What is the recommended depot medroxyprogesterone acetate (DMPA) dosage regimen for treating adenomyosis?

DMPA Dosage for Adenomyosis

I cannot provide a definitive evidence-based recommendation for DMPA dosage specifically for adenomyosis, as the provided evidence exclusively addresses contraception and endometriosis treatment, not adenomyosis.

Critical Evidence Gap

The available guidelines and research do not address adenomyosis as an indication for DMPA. The evidence provided focuses on:

• Contraceptive use of DMPA 1, 2
• Endometriosis-associated pain management 3, 4, 5, 6, 7
• Long-term safety considerations 8, 9

Extrapolation from Endometriosis Data (Use with Caution)

While adenomyosis and endometriosis share pathophysiologic similarities as estrogen-dependent conditions, direct extrapolation requires clinical judgment:

Standard DMPA Dosing Options

Two equivalent formulations exist for hormonal suppression:

• 150 mg intramuscularly every 13 weeks 1, 2
• 104 mg subcutaneously every 13 weeks 1, 2

Both formulations can be administered up to 2 weeks late (15 weeks from last injection) without loss of efficacy 1, 2.

Evidence from Endometriosis Studies

For endometriosis-associated pain, research demonstrates:

• DMPA-IM 150 mg every 3 months was effective in reducing pelvic pain, with 72.5% patient satisfaction at 1 year 5
• The optimal injection interval is every 3 months rather than monthly dosing 3
• DMPA-SC 104 mg every 3 months showed equivalent efficacy to leuprolide for endometriosis pain with less bone density loss 4

Important Clinical Considerations

Bone Health Monitoring

• Do not limit DMPA use to 2 years based solely on bone density concerns 8
• Counsel all patients on 1300 mg calcium daily, 600 IU vitamin D, weight-bearing exercise, and smoking cessation 1, 8

Common Side Effects

• Nearly all patients experience menstrual irregularities initially, typically improving over time 1, 8
• Weight gain occurs variably; early weight gain (>5% at 6 months) predicts continued excessive weight gain 8
• Return to fertility is delayed 9-18 months after discontinuation 8, 9

Administration Flexibility

• Self-administration of DMPA-SC 104 mg is an off-label option that may improve access 2
• No routine follow-up visits are required between injections 1, 2

What This Means for Adenomyosis

Without adenomyosis-specific evidence, any DMPA use for this indication would be off-label. If considering DMPA for adenomyosis based on its mechanism of endometrial suppression, the standard contraceptive dosing (150 mg IM or 104 mg SC every 13 weeks) would be the rational starting point, informed by the endometriosis literature showing efficacy at these doses.