Injectable (Contraception, Hormonal)

Using the Progestin-only IM injection

Using the Progestin-only SC injection

Referral

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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

LoE:IIIb¹⁴

OR

• Medroxyprogesterone (long-acting), SC, 104 mg, 12 weekly

Progestin-only hormonal contraceptives are contraindicated in certain conditions, e.g. unexplained vaginal bleeding. Consult the individual professional information in this regard

Using the Progestin-only IM Injection

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 started immediately postpartum in both breastfeeding and non-breastfeeding women if no other method is acceptable or available

LoE:IVb¹⁵

Late injection

• The next injection can be as much as 4 weeks late if using the medroxyprogesterone acetate DMPA (long-acting), or 2 weeks late if using norethisterone enanthate (NET-EN)
  Injectable contraceptive may be administered later than recommended (>4 weeks late for DMPA or >2 weeks late for NET-EN) if:
  • She has not had sexual intercourse since 2 weeks after the scheduled date of her injection, or
  • She has used a backup method or has taken emergency contraceptive pills after any unprotected sexual intercourse since 2 weeks after the scheduled date of her injection, or
  • She is fully or nearly fully breastfeeding and she gave birth less than 6 months ago

However, in all three cases she will need a backup method for the first 7 days after the injection. Assess the need for emergency contraception in the event of a late injection (See Contraception, emergency)

LoE:IVb¹⁶

Using the Progestin-only SC Injection

May be administered by a healthcare professional (HCP) or with adequate training when considered appropriate by the HCP, self-injected by the patient, with medical follow up as necessary.

When to start the injection

• The first injection of 104 mg SC should be given during the first 5 days of a normal menstrual cycle to ensure the client is not pregnant
• The second and subsequent injections should be given at a 3 month interval (12 -14 weeks)
• Can be started immediately postpartum in both breastfeeding and non-breastfeeding women if no other method is acceptable or available

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Caution
Alternative contraceptive options should be considered if the continued use of medroxyprogesterone acetate (IM or SC) is extended beyond 2 years. All effective contraceptive options should be considered, taking into account client preferences and circumstances
A small increased risk of meningiomas (rare, and mostly benign tumours) have been reported following long-term administration of medroxyprogesterone acetate (long-acting),
Medroxyprogesterone (long-acting) should be discontinued if a meningioma is diagnosed
Caution is advised when recommending medroxyprogesterone (long-acting) to patients with a history of meningioma

LoE: IVb¹⁷

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REFERRAL

Heavy or prolonged bleeding, despite adequate treatment with combined oral contraceptives. See Breakthrough bleeding with contraceptive use.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_ April 2025

Chapter 7: Family Planning_7.2.3 Injectable