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Progestin-Only Injectable Contraceptives

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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

Session I: Characteristics of Progestin-Only Injectables


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)
  • 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).
types of progestin only injectables
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.

effectiveness of injectables
Effectiveness of Injectables


In this progression of effectiveness, where would you place progestin-only injectables?

More effective

Less effective

progestin only injectables mechanism of action
Progestin-Only Injectables:Mechanism of Action

Suppress hormones

responsible for


Thicken cervical mucus to block sperm

Note: Do not disrupt existing pregnancy

Source: Kingsley F and Salem R, 2010.

characteristics of progestin only injectables
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

progestin only injectables health benefits
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.

injectables and risk of breast cancer
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

effect of dmpa on bone density
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.

infant exposure to dmpa net en during breastfeeding
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.

injectables return to fertility
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.

progestin only injectables side effects
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

group activity injectables fact sheet
Group ActivityInjectables Fact Sheet

Review the fact sheet.

What additional questions or comments do you have about the characteristics of progestin-only injectables?