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Contraception - Management
How should a progestogen-only injectable be started in a woman who is not using contraception?
- Having menstrual cycles and not postpartum, or post-abortion or post-miscarriage:
- Give the injection during days 1–5 of the menstrual period. Additional contraception is not needed.
- You can also give the first injection after day 5 (unlicensed use) if reasonably certain the woman is not pregnant. Advise additional contraception for 7 days.
- Amenorrhoeic and reasonably certain not pregnant:
- Give the first injection at any time (unlicensed use). Advise additional contraception for 7 days.
- Postpartum and not breastfeeding:
- Give the first injection on day 21 — additional contraception is not needed. If the injection is given after day 21, advise additional contraception for 7 days.
- Injectable progestogens can be started before 21 days if there is good reason to do so. Noristerat® can be used immediately after birth. Depot medroxyprogesterone acetate can be started within 5 days of birth (prolonged heavy bleeding can occur).
- Breastfeeding:
- < 6 weeks postpartum: Noristerat® can be used immediately after birth. Delay using DepoProvera® until at least 6 weeks after birth. If because of the risk of pregnancy, it must be used before this, delay until at least day 21 days postpartum (unlicensed use).
- Between 6 weeks and 6 months postpartum, and amenorrhoeic: give the first injection at any time. Advise additional contraceptive for 7 days unless fully breastfeeding.
- > 6 weeks postpartum, and menstrual periods have returned: give the first injection as advised for other women having menstrual cycles.
- Women who are post-abortion or post-miscarriage:
- Give injections immediately after miscarriage (unlicensed use), or abortion (unlicensed use for depot medroxyprogesterone acetate). If started > 7 days after abortion (unlicensed use), advise additional contraception for 5 days.
In depth
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