Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously

• Published in: Contraception (Stoneham) Vol. 81; no. 6; pp. 487 - 495
• Main Authors: Segall-Gutierrez, Penina, Taylor, DeShawn, Liu, Xinwen, Stanzcyk, Frank, Azen, Stanley, Mishell, Daniel R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2010; Elsevier
• Subjects: Adult; Biological and medical sciences; Birth control; Body Mass Index; Class 3 obese; Contraception; Contraceptive Agents, Female - administration & dosage; Contraceptive Agents, Female - blood; Delayed-Action Preparations - administration & dosage; Depomedroxyprgesterone acetate; Estradiol - blood; Female; Follicular development; Genital system. Reproduction; Gynecology. Andrology. Obstetrics; Hormonal contraception; Humans; Immunoassay; Injection; Injections, Subcutaneous; Medical sciences; Medroxyprogesterone Acetate - administration & dosage; Medroxyprogesterone Acetate - blood; Metabolic diseases; Obese; Obesity; Obesity - blood; Obesity - physiopathology; Obesity, Morbid - blood; Obesity, Morbid - physiopathology; Obstetrics and Gynecology; Ovarian Follicle - drug effects; Ovarian Follicle - physiology; Ovulation; Ovulation - blood; Ovulation - drug effects; Ovulation Inhibition - blood; Ovulation Inhibition - drug effects; Pharmacology. Drug treatments; Progesterone - blood; Progestins - administration & dosage; Progestins - blood; Severity of Illness Index; Young Adult; Obese; Class 3 obese; Depomedroxyprgesterone acetate; Contraception; Injection; Follicular development; Ovulation; Human; Obesity; Controlled release form; Nutrition disorder; Progestagen; Follicular phase; Ovary; Female genital system; Dosage form; Medroxyprogesterone; Female; Subcutaneous administration; Woman; Ovarian follicle; Nutritional status
• ISSN: 0010-7824; 1879-0518; 1879-0518
• DOI: 10.1016/j.contraception.2010.01.021

Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the extremely obese population (BMI ≥40 kg/m2). The purpose of this 26-week prospective experimental study was to determine incidence of ovulation and follicular development among women with Class 1, 2 and 3 obesity after receiving DMPA-SC. Five normal-weight, five Class 1-2 obese, and five Class 3 obese women received subcutaneous injections of 104 mg DMPA-SC at baseline and 12 weeks later. Weekly progesterone levels, bimonthly estradiol (E2), and monthly medroxyprogesterone acetate (MPA) levels were measured by immunoassay methods for a total of 26 weeks in each subject. Ovulation did not occur in any subject more than 1 week after the first injection. There was large intersubject and intrasubject variability in E2 levels, and fluctuating E2 levels were more frequent among obese women than normal-weight women. Median MPA levels remained above the level needed to prevent ovulation but, compared with normal-weight subjects, were lower among Class 1-2 obese and lowest among Class 3 obese subjects. Fluctuating E2 levels reflective of follicular development occurred more often among Class 1, 2 and 3 obese women than normal-weight women after DMPA-SC injections. Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation. Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women.