Medroxyprogesterone Acetate Injection (Sub-Q and IM).doc

Depo Medroxyprogesterone Acetate (DMPA) Injection (Sub-Q and IM) I. INTRODUCTION DMPA, a progestin-only method of birth control, is available in two doses: ● A 1 cc crystalline suspension of 150 mg depot medroxyprogesterone acetate that is injected intramuscularly (IM) every three months (11-13 weeks)  A low dose 104 mg of depot medroxyprogesterone acetate in a 0.65 ml solution that is injected subcutaneously (subQ) every three months (12-14 weeks) II. CLIENT SELECTION  Indications – DMPA may be provided when: o Contraindications do not exist o A woman cannot use or has medical contraindications to estrogen containing methods o A long-term, high efficacy, non-coitus dependent, private contraceptive method is desired  Contraindications (CDC 3-- Risks outweigh advantages for method use; CDC 4-- Unacceptable risk for method use) o Unexplained vaginal bleeding (CDC 3 before evaluation) o Breast cancer (current CDC 4) (past CDC 3) ○ History of myocardial infarction, ischemic heart disease or stroke (CDC 3) ○ Cirrhosis (severe-decompensated) (CDC 3) ○ Liver tumors – adenoma or hepatoma (CDC 3) ○ Hypertension (160 systolic or 100 diastolic) (CDC 3) ○ Diabetes with nephropathy/retinopathy/neuropathy (CDC 3) ○ Other vascular disease or diabetes of 20 years duration (CDC 3) o Systemic Lupus Erythematous –positive (or unknown) antiphospholipid antibodies (CDC 3), severe thrombocytopenia (CDC 3) o Rheumatoid Arthritis-Immunosuppressive therapy (CDC 3 for continuation) o Migraine with aura at any age (CDC 3 for continuation) FYI – Risk Benefit Analysis ○ Other birth control methods should be considered in the risk/benefit analysis for the use of DMPA in women with osteoporosis risk factors – alcoholism, strong family history of osteoporosis, metabolic bone disease, anorexia nervosa, chronic use of drugs that can reduce bone mass (such as anticonvulsants or corticosteroids) and tobacco use. Osteoporosis information sh