SUBCUTANEOUS DEPO-MEDROXYPROGESTERONE ACETATE (DMPA-SC) USE IN OBESE AND MORBIDLY OBESE WOMEN: INCIDENCE OF OVULATION AND FOLLICULAR DEVELOPMENT by Penina Segall-Gutierrez
A Thesis Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE (CLINICAL AND BIOMEDICAL INVESTIGATIONS) December 2007
Copyright 2007 Penina Segall-Gutierrez
Background: Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the morbidly obese population. The purpose of this 26-week prospective experimental study is to determine incidence of ovulation and follicular development among obese and morbidly obese women after DMPA-SC.; Methods: Five normal weight, 5 obese, and 3 morbidly obese women received injections of DMPA-SC at baseline and 12 weeks. Weekly progesterone levels (P4), bimonthly estradiol (E2), and monthly medroxyprogesterone acetate (MPA) levels were measured by immunoassay methods.; Results: After the first week of DMPA-SC, no subject had evidence of ovulation. There was large inter-subject and intra-subject variability in E2 levels. Median MPA levels remained above the contraceptive threshold, but were lower among obese and morbidly obese subjects.; Conclusion: Fluctuating E2 levels reflective of follicular development occurred more often among obese and morbidly obese women after DMPA-SC Injection. Further studies should address the pharmacokinetics of DMPA-SC in morbidly obese women.