Real-World Effectiveness of Depot Medroxyprogesterone Acetate (DMPA): A Physician Survey on Failure Rates and Contributing Factors

Effectiveness of Depot Medroxyprogesterone Acetate (DMPA)

Abstract

Background:

Depot medroxyprogesterone acetate (DMPA) is a widely used contraceptive, but real-world data on its performance remain limited.

Objective:

This study evaluates physician-reported experiences with DMPA, focusing on failure rates, side effects, and prescribing trends.

Methods:

A cross-sectional survey of 34 obstetrician-gynecologists in Libya assessed: (1) contraceptive failure rates and causes, (2) side effect prevalence, (3) patient adherence behaviors, and (4) provider preferences. Quantitative data were analyzed descriptively; qualitative responses were thematically coded.

Results:

Failure rates: 61.8% of physicians reported 0–1% failure (consistent with perfect use), while 29.4% observed 2–3% failure (attributed to non-compliance [32.4%] and improper administration [29.4%]).

Side effects: Irregular bleeding affected 52.9% of users; 38.2% experienced multiple concurrent side effects. Discontinuation due to side effects occurred in 38.2% of cases.

Prescribing patterns: 50% of providers preferentially recommended DMPA for specific patients (e.g., those needing estrogen-free options), while 35.3% favored alternatives due to adherence challenges.

Conclusions:

While DMPA demonstrates high efficacy in ideal use, real-world effectiveness is compromised by adherence barriers and side effects. Targeted interventions—including improved provider training, patient counseling, and reminder systems—could optimize outcomes. These findings support individualized contraceptive counseling and underscore the need for accessible alternatives in clinical practice.