INJECTABLE

CONTRACEPTIVES
Objectives

Types
Mechanism of Action
Advantages and Disadvantages
Efficacy
Types

Progestin only
DMPA
NET-EN

Combined
MESIGYNA
CYCLOFEM
 DEPOT MEDROXYPROGESTERONE
ACETATE

Inhibition of Ovulation by blocking the LH surge

Thickens cervical mucus

Thins endometrium
Advantage

Very effective
Private
Long term protection
Not compliance base
Does not interfere with intercourse
Freedom of effects of oestrogen
Does not affect the quality of breast milk
Prevents endometrial cancer
Reduces incidence of ectopic pregnancies
Side Effects/Diasadvantages

Irregular menstrual bleeding

Amenorrhoea
Decreased bone density
Weight gain
Delayed return of fertility
Affects mood
Bloated feeling
Decreased sex drive
DEPO-PROVERA

150mg IM every 90 days

typical use failure rate 3%
Perfect use 0.3%
 DMPA
DMPA is immediately effective without the need of a backup method if
administered within :

5 days of the beginning of a normal menses

Immediately postabortion

Immediately postpartum in non breastfeeding women

6 weeks postpartum in exclusively breastfeeding

women
 Noncontraceptive health benefits

reduction in the incidence of endometrial carcinoma

Reduced incidence of
+ Iron deficiency anemia
+ Dysmenorrhea
+ Ovarian cysts

Contraceptive of choice for women with seizure disorders or sickle cell anemia
Norethisterone enanthate

Inhibition of Ovulation by blocking the LH surge

Thickens cervical mucus

Thins endometrium
Side effects similar to DMPA

For short term use (up to 2 doses)

awaiting vasectomy to become effective
Rubella vaccination
Given as 200 mg IM injection every 8 weeks

Efficacy is 97%
 COMBINED ONCE-A-MONTH
INJECTABLE CONTRACEPTIVES

MESIGYNA : norethisterone enanthate 50 mg + oestradiol valerate 5

mg

CYCLOFEM: medroxyprogesterone acetate 25 mg + oestradiol

cypionate 5 mg
Inhibition of Ovulation

Thickens cervical mucus

changes in the endometrium

MESIGYNA

Decrease withdrawal bleeding

Mesigyna : Fertility returns

rapidly (about 1 month after
discontinuation
 Cyclofem : As effective as Depo-provera, but
does not have the problem of menstrual
irregularity and heavy bleeding as well as
amenorrhoea
Side Effects

Weight gain
headaches
dizziness
breast tenderness
Indications for Injectables

Can be used by nearly all women who require contraceptive

metheods
Contraindications to Injectables
Absolute (MEC 4) Relative (MEC 3)

Current Breast Ca Diabetes >20/ complications

Uncontrolled hypertension
(systolic>160/diastolic>100)

Severe liver disease/tumors

Positive anti-phospholipid antibodies (sle if

antibody unknown)

Breast ca with no evidence of disease for 5

years
QUESTIONS?