“Is there a specific amount of weight gain in a client that would be unacceptable to continuing DMPA if that is her method of choice? We have tried other options and she wants to use DMPA despite a significant amount of weight gain. Thank you.”
This is a great question, and I have not seen a specific number of pounds or percentage of BMI change that is a contraindication to DMPA (Depo Provera) use. But I agree it is concerning and should prompt discussing other methods, which you’ve done. The CDC rates use of Depo in obese adults with BMI ≥ 30 a category “1” (use under any circumstances) and for those CDC explanation of their rating, they do not address excessive weight gain with use or mention this as a reason to stop.
It is interesting that she doesn’t seem concerned about her weight gain, although this is a reason for discontinuation in 12-19% of users. We know that those who gain weight early in their use tend to continue to gain weight. We also know that baseline obesity is a risk factor for weight gain on Depo.
I’d be interested to know how much weight she’s gained, because that might influence me. Twenty pounds? 35? 50? 100? I completely agree that as a provider you want her to understand the risks to her body with excessive weight gain—not easy to shed and may contribute to health problems. Yet, if it is the only method she will use, you want her to continue to prevent unintended pregnancy.
Are there new or creative ways to convey to her your discomfort with providing her something that may negatively impact her? And reassure her how you will help her manage the side effects of a new method that may be better for her?
I would also review diet. One quick message that I have found people respond to is not to “drink their calories,” including juices and smoothies which many people assume are healthy, and don’t realize can cause excessive calorie intake.
If I were her provider, I’d want to know the following: what is it that she specifically likes about Depo Provera?
The privacy that no one will find a pill pack? The convenience of not having to ingest a method – or apply, or place vaginally? Likes coming to clinic and having you administer the injection, or injecting it herself? If she likes these features, it makes me think she may like a long-acting method like implants and IUDs.
I would encourage her to try another method with the qualities she like in Depo, and with the understanding you can always discontinue the method if she doesn’t like it – even a long-term method. But, to answer your question, there appears to be no specific amount of weight gain that is a contraindication to use.
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