Medroxyprogesterone injection for contraception

Type of medicine	Used for	Also called	Available as
A progestogen (female hormone)	Contraception	Depo-Provera®; SAYANA PRESS®	Intramuscular injection (Depo-Provera®), and subcutaneous injection (SAYANA PRESS®)

Medroxyprogesterone is a progestogen, which is a female hormone. It is used to prevent pregnancy. It is a very effective and safe form of contraception. Medroxyprogesterone is either injected into a muscle (Depo-Provera®) or under the skin (SAYANA PRESS®). It is then slowly released into your body. The injection will provide contraception for three months. Its advantages are that it is very effective as a contraceptive and you do not have to remember to take tablets. Also, it can be used when breast-feeding. The downsides are that your periods may become irregular and there may be a delay in your return to normal fertility after you finish using it. Also, the injection cannot be removed once it has been given so any side-effects can last for 2-3 months. Medroxyprogesterone works mainly by stopping the release of an egg from the ovary (ovulation). It also changes the lining of your womb (uterus) to make it less likely that an egg would attach to it, even if an egg were to fertilise. In addition, the mucus which forms a plug in the neck of the womb (your cervix) becomes thicker. This stops sperm getting through to the uterus to fertilise an egg. 

Before having a medroxyprogesterone injection

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you have a medroxyprogesterone injection it is important that your doctor or nurse knows:

• If you think you could already be pregnant.
• If you have any vaginal bleeding other than your normal monthly period.
• If you have any problems with the way your liver works.
• If you have a problem with your arteries, called arterial disease.
• If you have an inflammatory condition called systemic lupus erythematosus (SLE).
• If you have developed yellowing of your skin or the whites of your eyes (jaundice), severe itching, or a skin condition called pemphigoid gestationis during a pregnancy.
• If you have had breast cancer or a cancer that you have been told is dependent on a sex hormone.
• If you have a rare inherited blood disorder called porphyria.
• If you have ever had an allergic reaction to a medicine.
• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.

How medroxyprogesterone injection is given

• Before you are given the injection you will be asked to read a printed information leaflet from the manufacturer. The manufacturer's leaflet will give you important information about the injection and will provide a full list of the side-effects which you may experience from having it. Before you have the injection, please discuss with your doctor/nurse any questions you have as a result of reading the leaflet. You will be given the leaflet to take home.
• The injection will be given to you by your doctor or nurse. The first injection will usually be given during the first five days after the beginning of a normal menstrual period and when given in this way, you will be protected from pregnancy straightaway. If you are having medroxyprogesterone injection after recently giving birth, your doctor will advise you on the best time to have the injection.
• Depo-Provera® is usually given as a single injection into the muscle in your buttock. It can sometimes be given into the upper arm.
• SAYANA PRESS® is given as an injection under the skin of your outer thigh or your tummy (abdomen).

Getting the most from your treatment

• The timing of the injections is important, so remember to keep your scheduled clinic appointments. Your next injection will be due in 12 weeks time if you have had Depo-Provera® and it will be due in 13 weeks time if you have had SAYANA PRESS®. If you are more than five days late for your next Depo-Provera® injection, or more than seven days late for your next SAYANA PRESS® injection, you may be at risk of getting pregnant. If this happens, your doctor will want to be sure that you are not pregnant before giving you another injection. You also may need to use an additional form of contraception such as a condom for 14 days until this next injection takes effect.
• Your periods are likely to change. Spotting, breakthrough bleeding and delayed periods may occur. Some women have irregular bleeding which can be heavier and longer than normal.
• You may gain a little weight. Eating a well-balanced diet and taking regular exercise can help to keep this to a minimum but if this is a concern to you, you should discuss it with your doctor.
• Regularly check your breasts for any lumps or bumps. Speak with your doctor if you notice any changes.
• Please note: the injection will not protect you against HIV (AIDS) or any other sexually transmitted infections.
• If you are having any medical tests you should tell the person doing the test that you are using medroxyprogesterone as a contraceptive. This is because this form of contraception may affect the results of some tests, including cervical smears.
• If you have diabetes you may need to check your blood glucose more frequently, as medroxyprogesterone can affect the levels of sugar in your blood. Your doctor will be able to advise you about this.
• If you wish to use medroxyprogesterone injection for more than two years, your doctor will want to discuss this with you, as there may be other options more suitable for you. This is because using medroxyprogesterone can lead to a gradual loss of bone mineral density.
• If you wish to try for a baby you may find that it can take up to a year after stopping using medroxyprogesterone injection before you are able to conceive, although this takes different times in different women. Some women have become pregnant within one month of stopping the injection; for others, it takes longer.

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