Depo

Question 1

What is the age limit for depo?

Answer 1

50 years

Question 2

Who is the depo not suitable for?

Answer 2

• CVD or stroke
• significant risk factors for arterial CVD
• Current or recent breast cancer
• severe decompensating cirrhosis or liver tumours
• unexplained vaginal bleeding
• high risk of developing osteoporosis

Question 3

What is the mechanism of action of depo?

Answer 3

• Main: inhibit ovulation (suppression of LH and FSH)
• thickening of cervical mucus
• endometrial atrophy
• reduction of sperm function and motility

Question 4

Advantages of depo?

Answer 4

• it’s discreet
• sayana press can be self-administered
• if pregnancy occurred, no risk to foetus
• not intercourse related
• safe and no attributable deaths
• safe in breastfeeding
• safe in sickle cell and possible reduction in sickle crisis pain
• helpful for ovulation pain
• often causes infrequent or no periods - therefore good for heavy menstrual bleeding or pain caused by endometriosis
• protects against PID, ectopics, functional ovarian cysts and fibroid formation
• reduce risk of ovarian and endometrial Ca

Question 5

Disadvantages of depo?

Answer 5

• up to 50% discontinue in first year
• first injections can cause irregular prolonged PV bleeding - tend to become amenorrhoeic with time
• possible increase risk in HIV acquisition
• weight gain in 1/3 of women
• SEs: mood changes, headaches, loss of libido, bloating and breast tenderness
• Delay in return to fertility
• ?increase in breast ca initially, then risk returns to normal after 5 years
• ?increase risk in cervical ca
• once injected, it cannot be removed
• injection site reactions (e.g. fat atrophy, redness, pain, bruising)
• reduction in bone mineral density

Question 6

Any drug interactions?

Answer 6

• liver inducing enzymes are ok
• ulipristal acetate: avoid depo when ulipristal acetate is being taken for fibroids. if used for EC, wait 5 days before administering depo

Question 7

What is the longest interval between depo injections before considering risk of pregnancy?

Answer 7

• 14 weeks

Question 8

Is there a delay in fertility?

Answer 8

• yes - mean time to ovulation is 5.3 months

Question 9

How can you manage irregular bleeding?

Answer 9

• prescribing continuous COC
• prescribing tranexamic acid 250mg QDS for 5 days or mefenamic acid TDS for 5 days (short term)
• reducing the injection interval by 2 weeks if bleeding occurs towards the end

Question 10

What is the name of drug and dose in the depot provera?

Answer 10

Medroxyprogesterone acetate 150mg

Question 11

What is the name of drug and dose in the Sayana press?

Answer 11

Medroxyprogesterone acetate 104mg