Counseling about injectables: Depo-Provera and Noristerat

Counseling about injectables: Depo-Provera and Noristerat – injectable contraceptives

INJECTABLE CONTRACEPTIVES are convenient, private, and very effective. This guide will help you, the family planning provider, tell your clients about the 3-month injectable called Depo-Provera@ (DMPA) or the 2-month injectable called Noristerat [R] (NET EN).(*)

Counseling is a step-by-step discussion between you and the client. Counseling helps each client choose and use the family planning method that best suits that person’s needs. Good counseling involves friendly, open talk with the client to find out politely what she wants and what concerns her.

The letters in the word GATHER stand for the steps in counseling a client about choosing a family planning method:

G: Greet clients

A: Ask clients about themselves

T: Tell clients about available methods including injectables

H: Help clients choose a method

E: Explain how to use that method

R: Return visits should be planned

Greet clients politely.

Ask how you can help.

Ask clients about themselves.

Find out their family planning needs and concerns. Help clients to express themselves. Ask if certain family planning methods interest them.

Tell clients interested in injectables these facts:

* Depo-Provera and Noristerat involve an injection every few months–3 months with Depo-Provera, 2 months with Noristerat.

* Both injectables prevent pregnancy very well.

* Both change vaginal bleeding for most women–often more bleeding or irregular bleeding at first and then no bleeding at all after a year. These changes are not harmful. They are not signs of serious health problems or pregnancy.

* Most women gain weight while using injectables.

* Some women notice headaches, dizziness, breast tenderness, moodiness, nausea, or acne. Less than one-quarter of women report any of these side effects, and more than three-quarters do not.

* Women who use injectables can become pregnant when they stop having injections. Becoming pregnant may take several months longer than usual, however.

* Does a woman need protection against AIDS or other sexually transmitted diseases (STDs)? Then she should use condoms whether or not she chooses injectables. If her partner will not use condoms, she should use spermicides.

Help clients choose a method that suits them.

Reasons to choose Depo-Provera or Noristerat:

* Very effective for several months at a time.

* Easy to use.

* Private.

* Can be used while breastfeeding.

* Helps prevent anemia (low iron in blood), ectopic pregnancy (outside the womb), and cancer of the endometrium (lining of the uterus). May help prevent ovarian cancer, sickle-cell crises, and epileptic seizures. Note: Women of any age, women who have had children, and women who have not had children can use Depo-Provera or Noristerat. Also, women with epilepsy, uncomplicated diabetes, tuberculosis, headaches, varicose veins, or deep venous thrombosis (blood clots in the leg) can use Depo-Provera or Noristerat.

Reasons to choose another method:

* Would not want vaginal bleeding changes or weight gain.

* Wants pregnancy in next 6 months.

* Cannot get injections every 2 or 3 months.

* Has certain medical conditions:

* Likely pregnancy

* Unexplained vaginal bleeding suggesting

pregnancy or a serious underlying


* Current breast cancer

* Past breast cancer*

* Severe high blood pressure*

* Heart disease due to blocked arteries*

* Diabetes with complications involving

the circulatory system*

* Hepatifis with symptoms; severe cirrhosis;

liver tumors(*)

* Past stroke(*) (*) A nurse or doctor can decide whether exceptions can be made in individual cases.

Explain how to use Depo-Provera or Noristerat.

When to start. A woman can start Depo-Provera or Noristerat.

* Any time that you, the provider, can be reasonably sure that she is not pregnant–for example, within the first 7 days after menstrual bleeding starts, or at any other time if she has not had unprotected sex since her last normal menstrual period. No pregnancy test is needed.

* Right after childbirth if she is not breastfeeding or if she is giving the baby other food or liquid along with breast milk. If possible, waiting for 6 weeks would be better.

* Right after an abortion.

* If a woman cannot have her first injection now, she should use another family planning method or not have sex until you can be reasonably sure that she is not pregnant. If needed, give her condoms or spermicide and explain how to use them.

Explain the injection procedure.

* Antiseptic is rubbed on the skin.

* The injection is given in the arm or buttock

with a sterile or disinfected needle and


* The client should not rub the injection site.

This could shorten effectiveness.

Return for follow-up shoul be planned.

Tell the client when and where to come for the next injections:

* For Depo-Provera: In 3 months and

every 3 months.

* For Noristerat: In 2 months and every

2 months.

* Urge the client to come back on time

if possible but to come back even if

she is late.

If a woman is more than 2 weeks late for Depo-Provera or more than I week late for Noristerat, she should use condoms or spermicide or else avoid sex. When you are reasonably sure that she is not pregnant, she can have her injection. She can come back up to 4 weeks early for Depo-Provera and up to 2 weeks early for Noristerat.

Discuss these reasons to come back at any time:

* Any questions or problems.

* Injection site is sore for more than 2

days or is bleeding or leaking pus.

* Very heavy vaginal bleeding (twice

as long or twice as much as usual).

* Severe, repeated headaches with

trouble seeing, speaking, or moving.

RELATED ARTICLE: Important Information About Depo-Provera (DMPA) Injectable Contraceptive

Effective, safe, Depo-Provera injectable contraceptive offers almost easy to use, complete protection from pregnancy and has been and reversible. proved safe. When you stop your injections, you can

get pregnant–usually not right away but 6 to 12

months later. Depo-provera does not prevent

transmitted diseases including AIDS. Vaginal After the first several injections you will probably have bleeding more vaginal bleeding or bleeding at unexpected times. changes. Later, you will probably have little vaginal bleeding or

none at all. These changes are not harmful. They do not

mean that you are pregnant or sick. They do not mean

that bad blood is building up inside you. Also, you may

gain weight when you use Depo-Provera. This also is

not harmful. Next injection Come back for an injection every 3 months. Try to in 3 months. come in on time. You can have the next injection up to 4

weeks early or up to 2 weeks late. But come back even

if you are more than 2 weeks late. Please come * For your next injection or another family planning back… method.

* If you develop extremely heavy bleeding (twice as

much or twice as long as normal for you) or long-lasting

soreness and redness where you had an injection.

* Any time you have any questions, problems, or concerns.

COPYRIGHT 1995 Department of Health

COPYRIGHT 2004 Gale Group