Depoprovera (Progestogen injection- medroxyprogesterone acetate)
- Injection to be within 5 days of last menstrual period
- Lasts 12 weeks per injection
Indications
- Not concordant with the COC pill or POP
- If there are contraindications to oestrogens
- Sickle cell disease
- If the patient requires long-term progestogens
- If the patient is on enzyme inducing drugs e.g. anti-epileptics
- If the patient is at risk of/is being treated for endometriosis
Contraindications
- see also POP
- short term contraception
- puerperium (6 weeks following childbirth)
- Severe obesity
- Dislike of amenorrhea (35% at one year)
- Uncontrolled hypertension
- Long term in those at high risk of osteoporosis
- In adolescents, it may be used after other methods have been considered unsuitable/unacceptable
- Re-evaluation (in all women) should happen every 2 years to assess risk/benefit ratio (including a DEXA scan if necessary)
- Alternative should be sought for those at risk (lifestyle or medical)
Implanon/Nexplanon (the implant)- Etonogestrel (Nexplanon also has barium so is radio-opaque)
- almost 100% effective
- lasts 3 years
- not suitable for those taking enzyme inducing drugs (e.g. antiepileptics)
- Consider changing earlier if problematic bleeding towards end
- Inserted between day 1 and 5 of the cycle for immediate effect
- Side effects include irregular bleeding; skin changes; headaches; weight gain; loss of libido; (amenorrhea)
Notes on Medicine/Surgery 