7.3.2.2 Progestogen-only Injectables

Injection

Prescribing Notes

• Progestogen-only injectables should be prescribed by brand.
• Progestogen-only injectables can cause menstrual dysfunction and weight gain. By the end of the first year of use, 80% of women will have become amenorrhoeic or have scanty infrequent periods.
• When progestogen-only injectables are stopped, ovarian activity can take up to a year to recover.
• Progestogen-only injectable use should be reviewed after 2 years in women of all ages.
• Sayana^® Press is an alternative to Depo-Provera^® for patients who wish to self-administer following training. The effectiveness of progestogen-only injectables is unaffected by enzyme-inducing drugs and interval between injections need not be altered.
• The Faculty of Sexual and Reproductive Healthcare (FSRH) produce eligibility criteria for contraceptive use see UKMEC.
• Drug interactions should be considered when prescribing contraceptives, see FSRH.
• For more information see FSRH.
• Patients aged 16 years and over can order repeat issues of Sayana Press via SH:24. This is a free HSC funded service where medical eligibility is assessed by HCPs and contraception supplied via post.

Caution

• Progestogen-only injectables are associated with a small loss of bone mineral density (BMD), which is usually recovered after discontinuation.
• There has been particular concern about use in women aged <18 years (who have not yet attained their peak bone mass) and among women who are approaching the menopause when additional BMD loss will occur. There is no available evidence on the effect of progestogen-only injectables on long-term fracture risk. Progestogen-only injectables can be used by adolescents who have yet to achieve their peak bone mass only if other methods are unacceptable or unsuitable.
• In women with risk factors for osteoporosis, a method of contraception other than progestogen-only injectables should be considered.

Implant

Prescribing Notes

• Nexplanon^® is a low dose long–acting progestogen implant which suppresses ovulation. Contraceptive effect lasts for up to 3 years.
• When Nexplanon^® is removed there is no delay in return to fertility.
• No more than 20% of women will experience amenorrhoea; the rest may have unpredictable and sometimes prolonged bleeding. This point should be covered carefully during counselling.
• Nexplanon^® insertion and removal requires specialist training.
• The FSRH produce eligibility criteria for contraceptive use see UKMEC.
• Drug interactions, including enzyme-inducing drugs, should be considered when prescribing contraceptives, see FSRH.
• For more information see FSRH.