Contraception: Depot Contraceptives

Depot contraceptives offer an effective, long-acting, low-dose method of contraception. They are available in different forms and their effects are reversible (some take longer to reverse than others). Depot contraceptives provide the user with a high level of contraception without the need to use any additional contraceptive methods.

How do they work?

Depot contraceptives release a progestogen over a period of time. Progestogens include etonogestrel, levonorgestrel, medroxyprogesterone and norethisterone. Progestogens provide contraception by: suppressing ovulation; slowing the internal movements of the fallopian tubes; inhibiting the growth of the lining of the womb (endometrium); preventing implantation of eggs; inhibiting penetration of sperm; and preventing fertilisation.

There are three types of depot contraceptives:

Intramuscular/subcutaneous injection - there are two intramuscular preparations (injected into a muscle) available: Depo-Provera® (medroxyprogesterone acetate) which provides cover for 12 weeks, and Noristerat® (norethisterone enantate) which provides cover for eight weeks. Sayana Press® (medroxyprogesterone acetate) is a subcutaneous preparation (injected under the skin) that provides cover for 13 weeks. All three preparations may be used in breastfeeding women, although it is recommended that medroxyprogesterone acetate be given no sooner than six weeks after birth.
Subdermal implant - one preparation is available: Nexplanon®. It is a flexible rod that is inserted under the skin; the rod releases the hormone (etonogestrel) gradually over three years, after which time it should be replaced.
Intrauterine system (IUS) - Jaydess®, Levosert® and Mirena® are devices that are inserted into the uterus. They have a reservoir of hormone (levonorgestrel) which is released slowly over several years. Jaydess® and Levosert® need to be replaced every three years while Mirena® needs to be replaced every five years. A return to fertility occurs on removal of these devices.

What are the advantages of depot contraceptives?

All methods of depot contraception are highly effective. Depot contraceptives can be given to women who may regularly forget to take the contraceptive pill or to those who dislike barrier methods of contraception. Once in place, intercourse can occur at any time with no need for additional contraception. They are particularly useful for women who should not become pregnant for a specified period, eg, after rubella vaccination. They are also useful for women who require long-term contraception.

Progestogens may help premenstrual symptoms and painful periods, and may provide protection against endometrial cancer.

What are the disadvantages of depot contraceptives?

Intramuscular injection
The effects of injectable depot contraceptives cannot be reversed immediately - once administered they will remain effective for the specified period. Although the method is fully reversible in the long term, there may be a delay of up to a year in the return of fertility.

Some women may experience side effects such as weight gain or depression. Menstrual periods are often irregular with this method, particularly after two or more injections.

Subdermal implant
A minor operative procedure under local anaesthetic is required for insertion and removal of Nexplanon®. Some women may develop ovarian cysts but these usually resolve without the need for treatment. Irregular bleeding may occur.

Intrauterine system
There may be some irregular bleeding in the first few months after insertion of Jaydess®, Levosert® or Mirena®. The IUS may be expelled and needs to be checked regularly to ensure that it is still in position. Some women may develop ovarian cysts but these usually resolve without the need for treatment.

Are there any regular checks necessary?

Intrauterine system
The IUS threads must be checked each month at the end of a period to ensure that the device is still in place.

Further information available from:

British Pregnancy Advisory Service (BPAS)
Head Office
20, Timothys Bridge Road
Stratford Enterprise Park 
Stratford-upon-Avon
Warwickshire CV37 9BF
Tel: 03457 30 40 30 (24 hours a day, 7 days a week)
Email: info@bpas.org
Internet: www.bpas.org

FPA (Sexual Health Charity)
23-28 Penn Street
London N1 5DL
Tel: 020 7608 5240
Internet: www.fpa.org.uk

For young people under 25 years:
Brook
Internet: www.brook.org.uk (for Ask Brook 24/7 service)

Fact sheet provided by MIMS

Date last reviewed: September 2016


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