MOA
-
primarily inhibiting ovulation
-
thickening of cervical mucus
- inhibit sperm penetration
Efficacy
-
failure \<0.4% @ 2 years
-
may ocntinue to age 50
-
review q2yrs
-
delay in return to fertility
-
no eveidence reduced fertility long term
-
up to 1 year delay
-
Starting
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first injhection D1-5 of normal menstrual cycle
- no additional
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any time if not pregnant and no risk of conception
- additional for 7d
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if \<D21 postpartum
- no additional
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\<5d post miscarriage/abortion
Ongoing:
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every 12 weeks (+5days)
- can have up to 2 weeks early
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late:
-
if up to 14 weeks then change of ovulation low
- no additional contraceptive
-
of ≥14+1/7:
-
No UPSI:
-
give injection
-
7 day rule
-
-
UPSI last 3/7 only:
-
give injection
-
offer ECP
-
7 day rule
-
Preg test 21/7
-
-
UPSI last 4-5d only:
-
give
-
ECP - CuIUD
-
no additional if opts for CuIUD
-
preg test 21/7
-
-
UPSI >5d
-
do not give
-
no ECP
-
barrier for 21d ntil preg neg and then 7d
-
2x preg tests iniital & @ 21d
-
-
-
Sideeffects
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bleeding
-
Amenorrhoea 14.4%
-
infrequent bleeding 24.2%
-
spotting 28%
-
prolonged bleeidng 33%
-
70% of Depot users are amenorrhoeic at 1yr of use
-
unacceptable bleeding:
-
consider STI
-
COC and Mefenamic acid may be effective in management of unacceptable bleeding associated with progestogen-only injectable use
-
-
-
Weight change
- mean weight gain = 3kg @ 2yrs
-
mood change, libido, headache
- no evidence of causal relationship
-
health concerns
-
doens’t appear to be associated wiht increased risk:
- stroke, vte, MI
-
BMD
-
small loss
-
usually recovered
-
no evidence on effect of long-term fracture risk
-
FDA black box warning:
-
against use > 2yrs
-
recent evidence suggests warning should be removed
-
-
-
Drug interactions
-
efficacy not reduced with concurrent use of medications
-
including abx and liver enzyme-inducing drugs
-
injection intervals do not need to be reduced
-