Fertility Control - Progestogen-Only Injection

Question 1

What is the Progestogen-Only Injection?

Answer 1

IM/SC Injection of DMPA (Depot Medroxyprogesterone Acetate) given at 12-13 week intervals.

Question 2

Efficacy of Progestogen-Only Injection (2).

Answer 2

1. > 99% Effective with Perfect Use.

2. 94% Effective with Typical Use.

Question 3

What is the only UKMEC4 Criterion of POI use?

Answer 3

Active Breast Cancer.

Question 4

Give 3 UKMEC3 Criteria of POI use.

Answer 4

1. IHD and Stroke.
2. Unexplained Vaginal Bleeding.
3. Severe Liver Cirrhosis and Liver Cancer.

Question 5

Fertility and POI Use.

Answer 5

It can take 12 months for fertility to return after stopping the injection so it is less suitable for women who wish to get pregnant in the near-term.

Question 6

Why is POI Use UKMEC2 in women above the age of 45?

Answer 6

It can cause osteoporosis (this should be especially considered for older patients or asthmatic/inflammatory condition patients).

Question 7

Mechanism of Action of POI (3).

Answer 7

1. Inhibit Ovulation.
2. Thickening Cervical Mucus.
3. Altering Endometrium to make it less accepting of implantation.

Question 8

Types of POI in the UK (2).

Answer 8

1. Depo-Provera (IM).

2. Sayana Press (SC - self-administered).

Question 9

What is the alternative POI that can be used?

Answer 9

Noristerat - contains Norethisterone. It works for 8 weeks and is a short-term interim contraception.

Question 10

Protection Offered by POI (3).

Answer 10

1. Starting on Days 1-5 offers immediate protection.
2. Starting after Day 5 will require 7 days of extra contraception e.g. condoms before the injection becomes reliably effective.
3. Delaying past 13 weeks creates a risk of pregnancy.

Question 11

Adverse Effects of POI (7).

Answer 11

1. Weight Gain (Unique).
2. Osteoporosis (Unique).
3. Changes to Bleeding Schedule (especially in 1st 3 months)
4. Acne.
5. Flushes.
6. Alopecia (Hair Loss).
7. Skin Reaction at Site of Injection.

Question 12

What do the FSRH guidelines suggest with problematic bleeding when on POI?

Answer 12

Take COCP in addition to injection for 3 months to settle bleeding or short course (5 days) of Mefenamic Acid.

Question 13

Why does POI cause Osteoporosis? (3).

Answer 13

1. Oestrogen generally helps maintain bone mineral density in women and is mainly produced by the follicles in the ovaries.
2. Suppressing the development of follicles will reduce the amount of Oestrogen produced.
3. This can lead to reduced bone mineral density.

Question 14

Benefits of POI (4).

Answer 14

1. Improves Dysmenorrhoea.
2. Improves Endometriosis-Related Symptoms.
3. Reduces Risk of Ovarian/Endometrial Cancers.
4. Reduces Severity of Sickle Cell Crises.