Initial Consultation
Initial Consultation
Before prescribing POI, the clinician should check the woman is medically eligible. UKMEC has the full criteria for medical eligibility. Caution should especially be given when prescribing for women who have multiple risk factors for cardiovascular disease/peripheral vascular disease, liver disease, those who wish to start a family soon, or at risk of weak bone density. It is contraindicated in women with current breast cancer.
If there are no contraindications, women should be fully counselled about the delay in return to fertility, altered bleeding patterns they may expect and suggestions to improve their bone health.
If starting during the first 5 days of their period or switching from DSG-POP/another POI/Progesterone only implant, they do not need any further contraception. If they are outside this window or switching from traditional POP/IUC/CHC (day 3 of HFI – end of 1st week HCH cycle) , then it is likely they will need further precautions for a further 7 days.
At the time of delivering POI, the patient should be weighed to assess need for longer needle/deltoid administration. FSRH does not recommend blood pressure check, though if the women is higher risk for cardiovascular disease this may be prudent.
The IM DMPA is usually given in the gluteal muscle of the buttock though can be administered into the deltoid muscle of the upper arm (this is the preferred site in larger women with deep adipose tissue).
Once administered it should be fully documented in the patient’s notes, including the batch number of the POI used, in case any drug reaction later occurs.
Current FSRH guidance advises women to return every 13 weeks (rather than 12 weeks) for repeat POI (both IM and SC). This is outside the product licence for IM DMPA but well within WHO guidelines that state 16 weeks (risk of pregnancy <16 weeks is <1% on IM DMPA). FSRH state it can it can be given up to 14 weeks without any further precautions. After 14 weeks, it can still be given if the health professional is reasonably sure the woman is not pregnant. Extra precautions are advised for the next 7 days. If there is a risk of pregnancy, emergency contraception should be considered and if needed, POI can be quick started though a pregnancy test must be taken at least 3 weeks after most recent episode of UPSI. Ulipristal acetate potentially interacts with IM DMPA so it is advised to use extra precautions for the first 14 days of IM DMPA. There is no evidence that POI while pregnant causes harm to the foetus.
Before leaving the women should be given the date of when her next POI is due.