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Contraception: Choices,
Culture, and Consequences
Jerusalem Makonnen,
Obj ectives
o ldenufy very eñecuve hormonal conLracepuve meLhods
LhaL are avallable ln non-dally and non-plll formulauons
o Clarlfy how each meLhod works
o ulscuss currenL cllnlcal lmpllcauon of each ln Lerms of
emcacy and safeLy
o ldenufy approprlaLe candldaLes who are able Lo use
each of Lhe meLhods and eñecuvely counsel Lhem
Hormonal Injections
Hor monal Inj ections
o Meslgyna (noreLhlndrone eLhanaLe 30 mg and
esLradlol valeraLe 3mg) lM monLhly ln[ecuon
o Lunelle (MedroxyprogesLerone aceLaLe 23mg
and esuadlol cysplonaLe 3 mg) lM monLhly
o noreLhlndrone eLhanaLe (200mcg) nL1-Ln
blmonLhly lM ln[ecuon
Progestin Inj ection: Characteristics
o MedoxyprogesLerone aceLaLe
(uepo Þrovera uMÞA)
o 130mg lM or 104 mg SC
• Cne ln[ecuon every 12-13 weeks
o very eñecuve!
• 99.7° eñecuve (Lheoreucal and acLual)
o Conunuauon raLes 26° -33° aL 1 year
Progesti n Inj ecti on: How Does It Work?
o lnhlblLs ovulauon Lhrough suppresslon of
folllcle sumulauon hormone (lSP) and
luLelnlzlng hormone (LP). Also lnhlblung
ConadoLropln releaslng hormone (Cn8P)
o LndomeLrlal changes
o Changes ln cervlcal mucus
Progestin Inj ection: Benefits
o uecreased rlsk of endomeLrlal cancer
o uecreased rlsk Þelvlc lnßammaLory ulsease
o uecreased mensLrual blood loss
o uecreased dysmenorrhea
o Amenorrhea for many women
o ConvenlenL, prlvaLe and hlghly eñecuve
Progestin Inj ection: Side Ef fects
o 8one loss
o lrregular bleedlng
o Amenorrhea
o 8reasL Lenderness
o Acne
o Peadache
o Mood changes (depresslon)
o WelghL galn
o uelayed reLurn Lo ferullLy (9-10 monLhs)
Progestin Inj ection & BMD
o 8Mu decreases by 1-2° per year
o luA: llmlL Lo 2 yrs. ln young women
• WPC & ACCC do noL agree
• 8one loss reverses by 1 year aûer dlsconunuauon.
o no lndlcauon for uLxA
o Welgh rlsks agalnsL rlsk of pregnancy
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Progesti n Inj ecti on: Contrai ndi cati ons
o MLC CaLegory 4: currenL or recenL breasL
o no eñecL on coagulauon or blood pressure
o no drug lnLeracuons
Progestin Inj ection: Candidates
o Women who can'L remember Lo Lake CCÞs,
change paLch or rlng
o Mlgralnes
o Selzure meds
o Women > 33 who smoke
o Women wlLh slckle cell anemla
o Women who may beneñL from esLrogen
suppresslon (ñbrolds, endomeLrlosls)
Pr ogest i n Inj ect i on: Ini t i at i on of Met hod
o Same day or Culck SLarL
o 8easonable cerLalnLy LhaL pauenL ls noL pregnanL
o no evldence LhaL lnadverLenL admlnlsLrauon of
uMÞA durlng pregnancy lncreases rlsk of
congenlLal anomalles or dlsrupLs pregnancy
o Þrovlde Lmergency ConLracepuon for fuLure use
o lf glven wlLhln 7 days of menses no back-up
meLhod necessary
Progesti n Inj ecti on: Pati ent Counsel i ng
o MensLrual cycle changes
o S1l Lransmlsslon
• SLudles ln low-rlsk women show no assoclauon
beLween uMÞA and Plv acqulsluon however
sLudles ln hlgh rlsk women show hlgher rlsk and
more rapld dlsease progresslon
Progestin Inj ection: Del ay
o 1radluonally
recommend cauuon
aûer > 14 weeks from
lasL uMÞA ln[ecuon
o WPC recommends 4-
week grace perlod
o 8epeaL up Lo 16 weeks
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