Depomedroxyprogesterone-induced Hypoestrogenism and Changes in Vaginal Flora and Epithelium

Leslie Miller, Dorothy L. Patton, Amalia Meier, Soe Soe Thwin, Thomas M. Hooton, David A. Eschenbach

Research output: Contribution to journalArticlepeer-review

151 Scopus citations


Objective: To identify the effects of depomedroxyprogesterone acetate (DMPA) on vaginal microbial flora and epithelium. Methods: Women who desired DMPA for contraception were evaluated before and at 3 and 6 months after initiation of 150-rng DMPA injections every 3 months. At each visit, we assessed genital symptoms, vaginal signs, vaginal microflora, and histopathology by vaginal biopsies. Results: Among 38 women observed for 6 months, there was significant reduction in mean serum estradiol level (99.9 ± 9.3 pg/mL to 26.6 ±1.6 pg/mL, P < .001). The number of subjects with any Lactobacillits did not change, but the number with hydrogen peroxide (H2O2)-positive Lactobacillus decreased from 20% before to 12% after 6 months of DMPA (P = .005). The log concentration in colony-forming units per milliliter of vaginal fluid of H2O2-positive Lactobacillns decreased in a linear manner from 4.0 ±0.6 at baseline to 2.5 ±0.6 after 6 months of DMPA use (P = .006). The mean number of cell layers in the epithelium was reduced slightly from 28.1 ±0.7 to 25.9 ±0.9 (P = .05), epithelial thickness decreased from 1.02 ±0.04 mm to 0.89 ± 0.05 mm (P = .005), and the glycogen-positive thickness decreased from 0.81 ±0.04 mm at baseline to 0.66 ±0.05 after 6 months of DMPA use (P = .005). Conclusion: Depomedroxyprogesterone acetate produced a systemic hypoestrogenic state associated with decreased H2O2-positive Lactobacillns colonization and slight thinning of the glycogen vaginal epithelial layer. Such changes possibly compromise the vaginal barrier to infection.

Original languageEnglish (US)
Pages (from-to)431-439
Number of pages9
JournalObstetrics and gynecology
Issue number3
StatePublished - Aug 23 2000
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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