5.5 Progestogen-only injection

Question 1

What is in the progestogen-only injection?

Answer 1

medroxyprogesterone acetate ( a type of progestin)

Question 2

How effective is DMPA?

Answer 2

99% effective with perfect use but women forget to book appointment by 12 to 13 weeks, typical effectiveness is 94%.

Question 3

What are the two version of progestogen-only injection in the UK?

Answer 3

Depo-provera - IM

Sayana Press - SC device and can be self injected

Question 4

Why are progestogen-only injection not recommended if pregnancy may be desired in the near future?

Answer 4

Can take 12 months for fertility to return after stopping injections.

Question 5

What is an alternative injection to DMPA and what is it used for?

Answer 5

Noristerat
works for 8 weeks
Short term contraception eg after partner has had a vasectomy.

Question 6

What are UKMEC 4 contraindications to progestogen-only injection?

Answer 6

UKMEC 4:

Active breast cancer

Question 7

What are UKMEC 3 contraindications to progestogen-only injection?

Answer 7

UKMEC 3:
IHD and stroke
unexplained vaginal bleeding
severe liver cirrhosis
liver cancer

Question 8

When is progestogen-only injection a UKMEC 2?

Answer 8

in women over 45 (should switch at 50)

due to osteoporosis / less BMD

Question 9

Why might progestogen-only injection not be appropriate for people with inflammatory conditions or asthma?

Answer 9

If they are taking steroids:

Can decrease BMD and risk osteoporosis

Question 10

What is a progestogen-only injection holiday?

Answer 10

After two years of injections you should stop for 6 months to allow BMD to return.

(poss do a DEXA in 3 or 5 years)

Question 11

What is the main mechanism of progestogen-only injection?

Answer 11

Inhibit ovulation by inhibiting FSH release from the pituitary meaning follicles don’t develop.

Question 12

Other than inhibiting ovulation, how else does the progestogen-only injection work?

Answer 12

thickening cervical mucous

altering endometrium and make it less acceptable for implantation

Question 13

On what day can the progestogen-only injection be started?

Answer 13

Days 1-5 of period with no extra precautions

After day 5 (and not pregnant) needs 7 days of condoms

Question 14

When can women get their next progestogen-only injection?

Answer 14

Ideally 12-13 weeks but can be as early as 10 weeks and as late as 14 weeks.

Question 15

Suppressing follicles with the progestogen-only injection causes what side effect?

Answer 15

Less oestrogen is released which can lead to a reduction in bone mineral density.

Question 16

What two side effects are unique to progestogen-only injection compared to other contraceptives?

Answer 16

decrease BMD and weight gain

Question 17

What are 9 side effects of progestogen-only injection?

Answer 17

• decrease BMD
• weight gain
• acne
• reduced libido
• mood changes
• headaches
• flushes
• alopecia
• skin reaction at injection site

Question 18

What can happen in the first six months of progestogen-only injection?

Answer 18

Problematic bleeding, generally settles over time and eventually amenorrhea

Question 19

What can help with initial problematic bleeding in progestogen-only injection?

Answer 19

FRSH suggest COCP for three months to help settle the bleeding

Or 5 days of mefenamic acid to stop the bleeding

Question 20

What tests might you do to rule out other cause of problematic bleeding when using the progestogen-only injection?

Answer 20

Sexual health screen
Pregnancy test
Cervical screen up to date

Question 21

What cancers does the progestogen-only injection reduce the risk of?

Answer 21

reduces the risk of ovarian and endometrial cancer

Question 22

What can progestogen-only injection do for dysmenorrhoea or endometriosis-related symptoms?

Answer 22

Improves painful periods and endometriosis related symptoms