Injectable Contraception

N92.1 + (Z30.4/8/9)

GENERAL MEASURES

Heavy or prolonged bleeding despite adequate treatment with combined oral contraceptives:

  • Do thorough gynaecological examination to exclude other pathology.
  • Check haemoglobin and prescribe iron if needed. See section 2.2 Anaemia, iron deficiency.

MEDICINE TREATMENT

  • Ethinylestradiol, oral, 50 mcg daily for 3 months.

LoE:III

OR

  • Combined oral contraceptive, containing 50 mcg ethinylestradiol, oral, for 3 months.

If no response to high dose ethinylestradiol, replace with:

  • NSAID, e.g.:
  • Ibuprofen, oral, 400 mg 8 hourly with or after a meal for 5 days.

LoEIII [40]

If no response to NSAID, replace with:

  • Tranexamic acid, oral, 500 mg 8 hourly for 4 days.

LoEI [41]

If there is no response to above-mentioned treatment:

  • Change to another method of contraception. See PHC STGs and EML Family planning.