Z30.0/Z30.4
Dual protection with barrier methods is recommended to reduce the risk of STIs, including HIV.
- Progestin-only injectable contraceptive, e.g.:
- Medroxyprogesterone (long-acting), IM, 150 mg, 12 weekly. LoEI[12]
Progestin-only hormonal contraceptives are contraindicated in certain conditions e.g. unexplained vaginal bleeding. Consult the package insert in this regard.
When to start the injection
- The injection can be started anytime within the menstrual cycle, provided pregnancy has been excluded. If the first injection is given within 7 days of the onset of the menstrual cycle, the contraceptive effect is achieved on the day of the first injection.
- If started after day 7,advise the woman to abstain from intercourse or use condoms for the next 7 days.
- Can be used postpartum.
Late injection
- If it has been <2 weeks since the missed injection, the next injection can be given without loss of protection. Continue with dual contraceptive method, i.e. condom in combination with the injection.
- If it has been >2 weeks since the missed injection, exclude pregnancy:
| Pregnancy test positive |
Pregnancy test negative or unavailable |
|
» Refer for ante-natal care (See Section 6.4: Antenatal care). or » TOP, see: Termination of pregnancy (TOP). |
» Provide emergency contraception, if indicated (see: Contraception, emergency). » Administer the next injection. » Advise the woman to abstain from intercourse or use condoms to prevent pregnancy for the next 7 days. |
| Pregnancy test positive |
Pregnancy test negative or unavailable |
See: Termination of pregnancy (TOP).
There is uncertainty of the risk of HIV acquisition associated with progestin injectable contraceptives (Refer to the WHO MEC 2017 guidelines[¹⁵]). Dual protection is recommended.
REFERRAL
Heavy or prolonged bleeding, despite adequate treatment with combined oral contraceptives. See: Breakthrough bleeding with contraceptive use.