To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months.
In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months.
From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4–5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P=.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment.
Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy.
ClinicalTrials.gov, https://clinicaltrials.gov, NCT01902485.
Our data indicate that timing of depot medroxyprogesterone acetate injection does not substantially increase surgery risk after medical abortion and may not reduce repeat pregnancy.
Gynuity Health Projects, New York, New York; the Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Secretariat of Health, Mexico City, Mexico; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Planned Parenthood of the Pacific Southwest, San Diego, California; Planned Parenthood of Southern New England, New Haven, Connecticut; Planned Parenthood Northern California, San Rafael, California; the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and Johns Hopkins University, Baltimore, Maryland.
Corresponding author: Elizabeth G. Raymond, MD, MPH, Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY 10010; e-mail: firstname.lastname@example.org.
Financial support provided by an anonymous donor. The funder had no role in the development of the study question or the study design or in the collection, storage, or analysis of data.
Financial Disclosure Dr. Jamshidi is a Nexplanon trainer (Merck). The other authors reported no potential conflicts of interest.
Presented at the 2015 National Abortion Federation Annual Meeting, April 18–21, 2015, Baltimore, Maryland; the XXI FIGO World Congress of Obstetrics and Gynecology, October 4–9, 2015, Vancouver, Canada; the Fifth Research Meeting on Unwanted Pregnancy and Unsafe Abortion: Public Health Challenges in Latin America and the Caribbean, September 28–30, 2015, Mexico City, Mexico; the North American Forum on Family Planning, November 14–16, 2015, Chicago, Illinois; and the 3rd International Congress on Women's Health and Unsafe Abortion, January 26–29, 2016, Bangkok, Thailand.
The authors thank the following personnel who were instrumental in collecting study data: Teresa López Flores and Maribel Martínez-Jiménez, Secretariat of Health, Mexico City; L. Fields, D. Freedman-Shara, G. Ward, J. Wilder, and S. Dobson, Planned Parenthood of Southern New England; Planned Parenthood of the Pacific Southwest Chula Vista Health Center; Jessica McClusky, Boston Medical Center; Jennifer Fortin and Sarah McKetta, Planned Parenthood League of Massachusetts; Margarita Avelar and Mariela Garcia, Planned Parenthood Northern California; and Torri Ross, Bayview Medical Center. The authors also thank Jennifer Britton, who managed study data at Gynuity.
The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.