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Contraception - Management
Managing common problems when using progestogen-only injectables
What advice should I give on what to do when the repeat progestogen-only injectable is late?
- Up to 14 days late (i.e. up to 98 days since the last injection):
- Repeat the injection. No additional contraception is needed.
- More than 14 days late (i.e. more than 98 days since the last injection):
- Exclude pregnancy before repeating the injection. Use additional contraception for 7 days.
- If pregnancy cannot be excluded:
- Consider if emergency contraception is indicated. For more information, see the CKS topic on Contraception - emergency.
- Advise alternative methods, and delay repeating the injection until there is a negative pregnancy test at least 3 weeks after the last unprotected sex.
- After the injection, continue with alternative contraception for 7 more days.
In depth
What advice should I give about menstrual irregularity to women using a progestogen-only injectable?
- Advise that many women experience irregularities in menstruation while using a progestogen-only injectable:
- A few women have very heavy or prolonged bleeding. This can be managed by:
- Treating with a combined oral contraceptive (either cyclically or continuously) for up to 3 months.
- Treating with mefenamic acid 500 mg twice or three times a day for 5 days.
- Changing to another contraceptive method.
- Some women experience prolonged amenorrhoea; this is most likely in older women and, with forewarning, is usually accepted.
- Exclude or manage other situations which could result in unscheduled bleeding, such as:
- Sexually transmitted infections.
- Risk of STI if the woman is under 25 years, or has a new sexual partner, or more than one partner in the last year.
- Pregnancy.
- Gynaecological conditions such as cervical cancer. Provided there is consistent and correct use of contraception, speculum examination is warranted:
- For persistent bleeding beyond the first 3 months of use.
- For new symptoms or a change in bleeding after at least 3 months of use.
- If the woman has not participated in a National Cervical Screening programme.
- If requested by the woman.
- After a failed trial of modification of treatment.
- If there are other symptoms such as pain, dyspareunia, or post coital bleeding. (Note that these symptoms also warrant pelvic examination.)
In depth
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