Cardiometabolic Risk Marker Changes in Centrally Obese Women Using Depot Medroxyprogesterone Acetate (DMPA) in Kigali, Rwanda.

Abstract

Background: Hormonal contraceptives, such as depot medroxyprogesterone acetate (DMPA), are known to increase the risk of cardiometabolic disease, especially in obese users who are already at high risk.

Objectives: This study aimed to evaluate changes in lipid profile, glycated hemoglobin (HbA1C), blood pressure (BP), and inflammatory markers over a 12-month follow-up in centrally obese women using DMPA in Rwanda.

Methods: A prospective study involving 65 abdominally obese women (aged 15-49 years) was conducted at two family planning centres in Kigali. Measurements were taken at baseline, six months, and twelve months, including a lipid profile, HbA1c, BP, and high-sensitivity C-reactive protein (hs-CRP). Changes were analyzed using the Wilcoxon signed-rank test, with a significance level of 5%.

Results: The study demonstrated significant changes in the median of cardiometabolic parameters over 12 months of DMPA use. WC increased from 96(41) to 99.5(44) cm, TG from 1.15(2.40) to 1.53(3.63) mmol/L, while HDL-c decreased from 1.09(1.55) to 0.90(0.99) mmol/L (all P=0.001). Lipid ratios also increased significantly, where the TC/HDL-c increased from 3.54(5.92) to 5.99(8.58), and LDL-c/HDL-c from 2.63(4.8) to 4.68(7.38) (P=0.001).

Conclusion: Given these findings, assessing central obesity before initiating DMPA and performing cardiovascular risk evaluations every six months is recommended to mitigate adverse effects.