Progestogen-only Injectable Contraception FSRH Mar 2015

Question 1

“progestogen-only injectable contraception”

When administered at the recommended dosing interval the failure rate in the first year of use & with typical use ?

Answer 1

• approximately 0.2% in the first year of use.

- With typical use the failure rate is approximately 6%

Question 2

DMPA use benefits

Answer 2

• may reduce pain endometriosis.

- may reduce the severity of sickle crisis pain.

Question 3

Use of DMPA & cancer risk

Answer 3

• not associated with an increased risk of ovarian or endometrial cancer and may offer some protection.
• possibly a weak association between current use of DMPA and breast cancer. Any increased risk is likely to be small and reduce with time after stopping.
• weak association between cervical cancer and use of DMPA for 5 years or longer. Any increased risk reduce with time after stopping and could be due to confounding factors.

Question 4

Use of DMPA

age

Answer 4

• advised to switch to another method at age 50 years. If not to continue, providing the benefits and risks have been assessed and informed of potential risks.
• under 18 , can be used after consideration of alternative methods. (weight gain, particularly under 18 years BMI ≥30 kg/m2)

Question 5

The efficacy of DMPA affected by?

Answer 5

• not reduced withenzyme inducing drugs.
• UPA reduce efficacy of hormonal, additional precautions are advised for 14 days after UPA for EC (outside product licence).
• No increased risk of pregnancy users with higher body weight, although data limited in BMI ≥40 kg/m2.

Question 6

DMPA timing

Answer 6

• every 13 weeks IM or SC, DMPA (outside the product licence for IM DMPA).
• up to 7 days late (up to 14 weeks after last injection) without need for additional contraceptive precautions (outside the product licence for IM DMPA).
• If necessary, an early repeat injection of DMPA can be administered from 10 weeks and from 6 weeks for NET-EN (outside product licence).

Question 7

DMPA & unscheduled bleeding

Answer 7

• who are medically eligible can be offered a combined COC for 3 months. (cyclic manner or continuously without HFIl (outside product licence).
• Longer-term use of the injectable and COC is a matter of clinical judgement.
• offere 500 mg mefenamic acid up to TID for 5 days.

Question 8

DMPA & STI

Answer 8

• consistent and correct use of condoms (male/ female) reduce risk of STI transmission and should be recommended
• A causal relationship between POIC and HIV
  transmission/acquisition not been established but cannot be completely excluded.

Question 9

DMPA & return of fertility

Answer 9

• can be a delay of up to 1 year in the return of

fertility after discontinuation of IM or SC DMPA.

Question 10

DMPA discontinue

Still wants contraception

Answer 10

to start another contraceptive method before or at the

time of their next scheduled injection even if amenorrhoeic.

Question 11

DMPA site of injection

Answer 11

• gluteal muscle preferred site for IM DMPA
• can be deltoid muscle
  . If deep adipose tissue in gluteal area, standard-length needles may not reach muscle layer and SC DMPA or deltoid for IM DMPA should be considered.
• SC DMPA should be injected into the abdomen or anterior thigh.

Question 12

DMPA

Injection site reactions

Answer 12

• more common with SC than IM

Question 13

DMPA

weight gain,

Answer 13

• associated with weight gain, particularly in women under 18 years of age with a body mass index (BMI) ≥30 kg/m2.
• Women who gain more than 5% of their baseline body weight in first 6 months of DMPA use are likely to experience continued weight gain.

Question 14

DMPA & CERVICAL CANCER

Answer 14

• weak association b/w cervical cancer and DMPA for 5 years or longer.
• Any increased risk appears to reduce with time after stopping and could be due to confounding factors.
• up-to-date with cervical cytology screening and, if relevant, have completed HPV vaccination.
• inform: link between HPV and cervical cancer, and
• advise: reduce risk, as condom, smoking cessation,
  regular cervical screening and, where appropriate, vaccination against HPV.

Question 15

DMPA & thromboembolism

Answer 15

• causal association with VTE not demonstrated in small number of studies.
• From the limited evidence available it is not possible to confirm or exclude an association between POIC use and myocardial infarction or stroke.

Question 16

Women using DMPA who wish to continue use should be reviewed How frequently?

Answer 16

every 2 years to assess individual situations, and to discuss benefits and potential risks.

Question 17

POIC & BMD

Answer 17

• associated with a small loss, which is usually recovered after discontinuation.

Question 18

Whilst there is little evidence available to demonstrate causation, BUT have been reported with use of DMPA

Answer 18

acne, 
decreased libido, 
mood swings, 
headache, 
hot flushes and 
vaginitis .