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Progestin-Only Injectable Contraceptives

Progestin-Only Injectable Contraceptives. Session I: Characteristics of Progestin-Only Injectables. Objectives. At the end of this session, participants will be able to: Describe the characteristics of progestin-only injectables in a manner clients can understand:

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Progestin-Only Injectable Contraceptives

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  1. Progestin-Only Injectable Contraceptives Session I: Characteristics of Progestin-Only Injectables

  2. Objectives At the end of this session, participants will be able to: • Describe the characteristics of progestin-only injectables in a manner clients can understand: • What progestin-only injectables are and how they work (mechanism and onset of action) • Effectiveness • Side effects • Non-contraceptive health benefits • Possible health risks (complications) • Other characteristics (STI/HIV protection, ease of use, return to fertility, when to initiate and discontinue)

  3. Objectives • Demonstrate the ability to: • Screen clients for medical eligibility for injectables • Explain to clients the insertion, removal, and follow-up procedures • Explain when to return to the clinic • Address common concerns, misconceptions, and myths • Conduct follow-up for injectable clients in a way that enhances continuing safety, satisfaction, and acceptance • Describe when to start use of injectables. • Explain how to manage side effects. • Identify conditions that require switching to another method. • Identify clients in need of referral for injectable-related complications. • Demonstrate the preparation of supplies, equipment, and the client and the technique of administration (using a fruit or vegetable).

  4. Key Points for Providers and Clients

  5. Key Points for Providers and Clients

  6. Types of Progestin-Only Injectables DMPA (depot medroxyprogesterone acetate) Injection every 3 months (13 weeks) NET-EN (norethisterone enanthate) Injection every 2 months (8 weeks) Have similar effectiveness, safety, characteristics and eligibility criteria Source: CCP and WHO, 2010; Kingsley, 2010.

  7. Effectiveness of Injectables Injectables In this progression of effectiveness, where would you place progestin-only injectables? More effective Less effective

  8. Relative Effectiveness of Family Planning Methods

  9. Progestin-Only Injectables:Mechanism of Action Suppress hormones responsible for ovulation Thicken cervical mucus to block sperm Note: Do not disrupt existing pregnancy Source: Kingsley F and Salem R, 2010.

  10. Safe and very effective Easy to use; requires no daily routine Long-lasting and reversible Can be discontinuedwithout provider’s help Can be provided outside of clinics Can be used by breastfeeding women Use can be private Does not interfere with sex Can be used by breastfeeding women Provide non-contraceptive health benefits Have side effects Cause delay in return to fertility Effectiveness depends on user getting injections regularly Provide no protection from STIs/HIV Characteristics of Progestin-Only Injectables Source: CCP and WHO, 2011

  11. Progestin-Only Injectables:Health Benefits • Help protect against: • Risks of pregnancy • Endometrial cancer • Uterine fibroids • May help protect against symptomatic pelvic inflammatory disease (PID) and iron-deficiency anemia • Reduce sickle cell crises in women with sickle cell anemia • Reduce symptoms of endometriosis (pelvic pain, irregular bleeding) Source: CCP and WHO, 2011; Manchikanti, 2007.

  12. Injectables and Risk of Breast Cancer • No effect on overall risk of breast cancer • Older studies found a somewhat increased risk during first 5 years of use • May be due to detection bias or accelerated growth of pre-existing tumors • Recent large study found no increased risk in current or past DMPA users regardless of age and duration of use • Little research has been done on NET-EN Source: Strom et al, 2004

  13. Effect of DMPA on Bone Density • DMPA users have lower bone density than non-users • Women initiating DMPA use as adults regain most lost bone • Long-term effect in adolescents unknown • Concerns about reaching peak bone mass • Long-term studies are needed • Generally acceptable to use Source: Cromer, 1996; Cundy, 1994; WHO, 2010.

  14. Infant Exposure to DMPA/NET-ENDuring Breastfeeding DMPA and NET-EN have no effect on: • Onset or duration of lactation • Quantity or quality of breast milk • Health and development of infant Initiation before 6 weeks postpartum is generallynot recommended. (WHO/MEC) Source: Koetsawang, 1987; WHO Task Force for Epidemiological Research on Reproductive Health, 1994a and 1994b; Kapp 2010; WHO, 2008; WHO, 2010; WHO, 2004, updated 2008.

  15. Injectables: Return to Fertility • Return to fertility depends on how fast a woman fully metabolizes the injectable • On average, women become pregnant 9–10 months after their last injection of DMPA • Length of time injectable was used makes no difference Sources: Pardthaisong, 1984; Schwallie, 1974.

  16. Progestin-Only Injectables: Side Effects • Many women experience no side effects. Possible side effects include: Headaches and dizziness • Amenorrhea (no menses) Abdominal bloating and discomfort Weight gain • Prolonged or heavy bleeding irregular bleeding or spotting Changes in mood and sex drive

  17. Group ActivityInjectables Fact Sheet Review the fact sheet. What additional questions or comments do you have about the characteristics of progestin-only injectables?

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