Z. Tuzcular Vural, I. Gönenç, G. Köse, N. Aka

Haydarpaca Numune Education and Research Hospital, Family Planning Unit, Istanbul, Turkey

Objectives We aimed to identify the effects of estrogen levels on genitourinary signs and symptoms during depo-medroxy-progesterone acetate (DMPA) use.

Design and methods Women who desired DMPA for contraception were evaluated before and at 6 months after initiation of DMPA injections. Inclusion criteria for the study were a minimum of two DMPA injections applied in the same unit. 74 women fulfilled the criteria and were included in the study. At each visit, we assessed genitourinary signs and symptoms and measured estrogen levels.

Results Of the 74 subjects receiving their first DMPA injection, 48 were able to be followed up for 6 months. The 48 subjects followed up for 6 months had a mean age of 34.3 ± 5.46 years and had the following characteristics: primary school education (91.7%), married (95.8%), multigravid (97.9%), regular menses (93.6%) and smokers (20.8%).The average body mass index (BMI) (kg / m2) was 28.5 ± 4.66 (range 22-39.9). After 6 months, there was significant reduction in mean serum estradiol levels (81.5 ± 22.3 pg/mL to 22.6 ± 14.7 pg / mL, p< 0.0001). External genital pruritus, dyspareunia, dysuria, urinary urgency, and external genitalia burning or pain were infrequent and unchanged .The subjective amount of vaginal discharge reported also did not change. The only parameter with significant difference was an increase in vaginal dryness (p< 0.05). A large proportion of the subjects had regular menses at baseline, but 35.4% were amenorrhoeic after 6 months of DMPA. Considering the possible symptoms related to estrogen reduction, only one woman had problems with hot flushes (2.1%).

Conclusion Use of DMPA over 6 months caused a marked reduction in serum E2 levels in our subjects. However, users of DMPA did not have genitourinary tract problems because of estrogen deficiency except vaginal dryness. Users should be asked about genitourinary signs and symptoms and simple solutions like lubricants or topical estrogen therapy should be offered to prevent dyspareunia.