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CHAPTER 4 - Progestin-Only Injectables

Key Points for Providers and Clients
  • Bleeding changes are common but not harmful. Typically there will be 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 (8 weeks) for NET-EN is important for greatest effectiveness. Subcutaneous DPMA can be self-injected.
  • The next injection can be as much as 4 weeks late for DMPA or 2 weeks late for NET-EN. Even if it is later than this, the client 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, combined injectable contraceptives contain both estrogen and progestin and must be given monthly, see Chapter 5 – Monthly Injectables.)
  • They do not contain estrogen, and so can be used throughout breastfeeding, starting 6 weeks after giving birth, and by women who cannot use methods containing estrogen.
  • After injection, the hormone is released slowly into the bloodstream. (See Chapter 5 – Monthly Injectables).
  • They are usually injected into the muscle (intramuscular injection). A newer formulation of DMPA can be injected just under the skin (subcutaneous injection). (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 (DMPA-SC) comes in two forms: the Uniject injection system currently marketed under the name Sayana Press; and the prefilled single-dose disposable hypodermic syringes marketed as Depo-SubQ Provera 104. The Uniject system allows DMPA-SC to be easily self-injected by clients who wish to do so.
  • NET-EN is also known as Noristerat, Norigest, and Syngestal. (See the job aid Comparing Injectables for differences between DMPA and NET-EN.)
  • Progestin-only injectables work primarily by preventing the release of eggs from the ovaries (ovulation).

Progestin-Only Injectable Syringe and Vial