Effect of depot medroxyprogesterone acetate on cardiometabolic risk factors among women of reproductive age in Rwanda: A prospective cohort study

Abstract

Objective: Depot medroxyprogesterone acetate (DMPA) injectable contraceptive is a widely used hormonal method that offers reversible and effective birth control for women worldwide. However, various studies have raised concerns regarding its potential association with increased cardiovascular disease risk, attributed to its influence on cardiometabolic risk factors. While previous studies have primarily focused on lipid profile, weight gain, blood pressure, and blood glucose, important aspects such as central obesity, glycated hemoglobin (HbA1C), and systemic inflammation have remained under-investigated. Thus, this study aimed to explore the influence of DMPA injectable contraceptives on lipid panel, HbA1C, visceral fat deposition, blood pressure, and inflammatory markers among women of childbearing age in Rwanda. Materials and Methods: The study was a prospective cohort and recruited an equal number of DMPA users (45) as the study group and users of nonhormonal (NH) contraceptives (45) as the control group. We recruited participants from two selected family planning centers in Kigali and collected data at baseline, 6 months, and 12 months. We measured the waist circumference, blood pressure, lipids profile (high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], total cholesterol [TC], and triglycerides [TG]), HbA1C, and high-sensitivity C-reactive protein (hs-CRP). We run the Mann–Whitney to compare the median (MD) change between DMPA and NH users. Data were presented as MD (interquartile range), with a significance level of 5%. Results: After a follow-up of 12 months, DMPA users experienced a significant increase in waist circumference, TG, LDL, TC, hs-CRP, and HbA1C ( P < 0.05), whereas they experienced a significant decrease in HDL than controls ( P < 0.05). However, our data did not indicate a significant difference in blood pressure changes between DMPA and NH users ( P > 0.05). Conclusion: The effect of DMPA injectable on cardiometabolic parameters was minimal in the first 6 months of use; however, it manifested statistically significant at 12 months of follow-up. It is recommended to initiate a follow-up with users at least 12 months of use and repeat every 6 months to check the status of cardiometabolic markers and intervene where necessary.