***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: OBJECTIVE To compare the efficacy and safety of SC depot medroxyprogesterone acetate ( DMPA-SC 104 ) with that of leuprolide acetate in treatment of endometriosis . DESIGN Phase 3 , multicenter , r and omized , evaluator-blinded , comparator-controlled trial . SETTING Clinical trial sites in Canada and United States . PATIENT(S ) Two hundred seventy-four women with surgically diagnosed endometriosis . INTERVENTION(S ) Intramuscular injections of DMPA-SC ( 104 mg ) or leuprolide acetate ( 11.25 mg ) , given every 3 months for 6 months , with 12 months of posttreatment follow-up . MAIN OUTCOME MEASURE(S ) Reduction in five endometriosis symptoms or signs ( dysmenorrhea , dyspareunia , pelvic pain , pelvic tenderness , pelvic in duration ) ; change in bone mineral density ( BMD ) , hypoestrogenic symptoms , bleeding , and weight . RESULT ( S ) The depot medroxyprogesterone acetate given SC was statistically equivalent to leuprolide in reducing four of five endometriosis symptoms or signs at the end of treatment ( month 6 ) and in reducing all five symptoms after 12 months ' follow-up ( month 18 ) . Patients in the  DMPA-SC 104  group showed significantly less BMD loss than did leuprolide  patients at month 6 , with scores returning to baseline at 12 months ' follow-up . No statistically significant differences in median weight changes were observed between groups . Compared with leuprolide , DMPA-SC 104 was associated with fewer hypoestrogenic symptoms but more irregular bleeding . CONCLUSION ( S ) Efficacy of DMPA-SC 104 was equivalent to that of leuprolide for reducing endometriosis-associated pain , with less impact on BMD and fewer hypoestrogenic side effects but more bleeding INTRODUCTION The study was conducted to assess the impact of depot medroxyprogesterone acetate subcutaneous injection 104 mg/0.65 mL ( DMPA-SC 104 ) on body weight . METHODS Changes in weight from pretreatment were analyzed using data from two 1-year , noncomparative trials of DMPA-SC 104 ( North/South American , N=722 ; European/Asian , N=1065 ) and a 3-year , r and omized study ( SC/IM ) comparing DMPA-SC 104  ( N=266 ) with the DMPA intramuscular injection 150 mg/mL ( DMPA-IM 150 ) . For each study , additional analyses were conducted for changes in body weight by age ( < 25 , 25 to 35 and > 35 years ) and body mass index  ( BMI ) ( < or=25 , > 25 to < or=30 and > 30 kg/m2 ) subgroups . RESULTS In both 1-year trials , the mean ( + /-SD ) weight gain at month 12 was < 2 kg [ 1.7 kg ( + /-4.5 SD ) in the Americas trial and 1.4 kg ( + /-3.6 SD ) in the Europe/Asia trial ] . In the SC/IM trial , mean weight changes were similar between DMPA-SC 104 and DMPA-IM 150 groups , with mean ( + /-SD ) gains at month 36 of 4.5+/-8.5 and 5.8+/-8.7 kg , respectively . Similar differences in weight gain were observed by age or baseline BMI in all studies . CONCLUSION DMPA-SC 104 was associated with modest weight gain in most women BACKGROUND The effects of subcutaneous depo-medroxyprogesterone acetate ( DMPA-SC ) injection on and rogenic markers in obese women have not previously been studied . STUDY DESIGN Five normal-weight [ body mass index ( BMI ) = 18.5 - 24.9 kg/m² ] , five obese ( BMI = 30 - 39.9 kg/m² ) and five extremely obese ( BMI ≥40 kg/m² ) women were recruited for this prospect i ve experimental study in which 104 mg DMPA-SC was administered at baseline and 12 weeks later . Serum levels of total testosterone ( T ) , and rostenedione ( A ) , dehydroepi and rosterone sulfate ( DHEAS ) , 3α- and rostanediol glucuronide and sex hormone-binding globulin ( SHBG ) were quantified by immunoassay methods at baseline and at 13 and 26 weeks following the first injection ; free T was calculated . RESULTS At baseline , obese women had lower levels of A and SHBG and higher total and free T levels than normal-weight women . There were a statistically significant decrease in the levels from baseline to week 26 among all three BMI classes for A , total T and SHBG ( p≤.03 ) and an increase from baseline to week 26 in weight ( p=.02 ) . In addition , there was a statistically significant decrease in DHEAS from baseline to week 13 among all three BMI classes ( p=.01 ) , which was not sustained at week 26 ( p>.1 ) . Overall , the three groups responded similarly to all changes at week 13 , and there were no statistically significant differences between groups at any time point ( p≥.06 ) . CONCLUSION DMPA-SC use in normal-weight , obese and extremely obese women can decrease serum and rogen markers BACKGROUND A formulation of depot medroxyprogesterone acetate ( DMPA ) has been developed that allows subcutaneous injection ( 104 mg/0.65 mL ; DMPA-SC ) and achieves highly effective contraception with a similar tolerability profile to intramuscular DMPA ( 150 mg/mL ; DMPA-IM ) . STUDY DESIGN This r and omized , evaluator-blinded study was design ed to compare efficacy , safety , and user satisfaction in women receiving DMPA-SC ( n=266 ) or DMPA-IM ( n=268 ) for 2 years with an option to continue for a third year . The primary objectives were to evaluate bone mineral density ( BMD ) changes and contraceptive efficacy after 2 years . RESULTS A total of 225 women completed the first 2 years of this study ( DMPA-SC , n=116 ; DMPA-IM , n=109 ) . After 2 years of DMPA use , BMD loss was marginally smaller in the DMPA-SC group than in the DMPA-IM group at both the total hip ( -3.3 % and -3.6 % , respectively ) and lumbar spine ( -4.3 % and -5.0 % , respectively ) . In those women who received DMPA during the third year , there were no statistically significant differences in BMD loss between DMPA-SC and DMPA-IM groups at the end of Year 3 . Recovery of BMD was observed in the small sub population of women who had discontinued DMPA-SC or DMPA-IM after the second year . The 2-year treatment-failure cumulative pregnancy rate was 0 % in the DMPA-SC group and 0.8 % ( 95 % confidence interval , 0.00 - 2.37 % ) in the DMPA-IM group ( life-table method ) . Adverse events were similar in the two groups except that injection site reactions were more common in the DMPA-SC group . CONCLUSION DMPA-SC is an effective and well-tolerated contraceptive option , providing comparable efficacy and BMD safety to DMPA-IM DMPA-SC 104 mg/0.65 mL is a new , low-dose subcutaneous ( SC ) formulation of Depo-Provera contraceptive injection ( 150 mg/mL medroxyprogesterone acetate injectable suspension ) that provides efficacy , safety and immediacy of onset equivalent to Depo-Provera intramuscular ( IM ) injection . Two large , open-label , Phase 3 studies assessed the 1-year contraceptive efficacy , safety and patient satisfaction with DMPA-SC administered every 3 months ( 12 - 13 weeks ) . Zero pregnancies were reported in both studies , which included a total of 16,023 woman-cycles of exposure to DMPA-SC and substantial numbers of overweight or obese women . DMPA-SC was well-tolerated and adverse events were similar to those reported previously with Depo-Provera IM . Thus , DMPA-SC offers women a new , highly effective and convenient long-acting contraceptive option BACKGROUND Subcutaneous depo-medroxyprogesterone acetate ( DMPA-SC ) has not been studied in the extremely obese population ( BMI > or=40 kg/m(2 ) ) . The purpose of this 26-week prospect i ve experimental study was to determine incidence of ovulation and follicular development among women with Class 1 , 2 and 3 obesity after receiving DMPA-SC . METHODS Five normal-weight , five Class 1 - 2 obese , and five Class 3 obese women received subcutaneous injections of 104 mg DMPA-SC at baseline and 12 weeks later . Weekly progesterone levels , bimonthly estradiol ( E(2 ) ) , and monthly medroxyprogesterone acetate ( MPA ) levels were measured by immunoassay methods for a total of 26 weeks in each subject . RESULTS Ovulation did not occur in any subject more than 1 week after the first injection . There was large intersubject and intrasubject variability in E(2 ) levels , and fluctuating E(2 ) levels were more frequent among obese women than normal-weight women . Median MPA levels remained above the level needed to prevent ovulation but , compared with normal-weight subjects , were lower among Class 1 - 2 obese and lowest among Class 3 obese subjects . CONCLUSION Fluctuating E(2 ) levels reflective of follicular development occurred more often among Class 1 , 2 and 3 obese women than normal-weight women after DMPA-SC injections . Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation . Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women Depo-Provera is a highly effective contraceptive , given intramuscularly ( 150 mg/mL ) once every 3 months . It has been in use in the United States for over 10 years . A new lower-dose formulation of Depo-Provera ( 104 mg/0.65 mL ) , has been developed that allows subcutaneous injection , potentially increasing the convenience , ease of administration and tolerability of this contraceptive . This prospect i ve , r and omized , single-center , single-dose trial evaluates the pharmacokinetics of the lower-dose formulation of Depo-Provera and compares the lower-dose formulation to the original formulation with regard to efficacy and duration of ovulation suppression and the return to ovulation at 12 months . While delivering a 30 % lower total dose than the intramuscular formulation , the lower-dose formulation of Depo-Provera  suppressed ovulation for more than 13 weeks in all subjects and was not affected by body mass index or race . Median time for return to ovulation was 30 weeks , with a 97.4 % cumulative rate of return to ovulation at 12 months BACKGROUND A clinical study compared efficacy and safety of depot medroxyprogesterone acetate ( DMPA ) with leuprolide for  endometriosis-associated pain .  METHODS This multicentre , 18 month , evaluator-blinded , comparator-controlled trial r and omized 300 women with laparoscopically diagnosed endometriosis to 6 month treatment with subcutaneous injection of  104 mg/0.65 ml DMPA ( DMPA-SC 104 ) every 3 months or leuprolide ( 3.75 mg monthly or 11.25 mg every 3 months ) , with 12 months post-treatment follow-up . Endpoints included patient response to treatment in five signs/symptoms ( dysmenorrhoea , dyspareunia , pelvic pain , pelvic tenderness , in duration ) and changes in bone mineral density ( BMD ) and productivity at 6 and 18 months . RESULTS DMPA-SC 104 and leuprolide produced equivalent ( P < 0.02 ) reductions in at least four pain categories and significant ( P < 0.001 ) improvements in composite score at months 6 and 18 . At month 6 , reductions in total hip and lumbar spine BMD were significantly less ( P < 0.001 ) with DMPA-SC 104 versus leuprolide .  BMD returned to pre-treatment levels 12 months post-treatment in the DMPA-SC 104 but not the leuprolide group . Total productivity also significantly ( P < or = 0.05 ) improved in both groups at 6 and 18 months . CONCLUSIONS DMPA-SC 104 reduces endometriosis-associated pain as effectively as leuprolide and improves productivity with significantly less BMD decline This r and omized double-blind study , with 24-week treatment and 24-week posttreatment periods , evaluated the effects of elagolix ( 150 mg every day , 75 mg twice a day ) versus subcutaneous depot medroxyprogesterone acetate ( DMPA-SC ) on bone mineral density ( BMD ) , in women with endometriosis-associated pain 
    Output:
    
Women with endometriosis using DMPA-SC over 6months had minimal decreases in bone mineral density , weight gain , few serious adverse events and experienced improved pain symptoms .
Women living with HIV tolerated injection of DMPA-SC with rare complications .
DMPA-SC and DMPA-IM also show therapeutic equivalence and similar effects on weight gain , changes in bleeding patterns and reports of other adverse effects when these different delivery systems were used by general population s of women .
CONCLUSION Evidence for use of DMPA-SC by women with select conditions and characteristics including age , obesity , endometriosis or HIV demonstrates that this method can generally be used safely in these context s. Further , DMPA-SC and DMPA-IM appear to be therapeutically equivalent with similar safety profiles when used by healthy women