Ask the client the questions below about known medical conditions. Examinations and tests are not necessary. If she answers “no” to all of the questions, then she can start progestin-only injectables if she wants. If she answers “yes” to a question, follow the instructions. In some cases she can still start progestin-only injectables.

1. Are you breastfeeding a baby less than 6 weeks old?

No.

Yes - she can start using progestin-only injectables as soon as 6 weeks after childbirth (see Fully or nearly fully breastfeeding or Partially breastfeeding, p. 69).

2. Do you have severe cirrhosis of the liver, a liver infection, or liver tumor? (Are her eyes or skin unusually yellow? [signs of jaundice])

No.

Yes - if she reports serious active liver disease (jaundice, active hepatitis, severe cirrhosis, liver tumor), do not provide progestin-only injectables. Help her choose a method without hormones.

3. Do you have high blood pressure?

No.

Yes - if you cannot check blood pressure and she reports having high blood pressure in the past, provide progestin-only injectables.

Check her blood pressure if possible:

• If she is currently being treated for high blood pressure and it is adequately controlled, or her blood pressure is below 160/100 mm Hg, provide progestin-only injectables.
• If systolic blood pressure is 160 mm Hg or higher or diastolic blood pressure 100 or higher, do not provide progestin-only injectables. Help her choose another method—one without estrogen.

4. Have you had diabetes for more than 20 years or damage to your arteries, vision, kidneys, or nervous system caused by diabetes?

No.

Yes - do not provide progestin-only injectables. Help her choose another method—one without estrogen.

5. Have you ever had a stroke, blood clot in your legs or lungs, heart attack, or other serious heart problems?

No.

Yes - if she reports heart attack, heart disease due to blocked or narrowed arteries, or stroke, do not provide progestin-only injectables. Help her choose another method—one without estrogen. If she reports a current blood clot in the deep veins of the leg or in the lung (not superficial clots), help her choose a method without hormones.

6. Do you have vaginal bleeding that is unusual for you?

No.

Yes - if she has unexplained vaginal bleeding that suggests pregnancy or an underlying medical condition, progestin-only injectables could make diagnosis and monitoring of any treatment more difficult. Help her choose a method to use while being evaluated and treated (but not implants or a copper-bearing or hormonal IUD). After treatment, re-evaluate for use of progestin-only injectables.

7. Do you have or have you ever had breast cancer?

No.

Yes - do not provide progestin-only injectables. Help her choose a method without hormones.

8. Do you have several conditions that could increase your chances of heart disease (coronary artery disease) or stroke, such as high blood pressure and diabetes?

No.

Yes - do not provide progestin-only injectables. Help her choose another method—one without estrogen.

Be sure to explain the health benefits and risks and the side effects of the method that the client will use. Also, point out any conditions that would make the method inadvisable, when relevant to the client.

Usually, a woman with any of the conditions listed below should not use progestin-only injectables. In special circumstances, however, when other, more appropriate methods are not available or acceptable to her, a qualified provider who can carefully assess a specific woman’s condition and situation may decide that she can use progestin-only injectables. The provider needs to consider the severity of her condition and, for most conditions, whether she will have access to follow-up.

• Breastfeeding and less than 6 weeks since giving birth
• Severe high blood pressure (systolic 160 mm Hg or higher or diastolic 100 mm Hg or higher)
• Current blood clot in deep veins of legs or lungs
• History of heart disease or current heart disease due to blocked or narrowed arteries (ischemic heart disease)
• History of stroke
• Multiple risk factors for arterial cardiovascular disease such as diabetes and high blood pressure
• Unexplained vaginal bleeding before evaluation for possible serious underlying condition
• Had breast cancer more than 5 years ago, and it has not returned
• Diabetes for more than 20 years or damage to arteries, vision, kidneys, or nervous system caused by diabetes
• Severe liver disease, infection, or tumor

Progestin-Only Injectables for Women with HIV

• Women who are infected with HIV, have AIDS, or are on antiretroviral (ARV) therapy can safely use progestin-only injectables.
• Urge these women to use condoms along with progestin-only injectables. Used consistently and correctly, condoms help prevent transmission of HIV and other STIs.