Talk:Depot medroxyprogesterone acetate

message: Maybe its just me, but it took quite some time to figure out what the drug does. I think in order to make the article clearer, someone needs to revamp the introduction and make it clearer. I would offer to, but this is way outside my knowledge. Sovereignlance (talk) 07:07, 21 December 2011 (UTC)
thread_title:  Introduction 

message: I've noticed that the two "LaCroix" studies (probably more accurately Scholes studies, as Scholes is the lead author) are billed as being essentially one study on the talk page and in the article. I'm not clear why this is. Looking at the studies, they describe two different patient populations. One study looked at a group of 170 women aged 14-18, enrolled in 1999-2000 (). The other study looked at 457 women aged 18-39 (), enrolled 1994-1999. There's no overlap in the cohorts (see their ages), and they were enrolled separately (not as part of the same project). So these would appear to be two separate studies, which reached similar conclusions. I think the confusion may arise from a third study (), in which Scholes et al. "pre-published" their results from the adolescent cohort, but that study is not referenced in the article. The bottom line is that there appear to be two separate studies (one in adolescents, one in adult women) which reached similar conclusions about reversibility of BMD after discontinuation of Depo (in addition to the small New Zealand study). I'll make an adjustment to the text to reflect this. MastCell 03:29, 5 November 2006 (UTC)
thread_title:  Lacroix studies 

message: Thank you, David. Points taken. Apologies to Cindery for being unnecessarily argumentative. To refocus on content issues, I'm curious to hear other opinions about labeling Lacroix a "Pfizer consultant" in the context of this article, as I notice I'm not the only editor to raise this concern. My own feeling is that it represents OR, as I mentioned above, again in needlessly incivil language for which I apologize. MastCell 03:35, 5 November 2006 (UTC)
thread_title:  Pfizer consultant 

message: I suggest that this article have a section just for evidence about cancer risks. Why is item #9 in the "Footnotes" section blank? --JWSchmidt 04:24, 5 November 2006 (UTC)
thread_title:  suggestion: cancer section 

message: "The majority of this article has been written by a single editor who persistently and blatantly violates WP:NPOV, WP:NOR, and restores inaccurate information, using Wikipedia as a soapbox to push their POV that Depo-Provera (and most other contraceptives) are dangerous products foisted on women by a conspiracy of greedy and malevolent corporations, public health organizations and physicians. 68.255.20.88 08:05, 3 November 2006 (UTC)
thread_title:  inaccurate inoformation 

message: how is the following NOT gibberish? 'Use of Depo may offer more privacy to some users than other forms of contraception, such as pills, condoms, and diaphragms, as there are no material objects which must be kept at home to continuously provide contraceptive protection.' —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).
It's not really possible to quantify that, but it seems pretty obvious. How IS that gibberish? If you're using the normal use of gibberish to mean something that doesn't make any sense, I don't see your point.71.63.119.49 01:13, 18 August 2007 (UTC)
thread_title:  gibberish? 

message: Many parts of this article are good and NPOV, but other parts of it read like a scathing review.  I'm sorry I don't have any better critcism at this time, but wow... this article seems to be highly POVed against use of Depo.  I don't want to start disputing facts, or quotes, like where there's that quote that (paraphrased) Depo is by far the most dangerous drug on the market (/paraphrased).  But it would be nice if the content outside of facts and quotes were more straight forward, honest, and neutral.  I mean, the dangers that are inherent in use of Depo are pretty clear given the facts, I don't think we need to bolster that with our own personal opinions. --Puellanivis 22:16, 4 December 2006 (UTC)
replies: text: You've probably seen on the talk page that issues of POV have been debated pretty heavily. I tend to agree with you. If you have some suggestions on how the page can be improved, please go for it. Don't worry - if others disagree with your edits, you'll hear about it. MastCell 00:36, 5 December 2006 (UTC)
replies: text: I completely agree. Mifepristone is in a similar state. -Severa  (!!!) 11:55, 19 December 2006 (UTC)
replies: text: I also agree (except few not many parts of this article are accurate and NPOV). Mifepristone (and Emergency contraception) are in similar states. All three articles should be  flagged to warn readers that the neutrality and factual accuracy of the articles are disputed.68.255.23.152 18:10, 20 December 2006 (UTC)

text: I think it is perfectly appropriate to flag articles that have been made extensively and pervasively biased and factually inaccurate as a result of hundreds and hundreds of edits by a single editor in a short period of time.68.255.23.152 20:20, 20 December 2006 (UTC)
thread_title:  WOAH! 

