When to start

Important: a woman can start injectables any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist .

Giving advice on side effects

Important: thorough counselling about bleeding changes and other side effects must come before giving the injection. Counseling about bleeding changes may be the most important help a woman needs to keep using the method.

Describe the most common side effects

• Lighter bleeding and fewer days of bleeding, irregular bleeding, and infrequent bleeding.
• Weight gain, headaches, dizziness, breast tenderness, and possibly other side effects.

Explain about these side effects

• Side effects are not signs of illness.
• Usually become less or stop within the first few months after starting injections.
• Common, but some women do not have them.
• The client can come back for help if side effects bother her.

Giving the injection

1. Obtain one dose of injectable, needle and syringe

• 25 mg MPA/estradiol cypionate or 50 mg NET-EN/estradiol valerate, intramuscular injection needle, and 2 ml or 5 ml syringe. (NET-EN/estradiol valerate is sometimes available in prefilled syringes.)
• For each injection use a disposable auto-disable syringe and needle from a new sealed package (within expiration date and not damaged), if available.

• Wash hands with soap and water, if possible.
• If injection site is dirty, wash it with soap and water.
• No need to wipe site with antiseptic.

• MPA/estradiol cypionate: Gently shake the vial.
• NET-EN/estradiol valerate: Shaking the vial is not necessary.
• No need to wipe top of vial with antiseptic.
• If vial is cold, warm to skin temperature before giving the injection.

4. Fill syringe

Pierce top of vial with sterile needle and fill syringe with proper dose. (Omit this step if syringe is preloaded with injectable formulation.)

5. Inject formula

• Insert sterile needle deep into the hip (ventrogluteal muscle), the upper arm (deltoid muscle), the buttocks (gluteal muscle, upper outer portion), or outer (anterior) thigh, whichever the woman prefers. Inject the contents of the syringe.
• Do not massage injection site.

• Do not recap, bend, or break needles before disposal.
• Place in a puncture-proof sharps container.
• Do not reuse disposable syringes and needles. They are meant to be destroyed after a single use. Because of their shape, they are very difficult to disinfect. Therefore, reuse might transmit diseases such as HIV and hepatitis.
• If reusable syringe and needle are used, they must be sterilized again after each use (see Infection Prevention in the Clinic).

Supporting the user

Give specific instructions

• Tell her not to massage the injection site.
• Tell the client the name of the injection and agree on a date for her next injection in about 4 weeks.

“Come Back Any Time”: Reasons to Return Before the Next Injection

Assure every client that she is welcome to come back any time—for example, if she has problems, questions, or wants another method; she has a major change in health status; or she thinks she might be pregnant.

General health advice: anyone who suddenly feels that something is seriously wrong with her health should immediately seek medical care from a nurse or doctor. Her contraceptive method is most likely not the cause of the condition, but she should tell the nurse or doctor what method she is using.

Planning the Next Injection

Agree on a date for her next injection in 4 weeks.

Ask her to try to come on time. She may come up to 7 days early or 7 days late and still get an injection.

She should come back no matter how late she is for her next injection. If more than 7 days late, she should abstain from sex or use condoms, spermicides, or withdrawal until she can get an injection. She can also consider emergency contraceptive pills if she is more than 7 days late and she has had unprotected sex in the past 5 days (see Emergency Contraceptive Pills).

Back to contents