Ask the client the questions below about known medical conditions. Examinations and tests are not necessary. If she answers “no” to all of the questions, then she can start progestin-only injectables if she wants. If she answers “yes” to a question, follow the instructions; in some cases she can still start progestin-only injectables.

1.    Are you breastfeeding a baby less than 6 weeks old?

NO   YES The client can start using progestin-only injectables as soon as 6 weeks after childbirth (see "Fully or nearly fully breastfeeding" or "Partially breastfeeding").

2.    Do you have severe cirrhosis of the liver or severe liver tumor?

NO   YES If the client reports severe cirrhosis or severe liver tumor, such as liver cancer, do not provide progestin-only injectables. Help her choose a method without hormones.

3.    Do you have high blood pressure?

NO   YES Check her blood pressure if possible:

• If the client is currently being treated for high blood pressure and it is adequately controlled, or her blood pressure is below 160/100 mmHg, provide progestin-only injectables.
• If systolic blood pressure is 160 mmHg or higher or diastolic blood pressure is 100 or higher, do not provide progestin-only injectables. Neither progestin-only injectables nor any methods containing estrogen are appropriate for the client; help her choose another method. 
• If the client reports having high blood pressure in the past, and you cannot check blood pressure, provide progestin-only injectables.

4.    Have you had diabetes for more than 20 years or do you have damage to your arteries, vision, kidneys, or nervous system caused by diabetes?

NO   YES Do not provide progestin-only injectables. Neither progestin-only injectables nor any methods containing estrogen are appropriate for the client; help her choose another method. 

5.    Have you ever had a stroke, blood clot in your leg or lungs, heart attack, or other serious heart problems?

NO   YES If the client reports heart attack, heart disease due to blocked or narrowed arteries, or stroke, do not provide progestin-only injectables. Help her choose a different method that does not contain estrogen. If she reports a current blood clot in one of her legs (affecting deep veins, not superficial veins) or in a lung and she is not on anticoagulant therapy, help her choose a method without hormones.

6.    Are you having vaginal bleeding that is unusual for you?

NO   YES If the client has unexplained vaginal bleeding that suggests pregnancy or an underlying medical condition, progestin-only injectables could make diagnosis and monitoring of any treatment more difficult. Help her choose another method to use until she has been evaluated and treated, but not implants or a copper-bearing or hormonal IUD. After treatment, re-evaluate the client’s eligibility for use of progestin-only injectables.

7.    Do you have or have you ever had breast cancer?

NO   YES Do not provide progestin-only injectables. Help her choose a method without hormones.

8.    Do you have several conditions that could increase your chances of heart disease (coronary artery disease) or stroke, such as high blood pressure and diabetes?

NO   YES Do not provide progestin-only injectables. Help the client choose a different method that does not contain estrogen.

Also, a woman should not use progestin-only injectables if she reports having lupus with positive (or unknown) antiphospholipid antibodies and is not on immunosuppressive treatment, or if she has severe thrombocytopenia. For complete classifications, see Appendix D – Medical Eligibility Criteria for Contraceptive Use. 

Be sure to explain the health benefits as well as the potential risks and side effects associated with the client’s chosen method. Also, point out any conditions that would make the method inadvisable for use by that particular client.