FSRH | Depot contraception

This is an updated guideline on the injectable contraceptive from the FSRH. The main new advice is that although women should be advised to swap to an alternative form of contraception after age 50, they can continue it if they prefer and are appropriately counseled. I am listing the main things that were new for me. 

  • Failure rate. With typical use the failure rate is 6%. 
  • Weight gain. There is an association between weight gain and women under 18 who have a BMI > 30. Women who gain 5% of their weight are likely to continue to gain weight. 
  • Injection route in obese women. You may not be able to inject it im into the gluteal region. Alternatives are im into the deltoid, or sc into the abdomen or anterior thigh. 
  • Emergency contraception. Women need 14d of additional precautions after using Ella-One. 
  • Frequency it can be given at. Minimum 10w. Normally aim for 13w. It can be given up to 14w without concerns about pregnancy. Apparently in some countries, it's even longer. 
  • Unscheduled bleeding. Exclude alternative causes. Then you can use 3m of the COC. Use longer than that hasn't been studied, so would be down to your clinical judgement. Another option is mefenamic acid 500mg TDS. 
  • Bone mineral density (BMD). There aren't any updates on this. We know women lose some BMD, but there is still no good evidence that this leads to an increased fracture risk. The advice therefore remains the same. Be careful with use in under 18s and those with other risk factors for osteoporosis. 

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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