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Contraceptive Technology and Reproductive Health Series:

Injectable Contraceptives
Post-test Answer Key

Section I: Injectables: An Overview


1. The following statements pertain to injectable contraceptives. Please indicate
whether each statement is True or False.
a.

Injectables are nearly as effective as female sterilization in preventing


pregnancy. True False
b. Injectables depend to a large extent on daily user compliance.
TrueFalse
c. The primary mechanism of action of injectables is suppression of
ovulation. True False
2. Typical one-year pregnancy rates in clinical trials for injectable contraceptives
are:
1
a. 0.4% or less.
b. 1%.
c. 10%.
d. 15%.
Section II: Progestin-only Injectables DMPA
3. The following statements pertain to the advantages and disadvantages of
DMPA as a contraceptive method. Please indicate whether each statement is
True or False.
a. DMPA is a reversible method of contraception. True False
b. DMPA increases the risk of ectopic pregnancy. True False
c. DMPA provides protection from endometrial cancer. True False
d. DMPA does not have a negative effect on lactation; however, it is
recommended that a woman who is breastfeeding wait until her child is six
weeks old before using it. True False
e. DMPA does not cause menstrual changes. True False
4. Which of the following are not potential health benefits of DMPA?
a. Reduced risk of vaginal yeast infections.
b. Reduced risk of acute pelvic inflammatory disease (PID).
c. Reduced symptoms of endometriosis.
d. Reduced risk of heart disease.
e. Protection against STDs, including HIV.

5. Which of the following are typical menstrual changes for women taking DMPA?
Check all that apply.
a. Over 40% of women experience prolonged or irregular bleeding after
the first DMPA injection.
b. By the end of the first year, 90% of women have no menstrual bleeding.
c. Bleeding changes are rarely seen in women taking DMPA.
d. Infrequent bleeding and amenorrhea become more common as the
duration of DMPA use increases.
6. On average, women can become pregnant how many months after their last
DMPA infection?
a. 2-4 months.
b. 6-8 months.
c. 9-10 months.
d. 12-24 months.
7. Check all that apply. It is safe for a breastfeeding woman to begin using
DMPA:
a. When her infant is six weeks old, preferably.
b. Only when her milk supply is completely developed.
c. Sooner than with combined injectables.
d. Immediately after birth, if necessary.
8. As a provider, what issue might keep you from recommending DMPA to
adolescent girls?
a. Concerns about bone density and osteoporosis.
b. Concerns about return to fertility.
c. Risk of ectopic pregnancy.
d. Loss of privacy.
9. Check all that apply. According to World Health Organization (WHO)
guidelines, DMPA and NET-EN are not recommended for or should not be
used by:
a. Women with low blood pressure.
b. Women who have diabetes with vascular complications.
c. Women with active hepatitis.
d. Women who have a sexually transmitted disease.
e. Women who have breast cancer.
10. A 32-year-old woman has three children and is not planning to have

more. She has suspicious, unexplained bleeding and is showing clinical


signs of anemia. She would like to use DMPA. What would you
recommend and why?
a. Recommend DMPA. According to WHO Guidelines, she falls under
Category 1, which means there are no health concerns.
b. Recommend NET-EN as a preferable solution, because it causes less

bleeding changes.
c. Recommend another contraceptive option. According to the WHO
guidelines, this woman falls under Category 4, which means she
should not use DMPA until the bleeding has been evaluated.
d. None of the above.
11. A 37-year-old woman who smokes heavily wants to use DMPA as a

method of contraception. What would you recommend and why?


a. She can use DMPA because smoking is not a contraindication for
progestin-only injectables.
b. Recommend Cyclofem instead because smoking is not a contraindication
for combined injectables.
c. Recommend another contraceptive option.
According to the WHO
guidelines, this woman falls under Category 3, which means she should not
use DMPA unless other methods are not available or acceptable.
d. None of the above.
Section III: Progestin-only Injectables NET-EN
12. Please indicate whether each statement regarding NET-EN is True or False.
a. NET-EN is effective for a shorter period of time than DMPA. True False

b. NET-EN can be initiated only during the first seven days of the
menstrual cycle. True False
c. NET-EN should be initiated no sooner than six weeks postpartum for
breastfeeding women. True False
d. Women who use NET-EN are more likely to have amenorrhea than
those who use DMPA. True False
e. It is possible to provide NET-EN to women immediately postabortion.
True False
13. Both DMPA and NET-EN can be started:
a. At any point in a womans menstrual cycle, as long as a woman is
not pregnant and it is used with a backup method if starting after
day seven.
b. Six weeks postabortion or postpartum, if not breastfeeding.
c. Only in the first seven days of a womans menstrual cycle.
d. None of the above.
14. The injection schedule for NET-EN:
a. Is once every month.
b. Is once every two months.
c. Is once every four months.
d. Varies for each woman.

