Thyroid function patterns in Ghanaian women using depo-medroxyprogesterone acetate

Abstract

Background: The main hormonal contraceptives of choice for most women in Ghana are progestin-only injectables, norethisterone enanthate and depot-medroxyprogesterone acetate (DMPA). As more women adopt these short-to-medium-action injectable contraceptives, over time, they may develop a disruption in their body’s metabolic processes, which may result in dyslipidaemia and glucose intolerance or may impact thyroid hormone function. In Ghana, limited knowledge exists regarding the effects, biosynthesis and activity of thyroid hormones among users of progestin-only injectables. Aims: The aim is to evaluate thyroid function among women on progestin-only injectable contraceptives and those who are not. Materials and Methods: Two hundred women of reproductive age (18–45 years) were recruited for this study. Of these, 100 women were on the depot medroxyprogesterone, and 100 women had no history of taking hormonal contraceptives and served as controls. Sociodemographic and clinical information was obtained from recruits using a standard questionnaire. Each participant had venous blood samples taken and analysed for levels of free thyroxine (FT4), free triiodothyronine (FT3) and thyroid-stimulating hormones (TSH). Results: The DMPA group had significantly higher levels of FT4 ( P = 0.001) and considerably lower levels of TSH ( P = 0.011) than the non-DMPA group. Results also showed that fifteen women in the DMPA group had overt hyperthyroidism (low TSH and high FT4), seven had a diagnosis of subclinical hyperthyroidism (normal TSH and high FT4) and four had isolated high FT3 (normal TSH, normal FT4 and high FT3). Conclusions: The use of DMPA can lead to changes in thyroid hormone levels and hyperthyroidism.