Sexual Health - Progestogen-Only Injection and Implant Flashcards
What is the progestogen only injection also called?
DMPA
How often is the injection given?
12-13 week intervals
Im or SC
How long does it take for fertility to return after stopping injections?
12 months
What are the two versions of the injection?
Depo-Provera (IM)
Sayana Press (SC)- self-injected by patient
What are the contraindications of the injection?
UKMEC4
Active breast cancer
UKMEC3
IHD and stroke
Unexplained vaginal bleeding
Liver cirrhosis
Liver cancer
Can cause osteoporosis
How does the injection work?
Inhibit ovulation
Inhibits FSH by pituitary gland, so follicles do not develop
Depot also:
- Thickens mucus
- Makes endometrium less receptive
How does protection from pregnancy work when giving the injection?
Day 1-5
Immediate protection
Day 5 onwards
7 days of extra contraception
What are the side effects of the progestogen only pill?
Irregular bleeding
After 1 year most women will have amenorrhoea
Weight gain
Reduced libido
Alopecia
Headaches
Osteoporosis
Increased risk of breast and cervical cancer
What can be given to settle problematic bleeding?
Mefenamic acid
What are the benefits of the injection?
Imrpoves dysmenorrhoea
Improves endometriosis
Reduces risk of ovarian and endometrial cancer
**Reduces severity of sick cell crisis **
How long does the implant last for?
3 years then needs replacing
How does the implant work?
Slowly releases progestogen into the systemic circulation
Inhibits ovulation
Thickens cervical mucus
Makes endometrium less receptive
90% effective, no user error
What is the absolute contraindication to the implant?
Active breast cancer
What does the implant contain?
Etonogestrel
Contains 68mg
When should the implant be inserted?
Day 1-5
Immediate protection
After day 5
7 days of extra contraception
How is the implant inserted?
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
How is the implant removed?
Lidocaine
Small incision made
Pressure on other end and removed with forceps
Need contraception immediately after
What are the benefits of the implant?
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
What are the drawbacks of the implant?
Minor operation
Worsens acne
No STI protection
Can cause problematic bleeding
Implants can be bent
Implants can become impalpable
What advice should women be given with the implant?
Palpate the implant occasionally
If impalpable, need extra contraception
USS of Xray may be needed to locate and then remove
How is bleeding affected by the implant?
1/3 have infrequent bleeding
1/4 have frequent of prolonged
1/5 have no bleeding
Rest normal
What is recommended when using the injection and implant with troublesome bleeding?
Injection
Use COCP for 6 months until bleeding settles
Implant
Use COCP for 3 months
