What follow-up is recommended for patients who start using the progestogen-only injection for contraception?

Follow-up recommendations for patients initiating progestogen-only injectable contraception include:

• Advise the woman to return every 13 weeks for a repeat injection of depot medroxyprogesterone acetate (DMPA), with a permissible delay of up to 7 days (up to 14 weeks off-label for intramuscular DMPA). Early repeat injections can be considered from 10 weeks for DMPA and from 6 weeks for norethisterone enantate (off-label) if necessary.
• At each visit for repeat injection, address any adverse effects such as weight gain, irregular menstrual bleeding, mood changes, or injection site reactions.
• Advise the woman to return promptly if she experiences signs of infection at the injection site (e.g., redness, swelling, pain, rash).
• Review women using DMPA every 2 years to assess the risks and benefits of continuing the method and to decide whether to continue or switch contraception.
• Inform women about the potential for menstrual irregularities, including amenorrhoea, spotting, or prolonged bleeding, and offer management options such as mefenamic acid or a short course of combined oral contraceptives if bleeding is problematic.
• Ensure women are up-to-date with cervical screening and HPV vaccination where relevant, and advise on strategies to reduce cervical cancer risk.
• For women aged 50 years and older, advise stopping DMPA due to concerns about skeletal health, but continuation may be considered after risk assessment and discussion.
• Perform pregnancy testing if pregnancy is suspected and be alert to ectopic pregnancy.
• Consider speculum and pelvic examination if bleeding persists beyond 3 months, if new symptoms arise, or if cervical screening is overdue.

These follow-up measures are based on the Faculty of Sexual and Reproductive Healthcare (FSRH) guidelines and NICE Clinical Knowledge Summaries (CKS) on progestogen-only injectable contraception ¹.