***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION This 7-year , prospect i ve , matched-cohort , clinical study evaluated the effects of intramuscular depot medroxyprogesterone acetate ( DMPA ) ( 150 mg/mL ) on  bone mineral density ( BMD ) in women aged 25 - 35 years . METHODS Bone mineral density changes in new DMPA-IM users ( n=248 ) were compared with those in women using nonhormonal contraception ( n=360 ) for up to 240 weeks of treatment and 96 weeks of posttreatment follow-up ( in subjects receiving > or=1 dose ) . RESULTS At week 240 of treatment , mean percentage changes from baseline in DMPA-IM vs. nonhormonal subjects were : -5.16 % ( n=21 ) vs. + 0.19 % ( n=65 ) , total hip ( p<.001 ) ; -5.38 % ( n=33 ) vs. + 0.43 % ( n=105 ) , lumbar spine ( p<.001 ) . At week 96 posttreatment , these values were : -0.20 % ( n=25 ) vs. + 0.84 % ( n=43 ) , total hip ( p=.047 ) ; -1.19 % ( n=41 ) vs. + 0.47 % ( n=66 ) , lumbar spine ( p=.017 ) . CONCLUSIONS These results show BMD declines during DMPA-IM use ; following discontinuation , significant increases in BMD occur through 96 weeks posttreatment A r and omized , single blind comparative trial of norethindrone enanthate ( NET-ENT ) and depo-medroxyprogesterone acetate ( DMPA ) was conducted in the Model Clinic , Decca , Bangladesh , to determine if there were differences in reported side effects , reasons for discontinuation and discontinuation rates of these two injectables . On all follow-up visits the proportion of women reporting no bleeding ( amenorrhea ) was higher for the DMPA clients compared to the NET-ENT clients . Concurrent with these findings , the proportion of women reporting irregular bleeding was consistently higher for the NET-ENT clients . Concurrent with these findings , the proportion of women reporting irregular bleeding was consistently higher for the NET-ENT clients compared to those receiving DMPA . By the fourth injection , less than 15 % of the clients in both drug groups still reported having regular cyclic bleeding ( 4 of the 26 DMPA clients and 4 of the 28 NET-ENT clients ) . Five of the 133 women on DMPA and 6 of the 106 women on NET-ENT became pregnant while using the injectables . At the end of one year of follow-up , 14 of the 133 DMPA and 14 of the 106 NET-ENT clients were still continuing ( came back for a fifth injection ) Final results are presented from a two-year WHO multinational comparative trial of three regimens : depot-medroxyprogesterone acetate ( DMPA ) given at 90-day intervals , norethisterone enanthate ( NET-EN ) given at 60-day intervals for the entire study period ( NET-EN ( 60-day ) ) , and NET-EN given at 60-day intervals for six months and thereafter at 84-day intervals ( NET-EN ( 84-day ) ) . 1587 DMPA subjects were observed for 20,550 woman-months , 789 NET-EN ( 60-day ) subjects were observed for 10,361 woman-months , and 796  NET-EN ( 84-day ) subjects were observed for 10,331 woman-months . This clinical trial represents the largest clinical trial undertaken on injectable contraceptives . After two years , the pregnancy rate with NET-EN ( 84-day ) was 1.4 ( + /- 0.6 S.E. ) per 100 women , as compared with the two-year rates of 0.4 ( + /- 0.3 S.E. ) per 100 women observed with DMPA and 0.4 ( + /- 0.2 S.E. ) with NET-EN ( 60-day ) . Both discontinuation rates for amenorrhea and the prevalence of amenorrhea lasting more than 90 days were significantly higher with DMPA than with either NET-EN regimen . Terminations for bleeding problems were similar with the three treatments , despite a better cyclic pattern for the first six months with the NET-EN regimens . The three treatments were comparable with respect to discontinuation rates for other medical or personal reasons , and for all reasons combined . For family planning programs , NET-EN ( 60-day ) has the advantage of low pregnancy rates compared to NET-EN ( 84-day ) , and a schedule of administration that does not change . Both NET-EN regimens produce less amenorrhea than DMPA . However , the NET-EN ( 60-day ) regimen has the logistic and economic disadvantage of requiring more frequent injections . All three injectable regimens compare favourably with oral contraceptives in terms of pregnancy and total continuation rates observed in clinical trial setting OBJECTIVE This study aims to assess changes in bleeding patterns with the use of depot medroxyprogesterone acetate ( DMPA ) 104 mg/0.65 ml subcutaneous injection ( DMPA-SC 104 ) . STUDY DESIGN An analysis was conducted using data from two 1-year , noncomparative clinical trials ( N=1787 ) and a 2-year r and omized study comparing DMPA-SC 104 ( N=266 ) with DMPA intramuscular injection ( DMPA-IM ) .  Bleeding was analyzed per 30-day interval by category and number of days . Analyses also were performed for age and body mass index ( BMI ) subgroups and for the percentages of women shifting from bleeding/spotting to amenorrhea after each injection . RESULTS Each study showed decreased incidence of irregular bleeding and increased amenorrhea with continued use of DMPA-SC 104 . Rates of amenorrhea at Month 12 ( 52 - 64 % across studies ) and Month 24 ( 71 % in the 2-year trial ) were comparable with those originally reported for DMPA-IM .  