How late can you give Depo-medroxyprogesterone acetate?
S. Jones, M. Kishen
Abacus Clinics for Contraception and Reproductive Health, Liverpool, UK
Aim: To formally assess acceptability and outcome of management of
clients who present for a repeat injection of Depomedroxyprogesterone acetate (DMPA)
150mg/ml more than eighty-nine days after their previous injection, having had
unprotected sexual intercourse (UPSI) after the protection of their previous
DMPA injection ended.
Background: DMPA licence is for 89 days in the United Kingdom. Nurses
provide a large proportion of the contraceptive care in our service using
patient group directions (PGDs) which allow nurses to issue hormonal
contraceptive methods without a prescription. In our service, clients who
present for a repeat injection after eighty-nine days since their previous
injection, having had pregnancy risk, are counselled and given the choice of (a)
receiving their DMPA injection the same day with or without emergency
contraception (EC) if appropriate, with full awareness that pregnancy has not
been excluded or (b) EC if appropriate and waiting for their next injection
until pregnancy is excluded by a pregnancy test three weeks after the last UPSI.
They are informed that there is no increased risk of abnormality to a fetus if
conception has occurred, based on currently available evidence. As option (a) is
outside our current PGDs, nurses need to consult a doctor if a client chooses
this option. As we wish to incorporate this option into our PGDs, we decided to
audit the acceptability and outcome of this practice.
Method: A retrospective audit of case-notes of continuing DMPA users.
Results: Eighty-three cases were identified who met specified criteria
for delayed use with risk of pregnancy during 2002/ 2003;18 had UPSI between 89
days and 13 weeks, 23 had UPSI between 13 and 14 weeks and 42 had UPSI after 14
weeks. Seventy-five clients (90%) chose to have DMPA on the day, without
excluding pregnancy risk, and eight (10%) chose to wait until pregnancy was
excluded before having the next injection. No pregnancies occurred. Twenty four
(32%) attended for pregnancy test three weeks later as advised, 47 (63%)
excluded pregnancy by test only at the time of the next injection and 4 (5%) did
a home pregnancy test.
Conclusion: This is acceptable and safe clinical practice from both
the clinicians’ and the clients’ perspective. It enables women who default an
arranged date for a repeat injection to link back into effective contraception
as soon as possible.
