A Prospective Study on Comparison of Depot Medroxyprogesterone Acetate and Postpartum Intrauterine Contraceptive Device as Contraceptive Method

Abstract Introduction: Contraception is one of the proximate determinants of fertility and the most important predictor of fertility transition. Depot Medroxyprogesterone Acetate (DMPA) and Intrauterine Contraceptive Device (IUCD) share some common features- both are Long Acting and Reversible Contraceptives (LARC), but the mechanisms are different. DMPA is a non-invasive, hormonal man oeuvre while IUCD is an invasive, non-hormonal one. The aim of our study was to compare the acceptance and reasons for non-compliance between DMPA and Postpartum Intrauterine Contraceptive (PPIUCD). Materials & Methods: This hospital-based prospective and comparative study was conducted in the Department of Obstetrics and Gynaecology at SMS Medical College and Hospital, Jaipur. Women with a PPIUCD in-situ who were willing and medically fit to continue its use, as well as those willing and fit to use the DMPA injection, were included. Total of 200 post-partum women (100 in each group) were randomly assigned to two groups: Group A (DMPA as contraception) and Group B (PPIUCD as contraception). Results: The mean age for DMPA group was 27.8 years while for PPIUCD group mean age is 25.6 years. Primi parous women wished to continue PPIUCD more than women with two or more children (X2=6.71 & P-value=0.03). 25% of DMPA users and 10% of PPIUCD users had previously used oral pills, while 37% of DMPA users and 35% of PPIUCD users had used condoms. The DMPA group reported more irregular spotting and high rate of amenorrhea as menstrual changes while PPIUCD group reported more irregular increased menstrual flow. Weight gain is significantly higher in the DMPA group (22%) compared to the PPIUCD group (5%) (χ² = 30.2, P = 0.001). Injection site reactions were unique to the DMPA group, while overall complication rates were higher in the PPIUCD group. Continuation rates were higher in the DMPA group (85%) compared to the PPIUCD group (70%) (χ² = 1.2, P = 0.01). The pregnancy rate was low, with only one case reported in the PPIUCD group. Conclusion: Both methods effectively prevent pregnancy, but DMPA is more acceptable and more compliant method as compared to PPIUCD in women in post-partum period.