Progestogen-only injectables Flashcards
How does it work
- inhibits ovulation
- thickens cervical mucus / reduces sperm penetration
- changes to endometrium unfavourable for implantation
When can you start
Day 1-5 with no additional
Any other time but you need 7 days additional protection!!!
How effective - perfect vs typical
perfect- 0.2% failure
typical- 6% failure
UKMEC for injection if pt has CIN
UKMEC 2
UKMEC for injection if pt has cervical cancer
UKMEC 2
UKMEC for injection if pt has undiagnosed breast mass
UKMEC 2
UKMEC for injection if pt has family with BRCA gene
2
UKMEC for injection if pt has breast cancer
UKMEC4 (same for all contraception apart from cu-iud)
UKMEC for injection if pt has past breast cancer
UKMEC 3 - same for all contraception apart from cu-iud
UKMEC for injection if pt has long QT
UKMEC 2 (is 1 for POP and imp but also 2 for CHC)
UKMEC for injection if pt has unexplained vaginal bleeding
ukmec 3 (is 2 for POP and CHC, 3 for imp)
UKMEC for injection if pt has multiple risk factors for CVD
smoking, diabetes, hypertension, obesity, dyslipidaemia
UKMEC 3 !!!!! - like CHC. Others are 1 or 2.
UKMEC for injection if pt has vascular disease
ukmec 3!!!! is 4 for CHC and 2 for the other hormonal contraceptions
UKMEC for injection if pt has severe decomp liver disease
UKMEC 3
UKMEC for injection if pt has HCC or adenoma
UKMEC 3
Bleeding patterns? Pain?
unpredictable
amenorrhoea is common
may reduce pain assoc with endo
Cancer assoc?
Possibly a weak association between current use of DMPA and breast cancer and cervical cancer !!! (this is like CHC)
- remind women to have smears, hpv reduction-condoms/not smoking / smears/ vaccine
What issues do you need to warn people of? Say all !
- Associated with a small loss of BMD which is usually recovered after discontinuation, women under 18 should consider other methods first. Women should switch at 50
- Unable to confirm or exclude an association between DMPA and MI or stroke…
- The bleeding patterns
- May increase risk of breast and cervical cancer
- ASSOCIATED WITH WEIGHT GAIN (particularly in women <18 with BMI >30)
- Local site reaction
- SEs reported with no causal link yet: hair loss, headache, mood change, libido change, vaginitis, acne, hot flushes
What issues do you need to warn people of?
Associated with a small loss of BMD which is usually recovered after discontinuation, women under 18 should consider other methods first. Women should switch at 50
What issues do you need to warn people of?
Associated with a small loss of BMD which is usually recovered after discontinuation, women under 18 should consider other methods first. Women should switch at 50
How often injections to be done?
Every 12 weeks (10w earliest, 14 weeks latest) for IM DMPA, every 13 weeks (14w latest) for SC DMPA, every 8 weeks for NET-EN
Drug drug interactions
efficacy of DMPA not reduced with use of enzyme inducers!!
High BMI?
Not an issue
Return to fertility?
ALLOW 1 YEAR for return
