Sexual Health - Progestogen-Only Injection and Implant

Question 1

What is the progestogen only injection also called?

Answer 1

DMPA

Question 2

How often is the injection given?

Answer 2

12-13 week intervals

Im or SC

Question 3

How long does it take for fertility to return after stopping injections?

Answer 3

12 months

Question 4

What are the two versions of the injection?

Answer 4

Depo-Provera (IM)
Sayana Press (SC)- self-injected by patient

Question 5

What are the contraindications of the injection?

Answer 5

UKMEC4
Active breast cancer

UKMEC3
IHD and stroke
Unexplained vaginal bleeding
Liver cirrhosis
Liver cancer

Can cause osteoporosis

Question 6

How does the injection work?

Answer 6

Inhibit ovulation

Inhibits FSH by pituitary gland, so follicles do not develop

Depot also:
- Thickens mucus
- Makes endometrium less receptive

Question 7

How does protection from pregnancy work when giving the injection?

Answer 7

Day 1-5
Immediate protection

Day 5 onwards
7 days of extra contraception

Question 8

What are the side effects of the progestogen only pill?

Answer 8

Irregular bleeding
After 1 year most women will have amenorrhoea
Weight gain
Reduced libido
Alopecia
Headaches
Osteoporosis
Increased risk of breast and cervical cancer

Question 9

What can be given to settle problematic bleeding?

Answer 9

Mefenamic acid

Question 10

What are the benefits of the injection?

Answer 10

Imrpoves dysmenorrhoea
Improves endometriosis
Reduces risk of ovarian and endometrial cancer
**Reduces severity of sick cell crisis **

Question 11

How long does the implant last for?

Answer 11

3 years then needs replacing

Question 12

How does the implant work?

Answer 12

Slowly releases progestogen into the systemic circulation

Inhibits ovulation
Thickens cervical mucus
Makes endometrium less receptive

90% effective, no user error

Question 13

What is the absolute contraindication to the implant?

Answer 13

Active breast cancer

Question 14

What does the implant contain?

Answer 14

Etonogestrel
Contains 68mg

Question 15

When should the implant be inserted?

Answer 15

Day 1-5
Immediate protection

After day 5
7 days of extra contraception

Question 16

How is the implant inserted?

Answer 16

1/3 up upper arm on medial side

Lidocaine

Above the subcut fat

Should be palpable after insertion

Should pop-up on other side of skin when pressing on one end

Question 17

How is the implant removed?

Answer 17

Lidocaine

Small incision made

Pressure on other end and removed with forceps

Need contraception immediately after

Question 18

What are the benefits of the implant?

Answer 18

Effective
Improve dysmenorrhoea
Makes periods lighter or stop
Don’t have to remember to take pills
No weight gain
No effect on bone mineral density
No thrombosis risk increase
No restrictions for use in obese patients

Question 19

What are the drawbacks of the implant?

Answer 19

Minor operation
Worsens acne
No STI protection
Can cause problematic bleeding
Implants can be bent
Implants can become impalpable

Question 20

What advice should women be given with the implant?

Answer 20

Palpate the implant occasionally

If impalpable, need extra contraception

USS of Xray may be needed to locate and then remove

Question 21

How is bleeding affected by the implant?

Answer 21

1/3 have infrequent bleeding
1/4 have frequent of prolonged
1/5 have no bleeding
Rest normal

Question 22

What is recommended when using the injection and implant with troublesome bleeding?

Answer 22

Injection
Use COCP for 6 months until bleeding settles

Implant
Use COCP for 3 months