METHODS: This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression.
RESULTS: We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the \'>\' and \'<\' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively.
CONCLUSIONS: These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.
方法:这是对避孕选择和艾滋病毒结局的证据(ECHO)随机试验数据的二次分析,该试验来自埃斯瓦蒂尼的12个地点的7,829名未感染艾滋病毒的妇女,肯尼亚,寻求避孕的南非和赞比亚被随机分配到肌内储库-醋酸甲羟孕酮(DMPA-IM),铜宫内节育器(Cu-IUD)或左炔诺孕酮(LNG)植入物。使用3个月的行为问卷收集12至18个月的数据,这些问卷依赖于前3个月的召回,用于估计基线后性行为的相对风险,以及使用改良泊松回归分析随机分组之间的性欲和月经出血。
结果:我们观察到较小但总体上一致的影响,其中DMPA-IM使用者报告的特定高风险性行为的患病率低于植入使用者,低于Cu-IUD使用者(\'>\'和\'<\'符号表示统计学上的显着差异):多个性伴侣分别为3.6%<4.8%<6.2%;新性伴侣3.0%<4.0%<5.3%;性伴侣;性70%;过去7天无保护性行为33%<36%,37%;性交时阴道出血7.1%,7.1%<8.9%;无性行为4.1%,3.8%,3.4%(DMPA-IM>Cu-IUD);伴侣与他人发生性关系10%<11%,11%。唯一的例外是有96.5%的性伴侣,96.9%<97.4%(DMPA-IM
结论:这些研究结果表明,接受DMPA-IM治疗的女性,相对于植入物,性欲和性活动可能有适度下降,和相对于Cu-IUD的植入物。我们发现DMPA-IM比植入物更多的月经紊乱(正如预期的那样,两者都比Cu-IUD多)。这些发现对于告知妇女和决策者的避孕选择非常重要,并强调需要对其他避孕方法的效果进行强有力的比较。