Return to fertility after subcutaneous depot medroxyprogesterone acetate: a narrative review.
Level 5 - mechanism / opinion, no new human data
Narrative review of four trials without formal meta-analysis
PubMed 41184158 · doi:10.1136/bmjsrh-2025-202839
What was done
A narrative review searched multiple databases (including PubMed, Cochrane Library, EMBASE, Web of Science, Scopus, and WHO registries) for studies evaluating the time to return to fertility after standard-dose subcutaneous depot medroxyprogesterone acetate (DMPA SC 104 mg) in reproductive-aged women. Included trials compared DMPA SC against intramuscular formulations (DMPA IM) with follow-up durations ranging from 7.5 to 18 months after the final injection.
What was found
Four of 31 identified articles met inclusion criteria. The median time to ovulation for DMPA SC 104 mg was 212 days compared with 183 days for DMPA IM 150 mg, which was not statistically significantly different. There were no differences in time to ovulation across subgroups defined by region, body mass index, or age. No studies reported data on time to pregnancy or the effects of dosing duration or frequency.
Why it matters
These findings suggest that subcutaneous DMPA has a similar timeline for return of ovarian function compared to the intramuscular formulation, supporting equivalent counseling regarding return to fertility.
Limits
Only 4 studies met inclusion criteria, and total participant sample size was not reported in the abstract. Return to fertility was measured only via the surrogate outcome of return to ovulation, with no data on actual pregnancy rates or the impact of treatment duration.