message: I've removed the following from "Warnings and Precautions":
Some women may prefer amenorrhea. According to Jerilynn Prior, M.D., professor of endocrinology and metabolism at the University of British Columbia in Vancouver, and board member for the Society for Menstrual Cycle Research,"the most important thing to emphasize about menstrual suppression is that the long-term effects are simply unknown," and "allowing the one vital sign unique to women to go unmonitored...could ultimately lead to an enormous uncontrolled experiment with a woman's health."
The "some women may prefer..." sentence is unsourced, and the quote on the importance of a menstrual cycle and the possbile risks of amenorrhea is in no way specific to Depo (it would apply equally to all forms of hormonal contraception) and is more appropriate for the hormonal contraception or amenorrhea articles. MastCell 18:32, 20 December 2006 (UTC)
replies: text: Also removed, from "Black Box Warning", the clause about WHO distribution vs. FDA approval. This has little to do with the black box warning on bone loss, and the controversy is already covered under the "Controversies" section, which is the more appropriate place for it. The removed source is here for archival purposes: . MastCell 18:43, 20 December 2006 (UTC)
replies: text: I know we've gone back and forth about LaCroix being a consultant to Pfizer, but to recap: in the studies cited here, a) no conflicts of interest are disclosed, and b) LaCroix is neither the lead nor senior author. The Pfizer consultancy thing is apparently based on a separate, unrelated article authored by LaCroix in 2003 in which she notes receiving consultancy fees from Pfizer. There are several issues here: a) the papers cited here do not disclose a conflict of interest; b) the potential conflict noted in the 2003 paper comes after one of the studies cited here - there's no indication whether LaCroix had received fees at the time of the relevant article's publication; c) joining fact A (LaCroix wrote a paper on Depo) with Fact B (LaCroix elsewhere disclosed a Pfizer consultancy fee in a different article) to advance Position C (that LaCroix had an undisclosed conflict relevant to the Depo paper) is the defintion of original research. Finally, the way it's phrased now, it seems to totally discount the results of two peer-reviewed studies based on an OR assertion of an undisclosed conflict of interest which no citable source seems to be alleging. Therefore I've removed it. MastCell 18:58, 20 December 2006 (UTC)
replies: text: Well thought out comments.  DPetersontalk 03:33, 15 January 2007 (UTC)
thread_title:  Recent edits 

