Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation
Background Intellectual disability is defined as an IQ of 70 or below. Women with intellectual disability frequently experience menstrual distress leading to the use of hormonal medications such as depot medroxyprogesterone acetate (DMPA). Despite risks such as reduced bone mineral density (BMD) a...
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Cambridge University Press
2025-09-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472425007860/type/journal_article |
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| author | Marianne Bergman Alaa Martin |
| author_facet | Marianne Bergman Alaa Martin |
| author_sort | Marianne Bergman |
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Background
Intellectual disability is defined as an IQ of 70 or below. Women with intellectual disability frequently experience menstrual distress leading to the use of hormonal medications such as depot medroxyprogesterone acetate (DMPA). Despite risks such as reduced bone mineral density (BMD) and weight gain, DMPA is widely used in this cohort, prompting investigation into its suitability and risks.
Aims
A narrative review and local service evaluation were conducted to determine whether clinical management reflected recommendations in the literature.
Method
PsycINFO and Medline were searched for articles post-1995 on contraception in menstruating women with intellectual disability. Contraceptive use in 100 randomly selected women was evaluated. Data were collected on physical health issues, general practitioner records were reviewed for contraceptive administration and risk discussions, and surveys assessed risk understanding and satisfaction.
Results
The review identified 27 papers with higher DMPA use in the intellectual disability population compared to the general population, and specific BMD risks. The case series found 23 women with intellectual disability using DMPA, and revealed knowledge gaps in risk and monitoring, inappropriate use given individual risk, and poor proactive risk management.
Conclusions
Findings indicate disproportionate DMPA use in women with intellectual disability, with inadequate clinical justification and risk awareness. Many women and carers were unaware of BMD risks, and DMPA alternatives were rarely considered. Individualised contraceptive management and closer review of DMPA use in this cohort is needed. Monitoring could include dual X-ray absorptiometry (DEXA) scans, vitamin D and calcium supplementation, and weight management. Further research is needed into higher DMPA use and risks within this population.
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| format | Article |
| id | doaj-art-e2bb2a66c7334c0690b7cf8b7b627bfd |
| institution | Kabale University |
| issn | 2056-4724 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj-art-e2bb2a66c7334c0690b7cf8b7b627bfd2025-08-20T04:58:23ZengCambridge University PressBJPsych Open2056-47242025-09-011110.1192/bjo.2025.786Injectable contraceptive use in women with intellectual disability: narrative review and service evaluationMarianne Bergman0https://orcid.org/0009-0004-0279-7102Alaa Martin1Essex Partnership University Trust, Wickford, UKIntellectual Disability, Hertfordshire Partnership Foundation Trust, Hatfield, UK Background Intellectual disability is defined as an IQ of 70 or below. Women with intellectual disability frequently experience menstrual distress leading to the use of hormonal medications such as depot medroxyprogesterone acetate (DMPA). Despite risks such as reduced bone mineral density (BMD) and weight gain, DMPA is widely used in this cohort, prompting investigation into its suitability and risks. Aims A narrative review and local service evaluation were conducted to determine whether clinical management reflected recommendations in the literature. Method PsycINFO and Medline were searched for articles post-1995 on contraception in menstruating women with intellectual disability. Contraceptive use in 100 randomly selected women was evaluated. Data were collected on physical health issues, general practitioner records were reviewed for contraceptive administration and risk discussions, and surveys assessed risk understanding and satisfaction. Results The review identified 27 papers with higher DMPA use in the intellectual disability population compared to the general population, and specific BMD risks. The case series found 23 women with intellectual disability using DMPA, and revealed knowledge gaps in risk and monitoring, inappropriate use given individual risk, and poor proactive risk management. Conclusions Findings indicate disproportionate DMPA use in women with intellectual disability, with inadequate clinical justification and risk awareness. Many women and carers were unaware of BMD risks, and DMPA alternatives were rarely considered. Individualised contraceptive management and closer review of DMPA use in this cohort is needed. Monitoring could include dual X-ray absorptiometry (DEXA) scans, vitamin D and calcium supplementation, and weight management. Further research is needed into higher DMPA use and risks within this population. https://www.cambridge.org/core/product/identifier/S2056472425007860/type/journal_articleContraceptionhormonesintellectual disabilityphysical health |
| spellingShingle | Marianne Bergman Alaa Martin Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation BJPsych Open Contraception hormones intellectual disability physical health |
| title | Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation |
| title_full | Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation |
| title_fullStr | Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation |
| title_full_unstemmed | Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation |
| title_short | Injectable contraceptive use in women with intellectual disability: narrative review and service evaluation |
| title_sort | injectable contraceptive use in women with intellectual disability narrative review and service evaluation |
| topic | Contraception hormones intellectual disability physical health |
| url | https://www.cambridge.org/core/product/identifier/S2056472425007860/type/journal_article |
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