Injectable_Contraceptives_Flashcards
What is the main injectable contraceptive used in the UK?
Depo Provera, which contains medroxyprogesterone acetate 150mg.
How often is Depo Provera given?
Every 12 weeks via intramuscular injection, but can be given up to 14 weeks after the last dose without the need for extra precautions.
What is the main method of action of Depo Provera?
Inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.
What is a major disadvantage of Depo Provera?
The injection cannot be reversed once given and there may be a delayed return to fertility (up to 12 months).
What are the adverse effects of Depo Provera?
Irregular bleeding, weight gain, potential increased risk of osteoporosis.
What are the contraindications for Depo Provera?
Breast cancer: current breast cancer is UKMEC 4, past breast cancer is UKMEC 3.
What is another injectable contraceptive licensed in the UK and how often is it given?
Noristerat, given every 8 weeks, but it is rarely used in clinical practice.
What does the BNF advise regarding the interval for Depo Provera injections?
A pregnancy test should be done if the interval is greater than 12 weeks and 5 days, although this is not commonly adhered to in the family planning community.
SUMMARISE INJECTABLE CONTRACEPTIVES
Injectable contraceptives
Depo Provera is the main injectable contraceptive used in the UK*. It contains medroxyprogesterone acetate 150mg. It is given via in intramuscular injection every 12 weeks. It can however be given up to 14 weeks after the last dose without the need for extra precautions**
The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.
Disadvantages include the fact that the injection cannot be reversed once given. There is also a potential delayed return to fertility (maybe up to 12 months)
Adverse effects
irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time
Contraindications
breast cancer: current breast cancer is UKMEC 4, past breast cancer is UKMEC 3
*Noristerat, the other injectable contraceptive licensed in the UK, is rarely used in clinical practice. It is given every 8 weeks
**the BNF gives different advice, stating a pregnancy test should be done if the interval is greater than 12 weeks and 5 days - this is however not commonly adhered to in the family planning community
Textbooks
Links
Faculty of Sexual and Reproductive Healthcare45
Progestogen-only InjectableContraception
A 25-year-old woman has come to your GP surgery requesting contraception. She is fit and well, reporting no symptoms and a pregnancy test comes back negative. She is a model and is concerned that starting on contraception may cause her to gain weight. Which of the following should be avoided due to association with weight gain?
Combined oral contraceptive pill
Depo-provera injection
Mirena coil (implantable uterine system)
Nexplanon implant
Progesterone only pill
Depo-provera injection
Depo-provera is associated with weight gain
The only contraceptive that has a proven association with weight gain is Depo-provera, so should be avoided in people concerned with weight gain.
A 32-year-old woman presents to general practice requesting the progesterone-only injectable contraceptive. She says that she has used this in the past and it works very well for her. She has a past medical history of migraines with aura and irritable bowel syndrome. She is currently receiving treatment for breast cancer and is awaiting investigations for unexplained vaginal bleeding. She smokes approximately 20 cigarettes a day.
Why is this contraceptive method contraindicated?
Smoking >15 cigarettes a day
Current breast cancer
Migraine with aura
Unexplained vaginal bleeding
Age >30
Current breast cancer
Current breast cancer is a contraindication for injectable progesterone contraceptives
According to the UK medical eligibility criteria, current breast cancer is an absolute contraindication for progesterone-only injectable contraceptives.
Smoking >15 cigarettes a day is a contraindication for the combined oral contraceptive pill.
Migraine with aura is a contraindication for the combined oral contraceptive pill.
Unexplained vaginal bleeding is a contraindication for the initiation of the intrauterine device (IUD) and the intrauterine system (IUS).
Age >30 is not a contraindication for any contraceptive.