message: The Contraindications section of this Wikipedia article used to only say:
: Women with the following conditions should not use Depo Provera:
: * stroke 
: * currently pregnant 
: * current or past breast cancer 
: * liver problems or liver disease 
: * blood clots 
The full prescribing information from Pfizer for Depo-Provera in the United States lists the following in its Contraindications section:
* 1. Known or suspected pregnancy or as a diagnostic test for pregnancy
* 2. Undiagnosed vaginal bleeding
* 3. Known or suspected malignancy of the breast
* 4. Active thrombophlebitis, or a current or past history of thromboembolic disorders, or cerebrovascular disease.
* 5. Significant liver disease
* 6. Known hypersensitivity to Depo-Provera CI (medroxyprogesterone acetate or any of its other ingredients.
The summary of product characteristics (SPC) from Pharmacia (Pfizer) for Depo-Provera in the United Kingdom and Europe says the following its Contraindications section:
* Depo-Provera is contra-indicated in patients with a known sensitivity to medroxyprogesterone acetate or any ingredient of the vehicle.
* Depo-Provera should not be used during pregnancy, either for diagnosis or therapy.
* Depo-Provera is contra-indicated as a contraceptive at the above dosage in known or suspected hormone-dependent malignancy of breast or genital organs.
* Whether administered alone or in combination with oestrogen, Depo-Provera should not be employed in patients with abnormal uterine bleeding until a definite diagnosis has been established and the possibility of genital tract malignancy eliminated.
The WHO Medical Eligibility Criteria for Contraception and the RCOG FFPRHC UK Medical Eligibility Criteria for Contraception have more informative annotated tables of relative (category 3) and absolute (category 4) contraindications for Depo-Provera than the list drawn from Pfizer's US-only full prescribing information and patient package insert.
Significantly, Pfizer's US-only label information lists "past history of thromboembolic disorders" as a contraindication to using Depo-Provera, whereas the UK and European SPC, the WHO and FFPRHC Medical Eligibility Criteria for Contraception, and current medical reference textbooks do not and even suggest progestogen-only contraceptives including Depo-Provera as alternatives to combined oral contraceptives containing estrogen for which a "past history of thromboembolic disorders" is an absolute (category 4) contraindication.
It is also useful to distinguish contraceptive methods like Depo-Provera and other hormonal contraceptives where use during pregnancy is not indicated but accidental use has not been found to be harmful, from contraceptive methods like the IUD where use during pregnancy is an absolute (category 4) contraindication (because of the risk of serious pelvic infection and septic spontaneous abortion).
The link to the WHO and FFPRHC Medical Eligibility Criteria for Contraception Progestogen-only contraceptive tables also provides easy comparison of injectable progestogen-only contraceptives including Depo-Provera with oral progestogen-only contraceptives (minipills) and progestogen-only implants (Norplant, Jadelle, Implanon) that explain why Depo-Provera has more relative (category 3) contraindications than progestogen-only minipills or implants: 1) Depo-Provera is long-acting and not rapidly reversible 2) Depo-Provera's relatively high progestogen dose suppressing follicular development and ovulation leads to a hypo-estrogenic state which may decrease protective HDL and could theoretically increase cardiovascular risk (though it has not been shown to do so)--which would be of most concern with women already at very high cardiovascular risk (such as those with a history of ischemic heart disease, stroke, complications of hypertension, or complications of diabetes).
If this Wikipedia article's Contraindication section is too long, perhaps:
* a stub article defining the FFPRHC could help shorten the introductory sentence?
* "breastfeeding < 6 weeks postpartum" should be deleted? (since the FFPRHC does not consider it to be a relative contraindication)
69.208.162.137 20:54, 16 January 2007 (UTC)
replies: text: Apologies for the perhaps too-hasty reversion. I think the expansion is a good idea - although perhaps we could find a way to make it a little more user-friendly (move away from Category 3, Category 4, etc to just a description of what those terms mean)? MastCell 21:31, 16 January 2007 (UTC)
thread_title:  Contraindications 

