INJECTABLES
CONTRACEPTIVES
By: Fetene K. (BSc, MSc)
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• At the end of this session students will be able to:
✓Identify the deferent types of injectable
contraceptives
✓ discuss how injectable works
✓Identify eligible women for injectable
✓Discuss safety and effectiveness
✓Describe the side effects & their management
✓Identify how to provide follow up and referral as
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✓These are systemic progestin or a combination
of estrogen and progesterone preparations
administered by IM injection. Subcutaneous(SC)
✓Also known as ‘the shot’
✓Progestin only preparations include:
- Depot medroxyprogesterone acetate (DMPA,
DMPA-SC)
- Norethisterone enanthate (NET-EN) 3
• Combined injectable(new products)
✓Injectables containing both estrogen and
progestin are monthly.
- Cyclofem/cycloprovera =25 mg DMPA + 5
mg estradiol cypionate
- Mesigyna/Norigynon =50 mg NET-EN + 5
mg estradiol valerate
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DEPO MEDROXYPROGESTERONE
ACETATE(DMPA)
• DMPA is a suspension of microcrystals of a
synthetic progestin that is injected
intramuscularly.
• It is the most widely available and commonly
used injectable contraceptive in Ethiopia.
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DMPA
• How does it work
✓ Same mechanism of action as that of the POP,
except the duration of action(longer in DMPA).
✓ Inhibits Ovulation - Block LH surge
✓ Thickening cervical mucus
✓ Thins the Endometrial Lining- Hostile to implantation
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DMPA
ADMINISTRATION OF DMPA
• If the woman is reasonably not
pregnant prior to administration.
• Provide 150 mg every 3 months
• Gently shake the vial
• Administer by deep I.M. injection in
the gluteal or deltoid muscle
• Don’t massage the site of injection
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DMPA
STERILE INJECTION PROCEDURES
✓ Wash hands
✓ Clean injection site
✓ Use sterile needle/ syringe
✓ Dispose of wastes properly
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• Effectiveness
✓Depends on getting injections regularly
✓ When women have injections on time, <1
pregnancy per 100 women over the first year
✓Commonly used, about 3 pregnancies per
100 women over the first year
✓Have 3-4 weeks of grace period
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Characteristics of DMPA
• Advantages
✓ Highly effective, Safe and Long acting (three months).
✓One of the most private and confidential methods.
✓Convenient and easy to use
✓Completely reversible (an average of 4 months’
delay in return to fertility after discontinuing).
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• No estrogen side effects, can be used by
patients with heart disease, sickle cell anemia…
• DMPA has no Known health risk
• Allow some flexibility in return visit =>clients
can return 3 months + 2-3 weeks safely.
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• Non-contraceptive benefits:
✓Prevent ectopic pregnancy
✓Prevent uterine fibroids
✓Reduce risk of pelvic inflammatory disease
✓Decrease risk of endometrial cancer
✓Reduce menstrual flow & anemia
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• Disadvantage
✓It cannot easily be discontinued or
removed
✓ if a complication occurs or
✓if pregnancy is desired immediately.
✓It can increase the appetite of some
women, resulting in weight gain.
✓Does not protect STIs/ HIV/AIDS 13
• Nearly all women can use progestin-only
injectables safely and effectively, including
women who:
• Have or have not had children
• Are not married
• Are of any age, including adolescents and
women over 40 years old
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• Have just had an abortion or miscarriage
• Smoke cigarettes, regardless of woman’s
age or number of cigarettes smoked
• Are breastfeeding (starting as soon as 6
weeks after childbirth)
• Are infected with HIV, whether or not on
antiretroviral therapy 15
• Breastfeeding a baby less than six weeks old.
• Severe decompensated cirrhosis
• Blood pressure higher than 160/100 mm Hg.
• Diabetes more than 20 years of duration
or diabetes with vascular complications.
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• History or current heart attack or stroke
• Current blood clot in leg (deep venous
thrombosis) or lungs (pulmonary embolism)
• Undiagnosed abnormal vaginal bleeding (postpone
injection until bleeding can be evaluated)
• History or current breast cancer
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• DMPA may be given at any time when it is reasonably
certain the woman is not pregnant:
✓During the first seven days after the start of menses.
✓Immediately or within 7 days following abortion.
✓Postpartum-
- Immediately postpartum or 4wks if not breastfeeding
- B/n 6 wks & 6 months for fully breastfeeding women if
menses not returned.
- woman has not had intercourse since her last
menses 18
• First 3 months:
✓Irregular bleeding
✓Prolonged bleeding
• At one year:
✓No monthly bleeding
✓Infrequent bleeding
✓Irregular bleeding
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• Weight gain
• Headaches
• Dizziness
• Abdominal bloating and discomfort
• Mood changes
• Less sex drive
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• ACHES = danger signals and to contact a health
care provider immediately if these signs occur:
• Abdominal pains
• Chest pains or shortness of breath
• Headaches (severe), numbness, or
dizziness
• Eye problems (blurred vision or double
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• Heavy bleeding/ breakthrough bleeding
✓Reassure her that this is normal and expected for
up to 25 - 30% of women in the first 3-6 months
✓Giving 14 - 21 low dose COCs 1tab/day.
✓Alternatively, 14 - 21 days of Premarin (1.25
mg daily) or
✓ibuprofen (200 to 400 mg Q 4 hrs until
bleeding subsides or up to seven days) may be 22
• Amenorrhea: most common reason for
discontinuation.
✓Women must be counseled that:
- this is normal and expected during use of
DMPA.
- No harmful effects
- there can be health benefits, such as 23
• Weight Gain:
✓Counsel the client that fluctuations of 1-2kg
may occur
✓If the weight gain is >2.4kg(5Ib), counsel the
client on diet and exercise.
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• Headaches:
✓check blood pressure
✓If it is elevated, repeat BP
- Normal, continue DMPA injections
- If the BP is over 160/90, repeat BP on two
more occasions over the next two weeks,
refer 25
New clients
• Explain:
✓Most common side effects and what to do if they occur
✓Warning/danger signs of health risks,
✓Tell her not to massage the injection site
✓Tell to come back on time for the next injection
✓Invite the client to come back for any questions or
problems or if she wants to switch to another method
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• Correcting Misunderstandings
• DMPA:
✓Can stop monthly bleeding, but this is not
harmful.
✓Blood is not building up inside the woman.
✓Do not disrupt an existing pregnancy.
✓Do not make women infertile.
✓Do not cause birth defects.
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• Check if:
✓Client is satisfied with the injection or has concerns,
questions, problems.
✓There are any plans for having children or STI/HIV risk
• Help the client cope with side effects and other
problems; offer switching to another method if the
client is dissatisfied.
• Agree on the date of the next injection.
MEC
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