What are combined injectable contraceptives (CICs)?
Combined injectable contraceptives contain the hormones estrogen and progestin. They are administered by intramuscular injection once a month. No long-term safety information on the use of CICs is available yet. Therefore, the current medical criteria for CIC use are based on existing information on the use of Combined Oral Contraceptives (COCs).
How do CICs work? (mechanism of action)
Prevent monthly ovulation
Thicken cervical mucus (make it hard for sperm to penetrate cervix)
Change endometrium (make implantation less likely)
Who can use combined injectable contraceptives?
Women of any reproductive age and parity who:
Want to use this method of contraception
Have no contraindications
Who should not use CICs?
Women who have the following conditions (contraindications):
Pregnancy
Breastfeeding, during first 6 weeks of postpartum (not a good method for women who want to continue breastfeeding)
Unexplained vaginal bleeding
Current breast cancer
Liver tumors, active hepatitis or severe cirrhosis
Age 35 or older, who smoke heavily (20 cigarettes/day or more)
Greatly increased risk of cardiovascular conditions: blood pressure of 180/110 and higher, diabetes with vascular complications, history or current deep venous thrombosis, stroke, ischemic heart disease, severe headache with focal neurologic symptoms
Advantages
Safe and highly effective
Reversible
Easy to use (no daily routine)
Do not interfere with intercourse
May have beneficial non-contraceptive effects similar to combined oral contraceptives
Disadvantages
Common side effects (especially irregular menstrual bleeding/spotting during first three months)
No protection against STIs/HIV
Possible side effects
Irregular and/or prolonged bleeding
Spotting
Headache
Nausea
Breast tenderness
Weight gain
Mood change
Acne
Amenorrhea
Provide follow-up and counseling for:
Any client concern
Any warning signs of complications (thrombosis/thromboembolism):
severe chest pain or shortness of breath
severe headache with vision problems
sharp pain in leg or abdomen
Side effects
Importance of timely injection (delay for the next injection should not be more than three days)
