Contraceptive shot

 

Prof(Dr.Srimanta Pal) :Chapter – IV

(CONTRACEPTIVE INJECTIONS – CONTRACEPTIV SHOTS)

(Monthly or Quarterly shots :Hormonal contraception is one of the major discovery of the last millennium in the field of fertility control regulation. Contraceptives steroid have been in use for over five decades and today more than 100 million use them to control fertility. But the problem is non-compliance with the oral pills and this led to the discovery of newer drug delivery system such as injectables, implants, hormone impregnated devices like (IUDs, rings, pellets), which facilitate administration of bath steroids or for longer duration of time and avoid potential errors of the users as present with the contraceptive.

      Injectable contraceptives are approved for use in over 105 counties and have been used for many years by millions of women. They represent a safe and effective option for women seeking reversible contraceptive protection.

      Injectable contraceptives are popular with many women because they are highly effective and do not require daily effort (like oral contraceptives) or use at the time of sexual intercourse (like oral contractive) or something to use at the time of sexual intercourse (like barrier methods). Furthermore, some injectables can be used by women who cannot use methods that contain estrogen, including breastfeeding women. In some cultures, injectable contraceptives are favored over other methods because they can be used without the knowledge of husband, family members and friends.

      Women spend about 30 reproductive years living with their partner and have to lead a sexually active role but want to produce only 1-2 children. Act of reproduction became act  of pleasure but burden of contraceptive use primarily bestows with women. Thus due to this prolonged use contraceptive, safety is the most important criterion. Revolutions in contraceptive technology brought empowerment to women. Injectable contraceptives contain synthetic hormones that are administered by deep intramuscular injection. Injectables are a safe and effective method of reversible contraception for most women. Two types of injectable contraceptives are available: a) progestin-only injectable contraceptives and b) combined injectable contraceptives that contain both a progestin and an estrogen hormone. Progestin-only injectables include DMPA (depot medroxyprogesterone acetate) nd NET-EN (norethindrone enanthate). The former is usually administrated in three monthly basis while later is to be administrated on two monthly basis. Available combined injectables are Lunelle (Cyclofen).

      About 13 million couples throughout the world now use injectable contraceptives. Research on injectable contraceptives began shortly after the development of oral contraceptives. Kari Junkmann and colleagues at the German pharmaceutical firm Schering AG synthesized the first injectable progestins in 1953, and in 1957, developed norethindrone enanthate (NET-EN) which is marked under the brand name Noristerat. This was the first injectable contraceptive and is injected every two months.

      Subsequently the Upjohn Company, a US pharmaceutical firm, synthesized medroxyprogesterone acetate (Provera) in the late 1950s. Upjohn conducted the first clinical trial of Provera in its depot as (injectable) form (Depo Provera) – 1963. Depo Provera (DMPA) is injected every three months.

 

Selected injectable contraceptives

	Active ingredients	Duration of effect	Common trade names
DMPA (Progestogen-only)	150mg medroxyprogesterone acetate	90 days	Depo-Provers, Depo-Clinovir, Depo-Prodasone, Degestron, and others
NET-EN (progestogen-only)	200mg norethisterone enanthate	60 days	Noristerat, Norigest, Doryxas, and others
Cylofem (combined)	25mg medroxyprogesterone acetate and 5mg estradiol cypionate	30 days	Cyclofem, Cyclofemina, Cycloprovera, and others
Mesigyna (combined)	50mg norethisterone enanthate and 5mg estradiol valerate	30 days	Mesigyna, Norigynon

 

 

 

 

PART – I

Quarterly Shots

(Injection Depomearoxy progesterone: DMPA)

INDEX

Overview, P..; Prevalence, P..; Mode of action, P..; Brand Name, P..; Reliabilities, P..; Advantages, P..; Role in STI Prevention, P..; Drawbacks, P..; Dose of Schedule, P..; Follow up, P..; Side effects, P..; Health Risks, P..; Ideal Candidate, P..; Birth Defects, P..; Switching to some other methods, P..; Non contraceptive health benefits (use in Gynecological disease), P..; Return of fertility, P..; Counseling, P..; Conclusion, P..;

 

Overview:

      Depo Provera is a three month injectable contraceptive containing a synthetic progestogen which resembles the female hormone progesterone. Each dose contains 150mg of hormone in an aqueous suspension.

      The progestin is released slowly into the blood stream from the site of the injection and provides the client with a safe and highly effective form of contraception.

      Injectables were initially a result of research following the war, when in 1953; Dr Junkman found that a long-acting injection was created if progestogen and alcohol were combined.

      In 1957, research began on the injectable Norigest, now known as Noristerat, which is licensed for short-term use in the UK, i.e. following administration of the rubella vaccine. In 1963, trials commenced on the injectable Depo-Provera, which was  licensed in the UK for long-term use in 1984 when other methods were not suitable. Since 1990, it has been licensed as a first choice method. DMPA do not contain estrogen, and so can be sued throughout breastfeeding and by women who cannot use methods with estrogen.

      DMPA do not require daily action, do not interfere with sex. The injections are private: No one else can tell that a woman is using contraception; DMPA does not cause monthly bleeding (for many women) and may help women to gain weight

      Depoprovera is usually abbreviated as DMPA and in this book Depot medroxyprogesterone has been termed as ‘DMPA’. It needs lot of counseling sessions for patients, particularly when one is administering them injections and then not seeing them for three months, because the moment the patient experiences amenorrhea, she concludes the only cause of amenorrhea is pregnancy and worries herself needlessly.

      It is important that a selected candidate is counseled very well before being put on this medication. The caregiver needs to convince her that amenorrhea does not mean pregnancy.