Parenteral progestogen-only contraceptives (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

FSRH CEU Guidance: Drug Interactions with Hormonal Contraception (May 2022).
SPS article: Using contraception with enzyme-inducing medicines (June 2023).

MEDROXYPROGESTERONE ACETATE

Therapy notes

Formulation and dosage details

Formulation:

Injection 150mg/mL (aqueous suspension) (Depo-Provera®)

Dosage:

By deep intramuscular injection, 150mg within first 5 days of cycle or within first 5 days after parturition; for long-term contraception repeat every 13 weeks (if interval greater than 14 weeks, rule out pregnancy before next injection and advise additional contraceptive measures for 7 days after the injection) off-label refer to FSRH Clinical Guideline: Progestogen-only Injectable.

Formulation and dosage details

Formulation:

Suspension for injection 104mg/0·65mL (Sayana Press®)

Dosage:

By subcutaneous injection, 104mg within first 5 days of cycle, the second and subsequent doses should be given at 13 week intervals; for further information refer to SPC.

Notes:

  • Sayana Press®is administered by the subcutaneous route.
  • Rather than attending a clinic every 13 weeks for an injection, a woman can choose to self-administer Sayana Press®at home.
  • Women must be trained in the technique and supervised by an appropriately trained health care professional (HCP) administering the first dose.
  • Up to three injections may be given to take home with review at one year. 
  • Access to a HCP should be available if any problems arise. 
  • Give patients written information detailing administration instructions, potential side-effects and symptoms that should prompt medical review.
  • Systems should be in place for the provision and disposal of sharps.
  • Further information for HCP is available at www.sayanapress.co.uk.
  • There is also a patient-specific website (www.sayanaanswers.co.uk) which offers a text service to remind women when their next injection is due.

ETONOGESTREL

Therapy notes

MHRA advice: Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration (February 2020) (www.gov.uk).

  • Nexplanon® provides effective contraception for up to 3 years. The contraceptive effect of Nexplanon® is rapidly reversed on removal of the implant.
  • Recommend an alternative method of contraception if required.
  • For further information on progestogen-only implants refer to FSRH Clinical Guideline: Progestogen-only Implant.
  • Current Guidance recommends that the woman’s arm should be flexed at the elbow with her hand underneath her head (or as close as possible) during insertion and removal of the implant.
  • The implant should be inserted subdermally, overlying the triceps muscle about 8 to 10cm from the medial epicondyle of the humerus and 3 to 5cm posterior to the sulcus (groove) between the biceps and triceps muscles.
  • See Nexplanon site diagram for correct insertion site and Summary of Product Characteristics for further information and for demonstration videos.
  • It is strongly recommended that Nexplanon be inserted and removed only by healthcare professionals (HCPs) who have completed training for the use of the Nexplanon applicator and the techniques for insertion and removal of the Nexplanon implant.

Formulation and dosage details

Formulation:

Implant 68mg in each flexible rod (Nexplanon®)

Dosage:

Referral pathway for Deep Subdermal Implant Removal

Editorial Information

Document Id: F374