Adolescents' reasons for and experience after discontinuation of the long-acting contraceptives depo-provera and norplant

• Published in: Journal of adolescent health 1996-08, Vol.19 (2), p.118-123
• Main Authors: Harel, Zeev, Biro, Frank M., Kollar, Linda M., Rauh, Joseph L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent girls; Adolescents; Biological and medical sciences; Birth control; Body Mass Index; Cessation; Chi-Square Distribution; Comparison; Condoms; Contraceptives; Depo-Provera; Discontinuation; Drug Administration Schedule; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Health Knowledge, Attitudes, Practice; Hormonal contraception; Humans; Injectable contraceptives; Levonorgestrel - administration & dosage; Levonorgestrel - adverse effects; Medical sciences; Medroxyprogesterone acetate; Medroxyprogesterone Acetate - administration & dosage; Medroxyprogesterone Acetate - adverse effects; Menstruation - drug effects; Norplant; Patient Compliance; Patient Education as Topic; Patient Satisfaction; Pregnancy; Pregnancy in Adolescence - statistics & numerical data; Reasons; Sexual Behavior; United States
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/1054-139X(95)00322-J

The objectives of this study were to examine the reasons for discontinuation of the long-acting contraceptives Depo-Provera and Norplant in adolescents, and to assess the adolescents' experience after discontinuation of the methods. A total of 35 adolescents (gynecologic age 4.7 ± 0.3 years, and body mass index (BMI) 24.2 ± 0.61 who discontinued Depo-Provera, and 31 adolescents (gynecologic age 3.4 ± 0.3 years, BMI 24.1 ± 0.9) who discontinued Norplant ® were periodically assessed during use of the methods and up to 12 months after discontinuation. The most common reasons for discontinuation of both Norplant (after 21.8 ± 1.6 months of use) and Depo-Provera (9.2 + 0.9 months of use) were irregular menstrual bleeding (64%), weight gain (41%), and increased headaches (30%). Resumption of menstrual regularity and dysmenorrhea was noted sooner after discontinuation of Norplant, compared with Depo-Provera. The increase in BMI noted at discontinuation of DepoProvera (1.1, P = .0005) and Norplant (1.3, P = .03) persisted up to 6 months after discontinuation of either method (0.6, P = .01 post-Depo-Provera discontinuation; and 0.9, P = 0.02 post-Norplant discontinuation). Only 62% of the adolescents reported no break in contraceptive practice. The condom was the most popular method (37%) after discontinuation of Depo-Provera, and oral contraceptive (39%) after discontinuation of Norplant. The cumulative conception proportion reached 0.93 at 12 months after discontinuation of Norplant, and was significantly higher ( P = .01) compared with the cumulative proportion of conception after discontinuation of DepoProvera ( P = .50). Health care providers should aggressively manage physical problems associated with Depo-Provera and Norplant use, and expedite the transition to a new contraceptive method to minimize the high pregnancy rate observed after discontinuation of these methods in adolescents.