Cautions including any relevant action to be taken (1):
- If the individual is less than 16 years of age an assessment based on Fraser guidelines must be made and documented.
- If the individual is less than 13 years of age the healthcare professional should speak to local safeguarding lead and follow the local safeguarding policy.
- Discuss with appropriate medical/independent non-medical prescriber any medical condition or medication of which the healthcare professional is unsure or uncertain.
- Individuals aged under 18 years, should not use IM DMPA first line for contraception because of its effect on bone mineral density. IM DMPA may be considered if all alternative contraceptive options are unsuitable or unacceptable.
- Individuals of any age with significant lifestyle and/or medical risk factors for osteoporosis, other methods of contraception should be considered prior to use of IM DPMA – IM DMPA may be considered if all alternative contraceptive options are unsuitable or unacceptable. Significant risk factors for osteoporosis include:
- Alcohol abuse and/or tobacco use
- Chronic use of drugs that can reduce bone mass, e.g. anticonvulsants or corticosteroids
- Low body mass index or eating disorder, e.g. anorexia nervosa or bulimia
- Previous low trauma fracture
- Family history of osteoporosis
- Individuals aged under 18 years, should not use SC-DMPA first line for contraception because of its effect on bone mineral density. SC-DMPA may be considered if all alternative contraceptive options are unsuitable or unacceptable
- Offer Long Acting Reversible Contraception (LARC) to all individuals in particular those with medical conditions for whom pregnancy presents an unacceptable risk and those on a pregnancy prevention plan.
If an individual is known to be taking a medication which is known to be harmful to pregnancy a highly effective form of contraception is recommended. Highly effective methods include the LARC methods: IUD, IUS and implant. If a LARC method is unacceptable/unsuitable and a IM-DPMA is chosen then an additional barrier method of contraception is advised. See FSRH advice.
Reference:
- Patient Group Direction (PGD) (NHS Specialist Pharmacy Service).Administration of intramuscular (IM) medroxyprogesterone acetate (DMPA) injection . (Accessed 17th March 2021).
- Patient Group Direction (PGD) (NHS Specialist Pharmacy Service).Supply and/or administration of subcutaneous medroxyprogesterone acetate (SC-DMPA) injection . (Accessed 17th March 2021).