The safety of subcutaneously administered depot medroxyprogesterone acetate (104mg/0.65mL): A systematic review

Monica V. Dragoman, Mary E. Gaffield

Research output: Contribution to journalArticle

14 Scopus citations


Context: Depot medroxyprogesterone acetate (DMPA), a progestogen-only contraceptive injectable, has traditionally been formulated as a crystalline suspension delivered intramuscularly (IM) at a dose of 150. mg/1.0. mL. A new, lower dose formulation of DMPA (104. mg/0.65. mL) has been developed for subcutaneous administration (SC). Given its increasing global availability and public health relevance, DMPA-SC was prioritized for inclusion as a new method referenced in the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use (MEC), 5th Edition. Objective: This systematic review evaluated the published peer-reviewed literature regarding the safety of DMPA-SC among women with various characteristics or medical conditions. Results of this review informed the decision-making of a WHO Guideline Development Group in order to include recommendations on contraceptive eligibility within the revised MEC. Methods: We searched PubMed and Cochrane Library databases to identify all relevant evidence published in peer-reviewed journals regarding the safety of DMPA-SC when used by women of reproductive age, particularly those with select characteristics or conditions specified in the MEC, from inception through June 2015. The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force. Results: Fourteen studies met criteria for inclusion. Ten reported results relevant to DMPA users of varying age or with obesity, endometriosis or HIV; four compared the safety of DMPA-SC and DMPA-IM when used by general populations of healthy women. A randomized trial evaluating changes in bone mineral density among adult DMPA-SC and DMPA-IM users demonstrated no differences at 2. years of follow-up. Limited evidence reported no consistent differences in weight change or bleeding patterns according to age; however, adolescents (

Original languageEnglish (US)
StateAccepted/In press - Aug 6 2015
Externally publishedYes


  • Depot medroxyprogesterone
  • DMPA
  • Progestogen-only injectables
  • Safety
  • Subcutaneous

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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