Why I'm Offering DMPA to Patients With Uterine Fibroids

Andrew M. Kaunitz, MD


May 20, 2022

This transcript has been edited for clarity.

Hello. I'm Andrew Kaunitz, professor and associate chair in the Ob/Gyn Department, University of Florida College of Medicine in Jacksonville. Today, I'd like to discuss depot medroxyprogesterone acetate (DMPA) and uterine fibroids.

Uterine leiomyoma (fibroids) is the most common gynecologic tumor. The prevalence is particularly high among Black women. Investigators funded by the NIH conducted a prospective study of fibroid incidence and growth by recruiting women living in the Detroit, Michigan, area who self-identified as Black or African American. Women aged 23-35 years at baseline, with no known history of fibroids, were interviewed and received gynecologic ultrasound evaluations approximately every 20 months for a total of four study visits. Among more than 1600 evaluable participants, baseline mean age was 29 years and almost one quarter had body mass indexes (BMIs) ≥ 40. Ever-use of any combination estrogen-progestin contraceptive or DMPA was 81% and 43%, respectively.

At baseline, one or more fibroids were identified in almost one quarter of participants. The overall incidence of fibroids between visits approached 10% and was similar between ever- and never-users of DMPA. However, the incidence in recent users (those who had used DMPA within the prior 2 years) was only one half the rate [of incidence] among never-users. The fibroid growth rate among recent DMPA users was 42% lower than in never-users with 18 months of follow-up.

Though the dimensions of fibroids had essentially stabilized among recent DMPA users, dimensions increased by more than 70% in never-users. Among women who had recently used DMPA, the likelihood of tumor shrinkage was more than 40%, twice as high as the rate among women who had never used DMPA.

Given that progestins can cause fibroid growth, the findings of this study might appear paradoxical. However, estradiol is known to upregulate fibroid progesterone-receptor expression and DMPA use lowers serum estradiol levels.

Gonadotropin-releasing hormone (GnRH) antagonists, as well as agonists, can reduce fibroid dimension as well as fibroid-related bleeding. However, these treatments are expensive and package labeling indicates that they should not be used more than 2 years. In contrast, DMPA is inexpensive and, notwithstanding the package labeling suggestion that duration of use be limited, decades of experience indicate that this agent can be safely used for many years. I am hopeful that this carefully conducted study will lead to more assessments of DMPA's role in the management of symptomatic uterine fibroids. Meanwhile, in my practice, I plan to discuss and offer DMPA in selected patients with fibroids.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.