HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by MILLER, L. Articles by ESCHENBACH, D. A. Search for Related Content PubMed PubMed Citation Articles by MILLER, L. Articles by ESCHENBACH, D. A.

Depomedroxyprogesterone-induced Hypoestrogenism and Changes in Vaginal Flora and Epithelium

From the Departments of Obstetrics and Gynecology, and Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington.

Address reprint requests to: David A. Eschenbach, MD University of Washington Department of Obstetrics and Gynecology Box 356460 Seattle, WA 98195-6460 E-mail: eschen{at}u.washington.edu

Objective: To identify the effects of depomedroxyprogesterone acetate (DMPA) on vaginal microbial flora and epithelium.

Methods: Women who desired DMPA for contraception were evaluated before and at 3 and 6 months after initiation of 150-mg DMPA injections every 3 months. At each visit, we assessed genital symptoms, vaginal signs, vaginal micro-flora, and histopathology by vaginal biopsies.

Results: Among 38 women observed for 6 months, there was significant reduction in mean serum estradiol level (99.9 ± 9.3 pg/mL to 26.6 ± 1.6 pg/mL, P < .001). The number of subjects with any Lactobacillus did not change, but the number with hydrogen peroxide (H₂O₂)–positive Lactobacillus decreased from 20% before to 12% after 6 months of DMPA (P = .005). The log concentration in colony-forming units per milliliter of vaginal fluid of H₂O₂–positive Lactobacillus decreased in a linear manner from 4.0 ± 0.6 at baseline to 2.5 ± 0.6 after 6 months of DMPA use (P = .006). The mean number of cell layers in the epithelium was reduced slightly from 28.1 ± 0.7 to 25.9 ± 0.9 (P = .05), epithelial thickness decreased from 1.02 ± 0.04 mm to 0.89 ± 0.05 mm (P = .005), and the glycogen-positive thickness decreased from 0.81 ± 0.04 mm at baseline to 0.66 ± 0.05 after 6 months of DMPA use (P = .005).

Conclusion: Depomedroxyprogesterone acetate produced a systemic hypoestrogenic state associated with decreased H₂O₂–positive Lactobacillus colonization and slight thinning of the glycogen vaginal epithelial layer. Such changes possibly compromise the vaginal barrier to infection.

This article has been cited by other articles:

				L. Myer, L. Denny, T. C Wright, and L. Kuhn Prospective study of hormonal contraception and women's risk of HIV infection in South Africa Int. J. Epidemiol., February 1, 2007; 36(1): 166 - 174. [Abstract] [Full Text] [PDF]

				S. Ehrstrom, A. Yu, and E. Rylander Glucose in Vaginal Secretions Before and After Oral Glucose Tolerance Testing in Women With and Without Recurrent Vulvovaginal Candidiasis Obstet. Gynecol., December 1, 2006; 108(6): 1432 - 1437. [Abstract] [Full Text] [PDF]

				R. H. Beigi, L. A. Meyn, D. M. Moore, M. A. Krohn, and S. L. Hillier Vaginal Yeast Colonization in Nonpregnant Women: A Longitudinal Study Obstet. Gynecol., November 1, 2004; 104(5): 926 - 930. [Abstract] [Full Text] [PDF]

				S. Veres, L. Miller, and B. Burington A Comparison Between the Vaginal Ring and Oral Contraceptives Obstet. Gynecol., September 1, 2004; 104(3): 555 - 563. [Abstract] [Full Text] [PDF]

				E Rylander, A-L Berglund, C Krassny, and B Petrini Vulvovaginal candida in a young sexually active population: prevalence and association with oro-genital sex and frequent pain at intercourse Sex. Transm. Inf., February 1, 2004; 80(1): 54 - 57. [Abstract] [Full Text] [PDF]

				A. K. Ildgruben, I. M. Sjoberg, and M.-L. K. C. Hammarstrom Influence of Hormonal Contraceptives on the Immune Cells and Thickness of Human Vaginal Epithelium Obstet. Gynecol., September 1, 2003; 102(3): 571 - 582. [Abstract] [Full Text] [PDF]

				M. B. Sorensen, P. Collins, P. J.L. Ong, C. M. Webb, C. S. Hayward, E. A. Asbury, P. D. Gatehouse, A. G. Elkington, G. Z. Yang, A. Kubba, et al. Long-Term Use of Contraceptive Depot Medroxyprogesterone Acetate in Young Women Impairs Arterial Endothelial Function Assessed by Cardiovascular Magnetic Resonance Circulation, September 24, 2002; 106(13): 1646 - 1651. [Abstract] [Full Text] [PDF]

				S. Cauci, S. Driussi, D. De Santo, P. Penacchioni, T. Iannicelli, P. Lanzafame, F. De Seta, F. Quadrifoglio, D. de Aloysio, and S. Guaschino Prevalence of Bacterial Vaginosis and Vaginal Flora Changes in Peri- and Postmenopausal Women J. Clin. Microbiol., June 1, 2002; 40(6): 2147 - 2152. [Abstract] [Full Text] [PDF]