1. What are Injectable Contraceptives?
Injectable contraceptive is an effective method of contraception that can be injected subcutaneously or in the muscles (usually buttock or upper arm). It prevents pregnancy from taking place by releasing progestogen in the body. Each dose of injectable contraceptive is effective and can prevent pregnancy for three months. There are two main types of injectable contraceptives:
- Progestogen-only Injectables (POI) containing only synthetic progesterone. They are of two types:
- Depot Medroxy Progesterone Acetate (DMPA) – 3 monthly Injection.
- Norethisteroneenanthate (NET-EN) – 2 monthly Injection.
- Combined Injectables Contraceptive (CIC): containing estrogen (usually ethinylestradiol) and progesterone – 1 monthly injection.
The only injectable contraceptive currently available in INDIA is Progestin-only injectable that has Depot Medroxy Progesterone Acetate or DMPA. It is a safe method for maintaining spacing between pregnancies. It can also be used by breastfeeding women (after 6 weeks of delivery) as it does not affect the quantity, quality and composition of breast milk. It reduces blood loss during periods, decreases menstrual cramps and also reduces pre-menstrual tension. Women who cannot use contraceptive methods with Estrogens can freely use the injectables.
2. Who can take progesterone only injections?
Nearly all women can use progestin-only injectables safely and effectively, including women who:
- Have or have not had children
- Are not married
- Are breast feeding
- Are of any age, including adolescents and women over 40 years old
- Have just had an abortion or miscarriage
- Smoke cigarettes, regardless of woman’s age or number of cigarettes smoked
- Are infected with HIV, whether or not on antiretroviral therapy
3. How does Injectable Contraceptive method work?
The injectable contraceptive or DMPA work primarily by preventing the release of eggs from the ovaries.
They also effect following changes in the women’s body
- Thickens the cervical mucus, which makes it difficult for sperm to move through the cervix.
- Thins the lining of the womb so a fertilised egg is less likely to implant itself
4. What are its advantages?
- Do not require daily maintenance and once administered, no need to worry for three months.
- Do not interfere with sex
- Very private: No one else can tell that a woman is using contraception!
- Cause no monthly bleeding (for many women)
- May help women to gain weight
- it may reduce heavy, painful periods and help with premenstrual symptoms for some women
Help protect against the following conditions also
- Cancer of the lining of the uterus (endometrial cancer)
- Uterine fibroids
- Symptomatic pelvic inflammatory disease
- Iron-deficiency anaemia
5. What are its disadvantages?
The most common side effects of DMPA are irregular or prolonged bleeding and spotting, particularly during the first few months of use. Some other disadvantages ae as under:
- Changes in menstrual bleeding pattern, like irregular spotting or bleeding, scanty periods are common, rarely heavy bleeding may occur. Amenorrhoea, especially after first year of use, may be disturbing in some women
- Breast tenderness, weight gain, acne and depression are bother some side-effect
- Return of fertility may take up to 9 months after the last injection which is longer than other reversible contraceptive methods
- Requires another injection every 1-3 months
- Does not protect against sexually transmitted diseases including HIV/AIDS
6. What kind of bleeding changes may happen with DMPA injection?
DMPA injection causes changes in bleeding pattern of women.
First 3 months:
- Irregular bleeding
- Prolonged bleeding
At one year:
- No monthly bleeding
- Infrequent bleeding
7. Do periods completely stop after DMPA injection?
Up to 50 percent of women completely stop having menstrual periods (amenorrhea) after one year of DMPA use. However, periods generally return within six months of the last DMPA injection
8. When does fertility return after DMPA use?
DMPA is long-acting contraceptive method. It may not be ideal for women who wish to become pregnant shortly after stopping the medication. Although most women are able to conceive within 6-10 months, fertility may take up to 18 months to return after stopping the injection.
9. If a woman does not have monthly bleeding while using progestin-only injectables, does this mean that she is pregnant?
If you have been getting your injections on time, you are probably not pregnant and can keep using injectables. Eventually most women using progestin-only injectables will not have monthly bleeding. If you are still worried after being reassured, you can take a pregnancy test. If not having monthly bleeding bothers you, switching to another method may help.
10. Do DMPA and NET-EN cause abortion?
No. Research on progestin-only injectables finds that they do not disrupt an existing pregnancy. They should not be used to try to cause an abortion. They will not do so.
11. How much weight do women gain when they use progestin-only Injectables?
Women gain an average of 1–2 kg per year when using DMPA. Some of the weight increase may be the usual weight gain as people age. Some women, particularly overweight adolescents, have gained much more than 1–2 kg per year. At the same time, some users of progestin-only injectables lose weight or have no significant change in weight.