Injectables.ppt

Family planning methods by injectables

1. INJECTABLES

2. LEARNING OBJECTIVES
At the end of the session the trainees will
be able to:
•Describe the policy and standards for hormonal
contraceptives
•Enumerate hormonal contraceptives
•Describe hormonal contraceptives
•Manage the side effects and complications of
hormonal contraceptives
•Effectively counsel for hormonal contraceptives

3. TYPES OF INJECTABLES
Three types of long acting injectables are
available in Pakistan
•DMPA (Depo-Provera / Magestrone)
•NET.EN (Norigest)
•Mesigyna

4. DMPA
This progestin injectable contraceptive (PIC)
contain depot medroxyprogesterone acetate and is
prepared as a micro-crystalline suspension.
A dose of 150 mg in 1 ml of the suspension is
given by deep intramuscular injection at regular,
12-week intervals to protect the client from
unwanted pregnancy.
DMPA, the most widely used PIC, is also known as
“the shot”, “the jab”, Depo, Depo-Provera, and
Magnetron.

6. NET-EN
This PIC contain norethindrone enanthate
and is prepared in an oily solution.
A dose of 200 mg in 1 ml of oily solution is
given by deep intramuscular injection
regularly at 8-week intervals to protect the
client from unwanted pregnancy.

7. Mode of Action
The progestin in the injectable acts as a
contraceptive by:
Inhibiting ovulation most of the time.
Thickening cervical mucus to form a plug, which
inhibits the transport of sperm.
Making the endometrium less suitable for
implantation of the fertilized ovum.

8. POLICY
Injectable will be given to women who need a long
term method
Injectable will not be given to
A woman who is pregnant or suspected to be
pregnant
Postpartum women before 6 weeks of childbirth if
breastfeeding for Depo-Provera/ Magestrone and
Norigest and 6 months postpartum for Mesigyna
Injectables will be given to women immediately after
abortion

9. STANDARDS
Complete asepsis must be ensured while giving
injection
Use of disposable syringe should be made
compulsory
All health care providers must be trained in the
technique of administering injectables

10. EFFECTIVENESS
Very effective i.e.0.3 pregnancies per 100
women in first year of use (1 in every 333)
when give regularly on time. Pregnancy rates
may be higher for women who are late for an
injection or who miss an injection or if
providers run out of supplies.

11. Advantages
Very effective.
Privacy-No one.
One injection prevents pregnancy for 2-3 months.
Is reversible.
Dose not interfere with sex.
Increased sexual enjoyment because no need to
worry about pregnancy.
No daily pill-taking.
Allows some flexibility in return visit; client can
return for next injection upto 4-weeks late for
DMPA and 2 weeks late for NET-EN.

12. Does not effect the quantity and quality of breast milk.
Can be used by nursing mothers as soon as 6 weeks after
child birth.
No oestrogen-related side effects.
Help prevent endometrial cancer.
Help prevent uterine fibroids.
May help prevent ovarian cancer.
May help prevent iron-deficiency anemia.
Makes sickle cell crises less frequent and less painful.
Reduce symptoms of endometriosis(Pelvic pain, irregular
bleeding).
Protect against symptomatic pelvic inflammatory
disease(PID).
Women who are infected with HIV, have ADIS, or are on
antiretroviral (ARV) therapy can safely use progestrone-only
injectable.

13. Limitations
Menstrual changes like spotting and irregular
bleeding are common in the few first months of use
with both with Norigest and Depo-
Provera/Megestron.
Amenorrhea after prolonged used may occur.
The return of fertility can be delayed after stopping
the injection-an average of 10 months of DMPA
and 6 months for NET-EN.
Cannot be easily discontinued or removed from the
body if complications develop or if pregnancy is
desired.
Dose not protect against sexually transmitted
infections (STIs), including HIV/AIDS.

14. Side Effect
Amenorrhea (no monthly bleeding period).
Spotting or bleeding between monthly periods.
Heavy or prolonged bleeding(more than 8 days
long or twice as much as her usual menstrual
periods).
Unexplained abnormal vaginal bleeding that
suggests pregnancy or an underlying medical
condition.
Ordinary headaches.
Migraine headaches.
Mood changes.

15. CLIENT ASSESSMENT AS PER WHO
MEDICAL ELIGIBILITY CRITERIA (MEC)
Ask the client the questions below. If the answer is NO to
all of the questions, then client can use Injectables. If
answers YES to a question below, follow the instructions.
1. Is the client breastfeeding a baby less than 6 weeks
old?
Start using injectables beginning 6 weeks after childbirth
except combined injectable Contraceptive which can be
started after six months postpartum.
If fully or almost fully breastfeeding she is protected from
pregnancy for 6 months after childbirth or until the
menstrual period returns. The client must begin
contraception at once to avoid pregnancy.

16. CLIENT ASSESSMENT AS PER WHO
MEDICAL ELIGIBILITY CRITERIA (MEC)
2. Does the client have problems with her heart or
blood vessels? Has she ever had such problems? If
so, what problems?
Do not provide injectables if the client reports heart attack,
heart disease due to blocked arteries, stroke, blood clots
(except superficial clots), severe chest pain with unusual
shortness of breath, severe high blood pressure, diabetes
for more than 20 years, or damage to vision, kidneys or
nervous system caused by diabetes. Help the client
choose another effective method.

17. CLIENT ASSESSMENT AS PER WHO
MEDICAL ELIGIBILITY CRITERIA (MEC)
3. Does the client have high blood pressure?
If the client reports high BP check BP immediately.
If systolic BP is over 160 or diastolic BP over 100, do
not provide injection. Help the client choose another
method except COCs.
4. Does the client have or ever had breast cancer?
Do not provide injection. Help the client choose a
method without hormones.

18. CLIENT ASSESSMENT AS PER WHO
MEDICAL ELIGIBILITY CRITERIA (MEC)
5. Does the client have severe cirrhosis of the liver,
a liver infection or tumour?
Perform physical examination or refer. If the client has
serious active liver disease do not provide injection.
Refer for care. Help the client choose a method
without hormones
6. Does the client think she is pregnant?
Assess whether pregnant. Give condoms to use until
reasonably sure that pregnancy is excluded. Then
injection can be given start injection.

19. CLIENT ASSESSMENT AS PER WHO
MEDICAL ELIGIBILITY CRITERIA (MEC)
7. Does the client have vaginal bleeding that is
unusual for her?
If the client has unexplained vaginal bleeding that
suggests an underlying medical condition,
provide injection. Assess and treat any underlying
condition as appropriate, or refer.
Be sure to explain the health benefits and risks
and the side effects of the method that the client
will use. Also, point out any conditions that would
make the method inadvisable.

20. Site of Insertion
Upper lateral quadrant of non dominant
arm (deltoid) .
Upper lateral quadrant of buttock (gluteus
Maximus).