message: * Benefits
**Misrepresents and understates the significance and importance of the reduced risk of seizures in women with epilepsy: 
**Misrepresents and understates the significance and importance of the reduced risk of sickle cell crises in women with sickle-cell disease:  
 However, the  potential  benefits of Depo Provera in epilepsy and sickle-cell disease have been described in case reports and have not been studied in randomized controlled trials. 
* citing: Westhoff (2003). "Depot-medroxyprogesterone acetate injection (Depo-Provera®): a highly effective contraceptive option with proven long-term safety".  which says:
** "Women with sickle cell anemia also report total absence or a significant reduction in painful crises during treatment with DMPA.(, ) Unlike combination and progestin-only OCs, the contraceptive efficacy of DMPA does not appear to be compromised among women taking concomitant anticonvulsive therapy.() Data also indicate that DMPA has intrinsic anticonvulsant activity.(, , , ) Additionally, progestin-only contraceptives such as DMPA have been recommended as appropriate contraceptive choices for women who in whom estrogen (therefore any combination OC) is contraindicated.(, ) The potential benefits of DMPA in women with sickle cell disease and epilepsy have been described in case reports and have not been assessed in randomized trials."
* Speroff & Darney (2005). A Clinical Guide for Contraception, 4th ed. 
** "Efficacy, p. 203
*** Because serum concentrations are relatively high, efficacy is not influenced by weight (making this a good choice for overweight women) or by the use of medications that stimulate hepatic enzymes. On the contrary, depot-medroxyprogesterone acetate is an excellent contraceptive choice for women taking antiepileptic drugs because the high progestin levels raise the seizure threshold."
** "Advantages, p. 205
*** As noted, depot-medroxyprogesterone should be considered in patients with seizure disorders; an improvement in seizure control can be achieved probably because of the sedative properties of progestins.
*** An important advantage exists for patients with sickle cell disease because evidence indicates an inhibition of in vivo sickling with hematologic improvement during treatment. Both the frequency and the intensity of painful sickle crises are reduced."
* Hatcher (2004). "Depo-Provera Injections, Implants, and Progestin-Only Pills (Minipills)" in Hatcher et al. Contraceptive Technology, 18th ed. 
** "Advantages and Indications
*** Advantages of Depo-Provera, p. 467 (specifically as opposed to Advantages of All Progestin-Only Methods)
**** 1. Culturally acceptable. In some cultures, a woman may consider medication by injection desirable. Some women wish to use a contraceptive without the knowledge of their partner. Many couples find Depo-Provera attractive because it is not coitally dependent. A subcutaneous formulation of Depo-Provera that women could self-inject is being evaluated.
**** 2. Minimal drug interactions. There has been no demonstrated interaction between Depo-Provera and antibiotics or enzyme-inducing drugs. The only drug that decreases the effectiveness of Depo-Provera is aminoglutethimide (Cytadren), which is usually used to suppress adrenal function in selected cases of Cushing's disease.
**** 3. Fewer seizures. Depo-Provera has been found to decrease the frequency of grand mal seizures. Improvement in seizure control is probably due to the sedative properties of progestins. Taking anti-seizure medication has no impact on the efficacy of Depo-Provera.
**** 4. Fewer sickle cell crises."
** "Depo-Provera
*** Instructions for Using Depo-Provera, p. 481
**** Depo-Provera injections confer a number of noncontraceptive benefits by decreasing the following:
***** Risk of sickle cell crisis
***** Frequency of grand mal seizures"
* Mishell (2004). "Contraception" in Strauss & Barbieri, Yen & Jaffe's Reproductive Endocrinology, 5th ed. 
** "Long-Acting Contraceptive Steroids
*** Injectable Suspensions
**** Depot Formulation of Medroxyprogesterone Acetate
***** Non-contraceptive Health Benefits, p. 926
****** DMPA also has a beneficial effect on hematologic parameters in women with sickle cell disease, as well as reducing their incidence of clinical problems. Seizure frequency is reduced in women with epilepsy who take DMPA.
As with her description of the duration of reduced risk of endometerial cancer, I think the characterization in Westhoff's review article of "potential benefits" of Depo-Provera as having only been demonstrated in "case reports" is misleading and the further emphasis in this Wikipedia article of benefits not being based on a "randomized controlled trials" is even more misleading.
For the reduced risk of sickle cell crises, Westhoff cites 2 studies that found significant hematological and clinical benefits: 1) a 2-year placebo-controlled crossover trial completed by 23 patients and 2) a 1-year 3-way (DMPA, COCP, placebo) controlled trial with 43 women. They may not have been "randomized", but they were placebo-controlled trials, not "case reports".
For the reduced risk of seizures, Westhoff cites a 1-year clinical trial involving 14 women at the Yale Epilepsy Center, that was not placebo controlled, but was a "clinical trial," not a "case report."
Speroff & Darney, Hatcher, and Mishell all cite fewer sickle-cell crises and fewer seizures as significant, specific noncontraceptive health benefits of Depo-Provera without any qualifications implying the benefits are based on weak evidence that should be heavily discounted.
Of note, Darney, currently the chief of obstetrics & gynecology at UCSF's San Francisco General Hospital, co-wrote a JAMA article "Use of oral contraceptives by women with epilepsy"() with the lead authors (Mattson & Cramer) of the Yale DMPA study and should be the most knowledgeable of its significance among the review and textbook authors. 
I would suggest omitting from this Wikipedia article the sentence:
:"However, the potential benefits of Depo Provera in epilepsy and sickle-cell disease have been described in case reports and have not been studied in randomized controlled trials. 
and separating the benefits of reduced seizures and reduced sickle cell crises into separate bullet items: 
* Decreased incidence of seizures in women with epilepsy. Additionally, unlike most other hormonal contraceptives, Depo-Provera's contraceptive effectiveness is not affected by enzyme-inducing antiepileptic drugs. 
* Decreased incidence and severity of sickle cell crises in women with sickle-cell disease. 
I would also suggest changing:
* Possible decrease in the symptoms of endometriosis, primary dysmenorrhea, and ovulation pain. 
to:
* Decreased symptoms of endometriosis. 
* Decreased incidence of primary dysmenorrhea, ovulation pain and functional ovarian cysts.
A decrease in symptoms of endometriosis was found in a clinical trial.([], cited in Westhoff's review article).
The decreased incidence of primary dysmenorrhea, ovulation pain and functional ovarian cysts are a direct result of the anovluation caused by Depo-Provera.
69.208.168.135 22:28, 19 January 2007 (UTC)
thread_title:  Seizures and Sickle-Cell Crises 

