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Experience with medroxyprogesterone acetate (Depo-Provera) as an injectable contraceptive.

Depo-Provera injections appear to be a safe and effective alternative for women who cannot tolerate the estrogenic side effects associated with oral contraceptives or the pain and bleeding associated with IUDs. However, women considering the method should be fully aware of the possible risks: (a) inability to withdraw the drug promptly in the event of a serious reaction, (b) disruption of menstrual patterns, and (c) delayed return of fertility after discontinuing therapy. Some women may consider the required trip to the doctor every 3 months an additional disadvantage. For women in developing countries where anemia and nutritional problems are prevalent, Depo-Provera has additional advantages in relation to IUDs and OCs: it causes less bleeding than IUDs or OCs and, unlike oral contraceptives, it does not suppress vitamin levels (4-8). Since it requires a trip to the doctor every 3 months, it also provides a better opportunity for medical supervision and care. For postpartum women who which to breastfeed their babies, Depo-Provera has the additional advantage of causing no adverse effect on lactation (1, 2, 13, 14, 16, 18, 19, 25, 32, 36).

Abnormalities, Drug-Induced↗

Possible effect of medroxyprogesterone acetate (MPA) in lymphoid blast crisis of chronic myelogenous leukemia.

A patient with a lymphoid blast crisis of a chronic myelogenous leukemia (CML) was treated with vindesine, vincristine and prednisone. Blasts disappeared from the peripheral blood but persisted at a level of 60% in the bone marrow. After 5 weeks of continuous therapy, the patient became thrombopenic, and 2 weeks later blasts rose to 31%. After 7 weeks, 1 g MPA was given daily p.o. and weekly vincristine treatment was resumed. Blasts disappeared again from the peripheral blood, thrombocytes rose to a maximum of 274 g/l, and a remission with less than 5% blasts was demonstrated in the bone marrow. In another relapse after withdrawal of MPA, estrogen and progesterone receptors (PR) were found in the leukemic cells. Thus, a remission was seen during treatment with vincristine, prednisone, and MPA after a deterioration with vincristine and prednisone alone in a PR-positive leukemia, and an effect of MPA in this lymphoid blast crisis of a CML has to be discussed.

Blast Crisis↗

Mammary carcinogenesis induced by N-methyl-N-nitrosourea (MNU) and medroxyprogesterone acetate (MPA) in BALB/c mice.

MPA induces mammary tumors in virgin BALB/c mice with an average latency of 52 weeks. In order to determine whether the simultaneous administration of a chemical carcinogen, N-methyl-N-nitrosourea (MNU), shortened the latency of MPA-induced tumors, a total of 60 virgin female BALB/c mice were treated with either MNU + MPA or MNU or MPA. The experiment lasted 7 months. The incidence and latency of mammary tumors were significantly different between the 3 groups: 15/19 (79%) in MNU + MPA-treated mice with a latency of 154 +/- 19 days; 3/20 (15%) in MNU-treated mice with a latency of 179 +/- 7 days; 0/20 (tumors only start appearing after 10 months) in MPA-treated mice. Histologically, MNU + MPA-induced tumors were similar to the few tumors observed in MNU-treated mice: most of them were type B adenocarcinomas with a high degree of necrosis and calcification. Only one of the MNU + MPA-induced tumors expressed high levels of ER and PR and proved to be MPA-responsive in further passages. All the other tumors showed low or non-detectable levels of ER and PR together with an independent pattern of tumor growth. In MNU-treated mice the only tumor that was transplanted proved to be hormone independent and had low levels of PR and ER. In both MNU and MNU + MPA treated mice lung adenocarcinomas were detected. Cystic uterine glandular hyperplasias were observed in all animals. It can be concluded that MPA and MNU potentiate their carcinogenic effect in mammary gland.

Adenocarcinoma↗