Comments on: Bias against DMPA in favor of NET-EN http://www.infoforhealth.org/blog/?p=22 A conversation on the latest family planning and reproductive health information. Fri, 03 Sep 2010 19:08:32 +0000 http://wordpress.org/?v=2.1.3 By: Irina Yacobson http://www.infoforhealth.org/blog/?p=22#comment-10 Irina Yacobson Wed, 02 May 2007 19:30:19 +0000 http://www.infoforhealth.org/blog/?p=22#comment-10 It is important for providers to understand that in terms of safety there is no difference between DMPA and NET-EN. Both are considered very safe and offer some important non-contraceptive health benefits, although most of research was done around DMPA. Because they both contain progestin, NET-EN is expected to have the same health benefits as DMPA, although it was never demonstrated in clinical trials. The same way, no data are available on NET-EN and bone loss, but it is expected to have the same effect as DMPA. It is true that while DMPA and NET-EN have similar side effects, NET-EN affects bleeding patterns less than DMPA. With NET-EN one can expect shorter bleeding episodes in first 6 months and less absence of monthly bleeding after one year. At the same time providers should keep in mind that there are many women who would consider absence of menses, which is somewhat more common with DMPA, an advantage. So not all side effects are necessarily a negative. It is also true that fertility delay is generally less pronounced with NET-EN than with DMPA. Women who stop using DMPA become pregnant on average 10 months after their last injection. Women who stop using NET-EN become pregnant on average 6 months after their last injection. These are averages so a woman should not be worried if she has not become pregnant after 12 months after last injection. At the same time DMPA may be more convenient to use for many clients because it requires fewer visits to the clinic. So provider needs to decide if DMPA or NET-EN are safe for a woman and screen her for conditions that may preclude safe use of injectables. However, it is ultimately up to a woman to decide what is more important to her: fewer side effects, fertility return or convenience of use. Providers should be able to explore these issues with their clients while helping them to make an informed choice. Irina Yacobson, MD Family Health International It is important for providers to understand that in terms of safety there is no difference between DMPA and NET-EN. Both are considered very safe and offer some important non-contraceptive health benefits, although most of research was done around DMPA. Because they both contain progestin, NET-EN is expected to have the same health benefits as DMPA, although it was never demonstrated in clinical trials. The same way, no data are available on NET-EN and bone loss, but it is expected to have the same effect as DMPA.

It is true that while DMPA and NET-EN have similar side effects, NET-EN affects bleeding patterns less than DMPA. With NET-EN one can expect shorter bleeding episodes in first 6 months and less absence of monthly bleeding after one year. At the same time providers should keep in mind that there are many women who would consider absence of menses, which is somewhat more common with DMPA, an advantage. So not all side effects are necessarily a negative.

It is also true that fertility delay is generally less pronounced with NET-EN than with DMPA. Women who stop using DMPA become pregnant on average 10 months after their last injection. Women who stop using NET-EN become pregnant on average 6 months after their last injection. These are averages so a woman should not be worried if she has not become pregnant after 12 months after last injection.

At the same time DMPA may be more convenient to use for many clients because it requires fewer visits to the clinic.

So provider needs to decide if DMPA or NET-EN are safe for a woman and screen her for conditions that may preclude safe use of injectables. However, it is ultimately up to a woman to decide what is more important to her: fewer side effects, fertility return or convenience of use. Providers should be able to explore these issues with their clients while helping them to make an informed choice.

Irina Yacobson, MD
Family Health International

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