message: Removed the following intentionally deceptive false and deliberately misleading statement:
* Alleged bias of OB-GYN committee. A former director of the FDA Bureau of Drugs reportedly said that the OB-GYN Committee, which advised the FDA to approve Depo on the two occasions when it was not approved, was not capable of objectivity because members of the committee were in "the population control business." 
that was based on the last paragraph of a deceptive and misleading section of a 22-year-old Multinational Monitor article, that said:
:And population control is a highly politicized field. "When it comes to contraception and abortion," says one FDA medical officer, "people refuse to be scientific and objective." As a past director of the FDA's Bureau of Drugs, Dr. J. Krout, said several years ago, "Most of the members of that [OB-GYN] committee are in the population control business."
#The first quote from "one FDA medical officer", that "when it comes to contraception and abortion, people refuse to be scientific and objective" does not indicate that it is referring to an FDA advisory committee.
#This is juxtaposed with a sentence fragment "most of the members of that committee are in the population control business" from the April 30, 1974 testimony of J. Richard Crout, MD (Director, Bureau of Drugs, FDA) in the Fountain subcommittee hearings on the "Use of Advisory Committees by the FDA" that is misleadingly and deceptively quoted out of context. Dr. Crout was replying to hostile questioning by a House subcommittee staff member about the recommended approval of DES as an emergency contraceptive (only for emergency situations such as following rape). The subcommittee staff member's questioning was insinuating that the FDA Obstetrics-Gynecology Advisory Committee (whose main job was reviewing NDAs for contraceptives) was "not balanced" because it did not have an oncologist on it, but instead was primarily composed of leading obstetrician-gynecologists with extensive experience in contraceptive research. In part of the question that Dr. Crout was replying to, the subcommittee staff member said: "But, let's take this Ob-Gyn Committee. It seems to me this committee was composed almost exclusively of population control people. That is the impression I got." Instead of arguing over the subcommittee staff member's use of the politically loaded term "population control", Dr. Crout used the subcommittee staff member's terminology in agreeing that the ob-gyn advisory committee was primarily composed of ob-gyn's with experience in contraceptive research (along with some endocrinologists) and did not have an oncologist, or a cardiologist, or a hepatologist, or a nephrologist, etc., but that instead, specialists from other fields of medicine were brought in if needed to address specific issues requiring specialized expertise. (ref: p. 436, Use of Advisory Committees by the Food and Drug Administration, Hearings before the Intergovernmental Relations Subcommittee of the Committee on Government operations, House of Representatives, 93rd Congress, 2nd session, April 30, 1974)
#Dr. Crout never said: "the OB-GYN Committee, which advised the FDA to approve Depo on the two occasions when it was not approved, was not capable of objectivity because members of the committee were in 'the population control business.'"
68.255.19.25 05:08, 22 February 2007 (UTC)
replies: text: That's interesting - thanks for the context. It makes a lot of sense. Have you written on this topic before? You clearly have a great deal of knowledge about the history of Depo. MastCell 06:05, 22 February 2007 (UTC)
thread_title: Alleged bias of OB-GYN committee

message: I've put in a request to move the article from here Depo Provera to Depo-Provera as that it how it is referenced throughout http://www.depoprovera.com/ I've changed the references within the article to reflect the change. -- MacAddct1984 14:34, 21 March 2007 (UTC)
thread_title:  Name Change 