Changes in bleeding patterns showed no consistent differences according to age or BMI . The percentages of subjects shifting from bleeding and /or spotting to amenorrhea increased with each subsequent injection . CONCLUSION Clinical data show that the incidence of amenorrhea increases over time with the use of DMPA-SC 104 The acceptability of 2 and 3 month injectable contraceptives was assessed and compared , and the acceptability of the injectables was further compared with that of oral contraceptives ( OCs ) and IUDs among a r and om sample of women , who attended a clinic in Alex and ria , Egypt . The study was conducted by the University of Alex and ria . The sample included 100 acceptors of the 2-month injectable , norethisterone oenanthate ( NET-O EN ) , 100 acceptors of the 3-month injectable , depo-medroxy pregesterone acetate ( DPMA ) , 60 OC acceptors , and 60 IUD acceptors .  The women were interviewed prior to treatment and 2 or 3 times during the 6 months following their initial acceptance of the methods . Women who discontinued at any time during the 6-month period were interviewed concerning their reasons for discontinuing . The data was analyzed by calculating means and % distribution and by testing for significance . The percent lost to follow up was 12 % for the NET-O EN group , 12 % for DPMA users , and 0 % for IUD and OC acceptors . The mean age of the acceptors was 30.4 years for NET-O EN , 30.7 years for DMPA , 28.3 years for OCs , and 25.2 years for IUDs . For these acceptor groups , the respective mean number of years of schooling was 6.1 , 5.2 , 7.2 , and 7.5 , and the respective mean number of pregnancies was 5.6 , 5.4 , 3.8 , and 2.9 . All 320 of the women were married , and 319 were Muslim . 99.4 % lived in urban areas . 10 % had no living male children , and 23.7 % had no living female children . 2/3 of the injectable acceptors previously used 2 or more fertility control methods . A higher percent of IUD and OC acceptors , compared to injectable acceptors , reported using only 1 or no previous method . More than 1/2 of the injectable acceptors reported disruptions in their normal bleeding patterns . NET-O EN acceptors were more likely to experience heavy or prolonged bleeding while DPMA acceptors were more likely to report amenorrhea or a decreased flow . IUD acceptors were also bothered by bleeding problems . Almost all the women who reported changes in bleeding patterns were unhappy about the changes . Many of the women who reported amenorrhea worried that they might be pregnant . Women who experienced heavy or unpredictable bleeding worried about anemia and complained that bleeding interfered with their daily routines . 47.6 % of the women reported weight gains , but this was generally viewed as an advantage . Nausea was the major side effect associated with OC use . 32 % of the OC users , 28.0 % of the NET-E ON users , 30.0 % of the DMPA users , and none of the IUD users reported nausea . For all 4 groups , convenience and effectiveness were the major advantages the women attributed to their chosen method . Continuation rates were 68 % for NET-O EN , 70 % for DMPA , 75 % for OCs , and 75 % for IUDs . The major reason for discontinuation of injectables was bleeding problems . Among injectable users , a higher proportion of discontinuers ( 49 % ) than of continuers ( 20 % ) reported amenorrhea . The findings suggest that continuation for injectables could be improved if patients were given more detailed information about possible side effects and if they were advised to return to the clinic for treatment of any symptoms they experience The present work was a r and omized comparative study of two injectable progestogen-only contraceptives . The first group ( 200 subjects ) received 150 mg of depotmedroxyprogesterone acetate ( Depoprovera ) every 84 + /- 7 days and the second ( 200 subjects ) received 200 mg of norethisterone enanthate ( Noristerat ) every 56 + /- 7 days . Acceptors of injectable contraceptives in Assiut , Egypt , were mainly women looking for fertility termination .  Menstrual disruption was the main side effect among both treatment groups . Amenorrhoea was the commonest menstrual complaint and was the main reason for discontinuation in both groups . Only one pregnancy occurred during NET-EN use ; two more pregnancies occurred , one in each of the two groups but there were indications that conception preceded the first injection . Menstrual irregularities were generally more frequent with DMPA  users . However , DMPA had better one-year continuation rates than NET-EN ( 68.8 + /- 3.5 and 57.1 + /- 3.6 per 100 women , respectively ) 
    Output:
    
While the choice between DPMA and NET-EN as injectable progestogen contraceptives may vary between both health providers and patients , data from r and omized controlled trials indicate little difference between the effects of these methods , except that women on DMPA are more likely to develop amenorrhoea .
There is inadequate data to detect differences in some non-menstrual major and minor clinical effects