Can progesterone injection be used in a 16-year-old adolescent?

From the Guidelines

Progesterone injections can be used in 16-year-old patients as a form of contraception, specifically depot medroxyprogesterone acetate (DMPA), with a typical failure rate of approximately 6% and administration every 12 weeks 1.

Key Considerations

• The use of DMPA in adolescents is supported by its effectiveness in preventing pregnancy and its convenience, with injections required approximately every 12 weeks 1.
• However, it's essential to consider the potential side effects, including weight gain, delayed return to fertility, menstrual bleeding irregularities, and bone mineral loss, which is largely reversible after DMPA discontinuation 1.
• Patients receiving DMPA injections should be counseled about age-appropriate recommendations for supplementation with calcium and vitamin D and regular weight-bearing exercise to maintain skeletal health 1.
• Alternative treatments like oral progesterone or hormonal contraceptives might be more appropriate for adolescents, depending on their specific medical conditions and needs 1.

Recommendations

• Before initiating DMPA treatment, a thorough evaluation including pregnancy testing, hormone level assessment, and consideration of the patient's medical history is essential 1.
• Pediatricians should counsel adolescents about the most effective contraceptive methods first, including DMPA, and discuss correct and consistent use, potential barriers to success, and adverse effects 1.
• The use of DMPA in adolescents should be tailored to each patient's individual needs and medical conditions, with careful consideration of the potential benefits and risks 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Use of Progesterone Injection in Adolescents

• The study 2 discusses the use of reversible interventions for menstrual management in adolescents with gender dysphoria or incongruence, including depot-medroxyprogesterone acetate as a contraceptive option that offers menstrual suppression.
• However, this study does not specifically address the use of progesterone injections in 16-year-old adolescents for other purposes.
• Another study 3 investigates the use of progesterone in women with early pregnancy bleeding, but it does not provide information on the use of progesterone injections in adolescents.
• Studies 4, 5, and 6 discuss the use of progestagens, including medroxyprogesterone acetate, for the treatment of endometriosis and other conditions, but they do not specifically address the use of progesterone injections in 16-year-old adolescents.

Safety and Efficacy

• The study 3 reports that women aged 16-39 years were included in the trial, suggesting that progesterone therapy may be safe for use in adolescents.
• However, the study 4 notes that there is limited evidence to support the use of progestagens, including medroxyprogesterone acetate, for pain associated with endometriosis, and that the depot progestagen group experienced significantly more adverse effects.
• The study 6 reports that oral medroxyprogesterone acetate was effective in relieving symptoms and improving endometriosis in women, but it does not provide information on the use of progesterone injections in adolescents.

Clinical Implications

• The study 5 highlights the importance of progesterone in various physiological processes, including the menstrual cycle and pregnancy, and notes that novel progesterone-based drugs have many important functions, including contraception and treatment of dysfunctional uterine bleeding.
• However, the use of progesterone injections in 16-year-old adolescents would require careful consideration of the potential benefits and risks, as well as the individual's specific medical needs and circumstances, as noted in study 2.