RESUMEN
PIP: This reply to a letter criticizing the author's article on Depo-Provera use which appeared in the same publication argues that proponents of Depo-Provera have misled the public about its suitability for wide use. Because many Thai women have already used Depo-Provera for a decade or more, because it takes 10 times as much Depo-Provera to produce the same blood level in monkeys as in humans, and because tribal women in Thailand weighing less than 45 kg routinely received 6 month doses of 450 mg, 3 times the 3 month dose, any difference between the doses given experimental monkeys and village women is marginal. The study by McDaniel and Potts of women with endometrial cancer hospitalized in Chiang Mai and Lumpoon Provinces which examined Depo-Provera use among them had too small a sample to detect less than a 20-fold relative risk; moreover, very few cases of endometrial cancer actually came in for treatment. Depot medroxyprogesterone acetate (DMPA) and norgesterone produce a situation similar to early menopause in which the uterus is atrophic because ovulation has ceased, but estrogen production continues and the endometrium is stimulated. Menopausal women are at high risk of developing endometrial cancer. Research literature suggests that the reproductive systems of breastfed infants are vulnerable to longterm action of DMPA in milk. Babies exposed in utero may be at risk of vaginal adenosis or cardiovascular malformations. Giving Depo-Provera to mothers of nursing babies violates the restrictions on use of children in medical experiments evolved after the Nuremburg trials. The hostility of population control activists to critics concerned about cancer evidence may prevent abnormal conditions from being looked for. It is suggested that DMPA experimenters experiment on themselves for 10 years while a moratorium on use of Depo-Provera is observed until the results are available.^ieng