GRADE table 2(Question 2): Among healthy women or among a general population of women of reproductive age, do those who use depot medroxyprogesterone acetate (104 mg/0.65 mL) delivered subcutaneously (DMPA-SC) have an increased risk for serious adverse events or other relevant outcomes compared with those who use DMPA delivered intramuscularly (DMPA-IM)? (Indirect evidence)

OutcomeType and number of studies (number of participants)LimitationsInconsistencyImprecisionIndirectnessOther factorsQualityEstimate of effect
DMPA-SC vs DMPA-IM use in healthy women
Contraceptive efficacy1 RCT (n=534)No serious limitations
(1 good)		Cannot determine
(1 study)		Serious imprecisionNo indirectnessNoneVery lowLow rates of pregnancy with DMPA-SC and DMPA-IM
Weight gain1 study with pooled data from 3 studies (n=2321)Serious limitations (1 fair)Cannot determine
(1 study)		Serious imprecisionNo indirectnessNoneVery lowMedian weight gain 4.5 kg with DMPA-SC vs 5.8 kg with DMPA-IM at 36 months
Change in bleeding pattern1 RCT (n=534)No serious limitations
(1 good)		Cannot determine
(1 study)		Serious imprecisionNo indirectnessNoneVery lowNo differences in rates of intermenstrual bleeding or amenorrhoea between DMPA-SC vs DMPA-IM

DMPA: depot medroxyprogesterone acetate; IM: intramuscular; RCT: randomized controlled trial; SC: subcutaneous.

From: I, Development of the Medical eligibility criteria for contraceptive use, fifth edition

Cover of Medical Eligibility Criteria for Contraceptive Use
Medical Eligibility Criteria for Contraceptive Use. 5th edition.
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