A 31-year-old woman receives intramuscular depot medroxyprogesterone acetate (DMPA) 150 mg. She should be counselled that the injection is repeated every 12 weeks and that the adverse effect requiring specific counselling before initiation is:

• A Immediate loss of protection against sexually transmitted infections compared with other progestogens
• B Permanent infertility after two years of use
• C Increased risk of venous thromboembolism comparable to combined pills
• D Reversible reduction in bone mineral density with prolonged use ✓

Explanation

DMPA suppresses estradiol and causes a reversible decline in bone mineral density; FDA boxed warning and WHO guidance advise counselling, especially in adolescents and users beyond 2 years. Return of fertility may be delayed several months but infertility is never permanent, killing option B. As a progestin-only method it carries minimal thrombotic risk, which kills option C. All contraceptives except condoms offer no STI protection regardless of type, killing option A.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.