Efficacy of Fennel and Combined Oral Contraceptive on Menstrual Bleeding is Women using Depot Medroxyprogesterone Acetate: A Randomized Placebo –Controlled Trial.

Abstract

Abstract: Objective: Depot medroxyprogesterone acute (Depo –Provera) as an Injectable contraceptive mostly has such advantages as high efficiency, reversibility, and feasible usage. Menstrual cessation (amenorrhea) is one if the main complications of Depo Provera which can be the important reason for discontinuing it and increasing increase the unintended pregnancies. Therefore, the effective and safe approach to resolve this complication can result in higher using rate of this contraceptive method. We aimed to determine the efficacy of fennel capsules and low –dose combined oral contraceptive (LD-COC) pills on inducing menstrual bleeding and method continuation in women using depot –medroxyprogesterone acetate (DMPA) who had no menstrual bleeding during the previous 45 to 140 days. Study design: In this double –blind, double –dummy trial, 78 married women referred to health centers in Hamadan, Iran who complained of menstrual cessation induced by DMPA, were randomly allocated into fennel, LD-COC or placebo groups with an allocation ratio of 1:1:1. All the participants received two capsules and one pill daily for 21 days. We evaluated menstrual bleeding using the Higham pictorial chart within 40 days following beginning the intervention. Data were analyzed using SPSS 16. The significance level was considered lower than 0.05. Results: There was no loss to follow –up. Occurrence of menstrual bleeding among women receiving fennel (73%) and those receiving LD-COC (81%) was significantly higher (RR 3.1, 95%CI 1.6 to 6.2; RR 4.2, 95%CI 1.9 to 9.4, respectively) compared to the placebo groups (19%). Mean amount of menstrual bleeding among women who experienced menstruation in fennel group (21cc) was higher compared to placebo (MD 9, 95%CI 7 to 11) and LD-COC (MD 6, 95%CI 5 TO 8) groups. The rate of injection of subsequent DMPA in women using fennel (73%) and LD-COC (65%) were significantly higher compared to women using placebo (31%); (RR 2.5, 95%CI 1.3 to 3.7), respectively. Conclusion: Fennel and LD-COC can resolve DMPA induced amenorrhea and increase continuation rate of this contraceptive method.