Client suitability, administration, timing of first injection, documentation

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Assessment of client suitability

History

Clinical history taking and examination allow an assessment of medical eligibility for DMPA use. See UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)

In this context the history should include:

  • medical and drug history
  • family history
  • details of reproductive health and previous contraceptive use.
  • relevant social and sexual history (to assess risk of sexually transmitted infections – STIs)

Risk factors for osteoporosis should be assessed and alternative contraceptive choices discussed as appropriate.

Patient self administration of Sayana Press

See procedure for self-administration


Examination

BMI should be noted where possible prior to commencement of the injection. Patient self-reported is adequate.

Pelvic examination and cervical cytology if indicated 

Administration

Shake syringe vigorously

Subcutaneous DMPA

Activate the injector according to manufacturer's instructions

  • Inject into upper anterior thigh or abdomen.
  • Point needle downwards (towards the floor) and inject over 5 to 7 seconds.
  • Licensed for self-administration and can be offered routinely by staff trained to instruct patients.
  • See procedure for self administration.

 

Inreamuscular DMPA

  • IM injection into gluteus maximus or other muscle, e.g. deltoid.
  • IM administration into ventrogluteal site. This is the preferred site as it reduces the risk of superficial injection and sciatic nerve injury.
  • If not yet trained in ventrogluteal injection, or if client requests, the dorsogluteal site (upper outer quadrant of buttock) or deltoid should be used.

Management & timing of first injection

Management & timing of first injection

General initiation

Ideally, first injection should occur between days 1 to 5 (inclusive) of a normal menstrual cycle. No additional contraception is required.

Injections may also be initiated at any other time in the menstrual cycle if the clinician is reasonably certain that the woman is not pregnant and that there is no risk of conception. Additional contraception (barrier method or abstinence) should be advised for 7 days after initiation.

If the woman is amenorrhoeic, the clinician must be reasonably certain that the woman is not pregnant and there is no risk of conception. Additional contraception should be used for 7 days.
Post-partum

Up to day 21 postpartum – no additional contraception required

Day 21 post partum and beyond – additional 7 days contraception required
Following miscarriage
or termination

Initiate on day of surgical or second part of medical abortion or immediately following miscarriage: no additional contraception is required.

If started more than 5 days after
abortion or miscarriage, additional contraception is required for 7 days.
Switching from CHC

Up to day 3 of hormone-free interval – no additional contraception required

Day 4 of hormone-free interval to end of 1st week of pill-taking – 7 days of additional contraception required.

During weeks 2 or 3 of pill-taking – no additional contraception required provided method has been used correctly in preceding 7 days
Switching from
PO implant

3 years or less since implant insertion – no further contraception required.

More than 3 years since implant insertion – 7 days additional contraception
required.
Switching from POP
or levonorgestrel IUD		 Additional contraception for 7 days required.
Switching from
PO injectable		 If the woman’s previous method was another injectable, she should have the injection before or at the time the next injection was due. No
additional contraception is needed.
Switching from Cu-IUD
or barrier method

Days 1 to 5 of cycle – no additional contraception required.

After day 5 of cycle – further 7 days of contraception required.
Quick starting after
oral emergency
contraception

After levonorgestrel: give DMPA immediately and advise condoms for 7 days.

After ulipristal: wait for 5 days following ulipristal before administering DMPA. Advise condoms for a further 7 days (12 days in total following emergency contraception).

Patient requires a pregnancy test 3 weeks after last UPSI.

 

Documentation

  • The full visit history should be completed or updated as required on NaSH.
  • Written method information including contact number is given to client.
  • Prescription is recorded and dated.
  • Site of injection, batch number and expiry date of medication recorded.
  • Record date when injection is next due
  • Nurse supplying where appropriate under patient group direction
  • Consider notifying GP of prescription, if permission is given for correspondence.

Editorial Information

Last reviewed: 31/05/2024

Next review date: 31/05/2026

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group .

Version: 10.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health

Reviewer name(s): janice.allan@nhs.scot .