Last updated 20.09.12
Definition
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Long acting intramuscular injectible depo progesterone
hormonal contraceptive
Features
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3 monthly (12 weekly) IMI 150mg Medroxyprogesterone Acetate
(Progesterone)
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Every 10 weeks if on anticonvulsants
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Ovulation suppression
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Reversible but effect may last up to 1 yr+ --> infertility
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Implanon has reduced use of Depo-Provera
Indications
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Carcinoma: recurrent or metastatic breast or renal Ca
Contraindications/Precautions
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Thrombophlebitis
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Stroke
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Severely deranged liver function
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Undiagnosed vaginal bleeding
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Undiagnosed breast pathology
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Severe uncontrolled HTN
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Breast Ca (unless by oncologist)
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Anticonvulsants make less effective
Side Effects
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May cause irregular bleeding
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Usually for first few months
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1/3 pts amenorrhoea
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1/3 pts regular period w reduced bleed
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1/3 pts totally irregular period
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Consider 0.005 – 0.1mg Ethinyl Estradiol PO daily for 7-21 days
for 1-2 cycles (not longer)
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Upto 5% pts
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Bloating, abdomial discomfort
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Dizziness, nervousness, fatigue
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Headache
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May aggravate depression due to high progesterone
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Fluid retention/weight gain
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Avg 3kg after 2yrs (esp if overweight already)
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Bone mineral loss with long term use (>2 yrs)
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Reversible
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Consider alternative contraceptive if
high risk of osteoporosis
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Possbile reduction of
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Acute episodes of PID
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Recurrent vulvovaginal candidiasis
Dose
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Contraception: 150mg 3 monthly IMI
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Endometriosis: 50mg weekly IMI for 6/12
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Breast Ca: 500mg daily IMI for 4/52+
Procedure for
Contraception
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Timings
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Initiating with normal cycle
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Day 1-5 of cycle to ensure not preganant
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Bottle feeding: prior to day 21 post partum
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Breast feeding: after 4/52 post partum
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Subsequent dosings
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Within 12 weeks of last dose
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If >13 weeks after last dose must do pregnancy test prior
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Shake vial to evenly distribute solution
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Typically 150m/ml therefore 1ml administered
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21 or 23G needle
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Gluteal or deltoid muscles
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+/- 1 week cover with alternative contraception
References
RANZCOG College Statement
C-Gyn 4, July 2012
Contraception:
Your Questions Answered, John Guillebrand
Depa-Ralovera
Product Information Guide, August 2011