15. A 36-year-old woman is using NET-EN as a method of contraception.

She is three weeks late for her next injection. What do you do?
a. If you can be reasonably sure that the woman is not pregnant, give
her the next injection.
b. Even if you can be reasonably sure that the woman is not pregnant, tell her
she must use a condom until her next menstrual cycle begins, after which
she should return for another injection.
c. Advise her to choose an alternate method of contraception as injectables
cannot be given late.
d. None of the above.
Section IV: Combined Injectable Contraceptives
16. The following statements refer to combined injectable contraceptives.
Please indicate whether each statement is True or False.
a. The window for subsequent injections is up to five days early and five days
late. True False
b. Breastfeeding women should postpone the use of combined injectables
until six months postpartum. True False
c. Women who use combined injectables never experience changes in their
menstrual cycles. True False
d. Irregular bleeding due to combined injectables use is most common during
the first three months of use and then decreases over time. True False

17. Which two of the following are the commercial names for newer, widely
studied combined injectable contraceptives?
a. DMPA.
b. Cyclofem.
c. Mesigyna.
d. Topasel.
18. Which three of the following are advantages of combined injectables?
a. They are safe and highly effective.
b. Their use can be kept private since bleeding is more regular than
with progestin-only injectables.
c. They do not have to be administered as often as progestin-only
injectables.
d. They require no action at time of sexual intercourse.
19. Check all that apply. According to WHO guidelines, combined injectables are
not recommended for use by women:
a. Who are heavy smokers over 35 years of age.
b. With sexually transmitted diseases.
c. With high blood pressure.
d. With breast cancer.

20. A 25-year-old woman gave birth to her third child six weeks ago. She is

breastfeeding, but does not want to rely on the Lactational Amenorrhea


Method (LAM) for contraception. She wants to use another method,
possibly Cyclofem. What would you recommend and why?
a. Assure her that it will be fine to begin Cyclofem at six weeks
postpartum.
b. Counsel her on the availability of progestin-only injectables (DMPA
or NET-EN) and other methods such as oral contraceptives,
barrier methods and IUDs. Explain that if she still wants to use
Cyclofem, she can initiate this method at six months postpartum.
c. Counsel her against using any injectable contraceptives while she is
breastfeeding, because they affect the quantity and quality of
breastmilk and may harm her babys health and development.
d. None of the above.
Section V: Providing Injectables
21. Check all that apply. Counseling messages for women before beginning
injectable contraceptive use include:
a. Injectables do not provide protection against sexually transmitted
diseases, including HIV.
b. It is important not to massage the injection site.
c. No bleeding is likely to occur in the month after the first injection.
d. The need for regular, timely injections.
e. The timing of return to fertility.
22. Which two of the following demonstrate the correct technique for
administering DMPA?
a. The vial must be lightly shaken before injecting.
b. All the solution must be drawn into the syringe, especially for DMPA and
Cyclofem.
c. Injections may be given in the forearm, upper leg or back.
d. The preferred injection location for most women is the deltoid muscle
of the upper arm or the gluteus muscle of the buttocks.
23. Which three of the following demonstrate the sterile conditions needed to
deliver injectable contraceptives?
a. A sterile needle and syringe must be used for each injection.
b. The injection site should be cleaned with a new piece of cotton for
each client.
c. There are no special waste disposal instructions for maintaining a sterile
environment.
d. The provider should wash hands before each injection.
24. Choose the best answer. Delivery of injectables can be provided:

a. In clinics by nurses.
b. In pharmacies by pharmacists.
c. In homes by community-based workers.
d. All of the above.
25. The following statements refer to providing injectable contraceptives. Please
indicate whether each statement is True or False.
a. If a family planning clinic cannot maintain adequate supplies of all
injectable contraceptives, it is preferable to offer only one type of
injectable. True False
b. Injectable contraceptives may be used for four to six months past their
expiration date. True False
c. Health workers who provide injectable contraceptives need to be trained in
both technical skills and counseling skills. True False