How late can you give Depo-medroxyprogesterone acetate?

How late can you give Depo-medroxyprogesterone acetate?

S. Jones, M. Kishen

Abacus Clinics for Contraception and Reproductive Health, Liverpool, UK

Aim: To formally assess acceptability and outcome of management of

clients who present for a repeat injection of Depomedroxyprogesterone acetate (DMPA)

150mg/ml more than eighty-nine days after their previous injection, having had

unprotected sexual intercourse (UPSI) after the protection of their previous

DMPA injection ended.

Background: DMPA licence is for 89 days in the United Kingdom. Nurses

provide a large proportion of the contraceptive care in our service using

patient group directions (PGDs) which allow nurses to issue hormonal

contraceptive methods without a prescription. In our service, clients who

present for a repeat injection after eighty-nine days since their previous

injection, having had pregnancy risk, are counselled and given the choice of (a)

receiving their DMPA injection the same day with or without emergency

contraception (EC) if appropriate, with full awareness that pregnancy has not

been excluded or (b) EC if appropriate and waiting for their next injection

until pregnancy is excluded by a pregnancy test three weeks after the last UPSI.

They are informed that there is no increased risk of abnormality to a fetus if

conception has occurred, based on currently available evidence. As option (a) is

outside our current PGDs, nurses need to consult a doctor if a client chooses

this option. As we wish to incorporate this option into our PGDs, we decided to

audit the acceptability and outcome of this practice.

Method: A retrospective audit of case-notes of continuing DMPA users.

Results: Eighty-three cases were identified who met specified criteria

for delayed use with risk of pregnancy during 2002/ 2003;18 had UPSI between 89

days and 13 weeks, 23 had UPSI between 13 and 14 weeks and 42 had UPSI after 14

weeks. Seventy-five clients (90%) chose to have DMPA on the day, without

excluding pregnancy risk, and eight (10%) chose to wait until pregnancy was

excluded before having the next injection. No pregnancies occurred. Twenty four

(32%) attended for pregnancy test three weeks later as advised, 47 (63%)

excluded pregnancy by test only at the time of the next injection and 4 (5%) did

a home pregnancy test.

Conclusion: This is acceptable and safe clinical practice from both

the clinicians’ and the clients’ perspective. It enables women who default an

arranged date for a repeat injection to link back into effective contraception

as soon as possible.

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