Progestogen-only injectables

Question 1

How does it work

Answer 1

• inhibits ovulation
• thickens cervical mucus / reduces sperm penetration
• changes to endometrium unfavourable for implantation

Question 2

When can you start

Answer 2

Day 1-5 with no additional

Any other time but you need 7 days additional protection!!!

Question 3

How effective - perfect vs typical

Answer 3

perfect- 0.2% failure
typical- 6% failure

Question 4

UKMEC for injection if pt has CIN

Answer 4

UKMEC 2

Question 5

UKMEC for injection if pt has cervical cancer

Answer 5

UKMEC 2

Question 6

UKMEC for injection if pt has undiagnosed breast mass

Answer 6

UKMEC 2

Question 7

UKMEC for injection if pt has family with BRCA gene

Answer 7

2

Question 8

UKMEC for injection if pt has breast cancer

Answer 8

UKMEC4 (same for all contraception apart from cu-iud)

Question 9

UKMEC for injection if pt has past breast cancer

Answer 9

UKMEC 3 - same for all contraception apart from cu-iud

Question 10

UKMEC for injection if pt has long QT

Answer 10

UKMEC 2 (is 1 for POP and imp but also 2 for CHC)

Question 11

UKMEC for injection if pt has unexplained vaginal bleeding

Answer 11

ukmec 3 (is 2 for POP and CHC, 3 for imp)

Question 12

UKMEC for injection if pt has multiple risk factors for CVD

Answer 12

smoking, diabetes, hypertension, obesity, dyslipidaemia
UKMEC 3 !!!!! - like CHC. Others are 1 or 2.

Question 13

UKMEC for injection if pt has vascular disease

Answer 13

ukmec 3!!!! is 4 for CHC and 2 for the other hormonal contraceptions

Question 14

UKMEC for injection if pt has severe decomp liver disease

Answer 14

UKMEC 3

Question 15

UKMEC for injection if pt has HCC or adenoma

Answer 15

UKMEC 3

Question 16

Bleeding patterns? Pain?

Answer 16

unpredictable
amenorrhoea is common
may reduce pain assoc with endo

Question 17

Cancer assoc?

Answer 17

Possibly a weak association between current use of DMPA and breast cancer and cervical cancer !!! (this is like CHC)
- remind women to have smears, hpv reduction-condoms/not smoking / smears/ vaccine

Question 18

What issues do you need to warn people of? Say all !

Answer 18

1. Associated with a small loss of BMD which is usually recovered after discontinuation, women under 18 should consider other methods first. Women should switch at 50
2. Unable to confirm or exclude an association between DMPA and MI or stroke…
3. The bleeding patterns
4. May increase risk of breast and cervical cancer
5. ASSOCIATED WITH WEIGHT GAIN (particularly in women <18 with BMI >30)
6. Local site reaction
7. SEs reported with no causal link yet: hair loss, headache, mood change, libido change, vaginitis, acne, hot flushes

Question 18

What issues do you need to warn people of?

Answer 18

Associated with a small loss of BMD which is usually recovered after discontinuation, women under 18 should consider other methods first. Women should switch at 50

Question 19

What issues do you need to warn people of?

Answer 19

Associated with a small loss of BMD which is usually recovered after discontinuation, women under 18 should consider other methods first. Women should switch at 50

Question 20

How often injections to be done?

Answer 20

Every 12 weeks (10w earliest, 14 weeks latest) for IM DMPA, every 13 weeks (14w latest) for SC DMPA, every 8 weeks for NET-EN

Question 21

Drug drug interactions

Answer 21

efficacy of DMPA not reduced with use of enzyme inducers!!

Question 22

High BMI?

Answer 22

Not an issue

Question 23

Return to fertility?

Answer 23

ALLOW 1 YEAR for return

Question 24

how to manage unscheduled bleeding issues on injection

Answer 24

3 months of COC or 500mg mefenamic acid TDS for 5 days