To assess a woman's eligibility for use of a progestogen-only injectable:

• In young women and women with special needs, assess their competence to decide, and support them in making their own decisions about contraception.
• Exclude pregnancy.
• Assess the woman's risk for sexually transmitted infection, and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• Assess the risk for osteoporosis.
• Check the woman's blood pressure.
• Check the UK Medical Eligibility Criteria to ensure that the assessment is complete and that the woman is eligible for a progestogen-only injectable.
• Women should not use a progestogen-only injectable (UKMEC 4) in the following situations:
• Current breast cancer.
• Women should use a progestogen-only injectable only after consultation with an expert (UKMEC 3) in the following situations:
• Multiple risk factors for arterial cardiovascular disease (e.g. older age, smoking, diabetes, and hypertension).
• Vascular disease, including angina or other ischaemic heart disease, intermittent claudication, hypertensive retinopathy, stroke or transient ischaemic attack.
• Unexplained vaginal bleeding: before evaluation.
• History of breast cancer and no evidence of recurrence for 5 years.
• Diabetes with nephropathy, neuropathy, retinopathy, or other vascular disease.
• Cirrhosis of liver: severe (decompensated).
• Liver tumours: benign (hepatocellular adenoma) and malignant (hepatoma).
• Systemic lupus erythematosus with positive (or unknown) antiphospholipid antibodies, or with severe thrombocytopenia if considering initiating depot medroxyprogesterone acetate.
• If the woman is at increased risk for osteoporosis, she should consider alternatives to depot medroxyprogesterone acetate.

• Contraception for young women and women with learning disabilities:
• Contraception should be seen in terms of the needs of the individual rather than in terms of relieving the anxieties of carers or relatives.
• When a woman with a learning disability is unable to understand and take responsibility for decisions about contraception, carers and other involved parties should meet to address issues around the woman's contraceptive need and to establish a care plan.
• See Considerations for girls under 16.
• Risk factors for osteoporosis:
• Treatment with corticosteroids.
• Low body mass index (< 19 kg/m²).
• Family history of maternal hip fracture before age 75 years.
• Medical disorders independently associated with bone loss (e.g. chronic inflammatory bowel disease, rheumatoid arthritis, hyperthyroidism, coeliac disease).
• Conditions associated with prolonged immobility.
• The following examinations and laboratory tests are not required to assess eligibility for a progestogen-only injectable:
• Bone mineral density tests (also not required for the recommended re-evaluation after 2 years use of depot medroxyprogesterone acetate).
• Breast, pelvic, or genital examination.
• Cervical cytology screening.
• Routine laboratory tests, including haemoglobin measurements.
• Thrombophilia screening.

• These recommendations for assessing a woman before starting a progestogen-only injectable are based on the UK medical eligibility criteria for contraceptive use issued by the Faculty of Sexual and Reproductive Health Care [FSRH, 2009b] and guidance issued by the National Institute for Health and Clinical Excellence on the use of long-acting reversible contraceptives [National Collaborating Centre for Women's and Children's Health, 2005].
• The recommendations are also based on guidelines issued by the Medicines and Healthcare products Regulatory Agency (MHRA), and the Faculty of Sexual and Reproductive Health Care on the use of depot medroxyprogesterone acetate and norethisterone enantate injections [FFPRHC, 2002; CSM, 2004; FFPRHC, 2004e].