CHAPTER 4 - Progestin-Only Injectables

Key Points for Providers and Clients
Bleeding changes are common but not harmful. Typically, irregular bleeding for the first several months and then no monthly bleeding. Return for injections regularly. Coming back every 3 months (13 weeks) for DMPA or every 2 months for NET-EN is important for greatest effectiveness. Injection can be as much as 4 weeks late for DMPA or 2 weeks late for NET-EN. Even if later, she may still be able to have the injection. Gradual weight gain is common, averaging 1-2 kg per year. Return of fertility is often delayed. It takes several months longer on average to become pregnant after stopping progestin-only injectables than after stopping other methods.

Key Points for Providers and Clients

Bleeding changes are common but not harmful. Typically, irregular bleeding for the first several months and then no monthly bleeding.
Return for injections regularly. Coming back every 3 months (13 weeks) for DMPA or every 2 months for NET-EN is important for greatest effectiveness.
Injection can be as much as 4 weeks late for DMPA or 2 weeks late for NET-EN. Even if later, she may still be able to have the injection.
Gradual weight gain is common, averaging 1-2 kg per year.
Return of fertility is often delayed. It takes several months longer on average to become pregnant after stopping progestin-only injectables than after stopping other methods.

What Are Progestin-Only Injectables?

The injectable contraceptives depot medroxyprogesterone acetate (DMPA) and norethisterone enanthate (NET-EN) each contain a progestin like the natural hormone progesterone in a woman’s body. (In contrast, monthly injectables contain both estrogen and progestin. See Monthly Injectables.)
Do not contain estrogen, and so can be used throughout breastfeeding, starting 6 weeks after giving birth, and by women who cannot use methods with estrogen.
Given by injection into the muscle (intramuscular injection) or, with a new formulation of DMPA, just under the skin (subcutaneous injection). The hormone is then released slowly into the bloodstream. (See DMPA for Subcutaneous Injection.)
DMPA, the most widely used progestin-only injectable, is also known in its intramuscular form as “the shot,” “the jab,” the injection, Depo, Depo-Provera, and Petogen. The subcutaneous version in the Uniject injection system is currently marketed under the name Sayana Press and in prefilled single-dose disposable hypodermic syringes as depo-subQ provera 104.
NET-EN is also known as norethindrone enanthate, Noristerat, Norigest,and Syngestal. (See Comparing Injectables for differences between DMPA and NET-EN.)
Work primarily by preventing the release of eggs from the ovaries (ovulation).

Progestin-Only Injectable Syringe and Vial