message: I would like to treat this parameter the same on all the hormonal contraception articles.  Please read my opinion and discuss this issue at Talk:Combined oral contraceptive pill#Weight parameter in infobox. LyrlTalk     C   21:30, 20 August 2007 (UTC)
thread_title:  Weight gain parameter in infobox 

message: "Likewise, users of Depo-Provera have reported a significantly decreased risk of contracting cervical cancer. Because of it's carcinogenic benefits to users, it is sometimes administered with or as a carcinogenic medication."
: Obviously, this text has issues. Not only is it unsourced (though it was inserted as though it did), it uses the word carcinogenic wrongly. -- Ec5618 22:58, 31 January 2008 (UTC)
replies: text:  Not to mention that users seldom self-report a decreased risk of cancer. beefman (talk) 07:06, 23 January 2009 (UTC)
thread_title:  Added by anon 

message: Medroxyprogesterone beefman (talk) 07:06, 23 January 2009 (UTC)
replies: text: Don't think they should be merged.  DMPA contains Medoxyprogesterone, but it is formulated for injection as a contraceptive.  There are other uses which may use different formulations.  Zodon (talk) 08:51, 23 January 2009 (UTC)
thread_title:  Merge with Medroxyprogesterone? 

message: Is DMPA FDA-approved for use in sex offenders?  If not, perhaps this should be mentioned. beefman (talk) 07:06, 23 January 2009 (UTC)
thread_title:  Other uses 

message: I have removed text in the Warnings and Precautions section which stated "although one [study] notes that bone loss was not reversible in long-term users of Depo-Provera."  None of the cited studies makes such a note.  The one study (citation #36) which examined long-term users did not examine long-term users after they had discontinued using the drug.  These long-term users were only studied while still taking the drug--thus it is not appropriate to conclude that the bone loss was not reversible.  Rather, there is no information in the cited studies on bone-loss reversibility in these users.
If it is in fact true that there is a study showing irreversibility in long-term users, the citation needs to be updated to reflect the appropriate study.  Without such an update, the unsupported claim should not be reinserted in the article.  It was most likely originally based on an incomplete reading or understanding of the study in citation #36.
24.17.183.46 (talk) 22:16, 19 September 2009 (UTC)
thread_title:  Information Not Supported by Current Citation 

message: Why doesn't this article mention decreased sex drive caused by the use of depo?
Here's a quick source--just look on google for more:
http://answers.google.com/answers/threadview/id/785123.html  —Preceding unsigned comment added by 209.211.34.13 (talk) 23:24, 11 October 2009 (UTC)
thread_title:  Decreased sex drive? 

message: This site: [Youtube] has a video about this product.Agre22 (talk) 14:07, 22 November 2009 (UTC)
thread_title: Bone loss

message: The article is weak about the depo-provera's use in chemical castration in men.Agre22 (talk) 13:45, 29 December 2009 (UTC)
thread_title: Chemical castration

message: It would be great if there were another page, or at least a redirect page, that wasn't dependent on the Depo Provera brand name for progestin-only injectable contraceptives. Something like the Combined injectable contraceptive  or Contraceptive impant pages. Was trying to clean up some pages and remove brand names and redirect to types of contraceptives instead. Sorry, as a newbie can't really figure out how to do this myself.  —Preceding unsigned comment added by Emhawkins (talk • contribs) 07:56, 4 July 2010 (UTC)
thread_title:  Progestin-Only Injectable Contraceptive 

message: Hello fellow Wikipedians,
I have just added archive links to  on Depot medroxyprogesterone acetate. Please take a moment to review my edit. If necessary, add  after the link to keep me from modifying it. Alternatively, you can add  to keep me off the page altogether. I made the following changes:
*Added archive https://web.archive.org/20060506074850/http://www.issuesinmedicalethics.org:80/131di008.html to http://www.issuesinmedicalethics.org/131di008.html
When you have finished reviewing my changes, please set the checked parameter below to true to let others know.
Cheers. —cyberbot IITalk to my owner:Online 01:03, 19 October 2015 (UTC)
thread_title:  External links modified 

message: In an effort to reduce duplication. We should not have a separate article for each method of using this medication. It was simply a lot of duplication of content. Doc James (talk · contribs · email) 23:13, 23 December 2016 (UTC)
thread_title: Redirected to [[Medroxyprogesterone acetate]]