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Recommendations for Contraceptive Use |
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Combined Injectable Contraceptives |
Classification of Selected
Procedures for Combined Injectable Contraceptives (CICs)
| Procedure |
Class |
Rationale |
| Pelvic examination (speculum and
bimanual) |
C |
- A pelvic exam is not necessary to ensure safe use of
injectables as a contraceptive method.
- In some cases, a pelvic exam may help evaluate the question
of pregnancy beyond 6 weeks duration. In this case, it is Class A.
|
| Blood pressure |
B |
CICs are not known to modify
blood pressure, however due to the estrogen content, World Health Organization (WHO) has
included very high blood pressure as an important eligibility criterion1. |
| Breast examination |
B |
CICs do not cause breast
cancer. However, if the client has breast cancer, injectables should not be used. WHO
considers current breast cancer to be Category 4 for CICs (use of the method with this
condition is an unacceptable health risk)1. |
| Sexually transmitted disease
(STD) screening by lab tests (for asymptomatic persons) |
C |
Presence of an STD will not
affect the safe use of injectables. |
| Cervical cancer screening |
C |
Cervical screening is not needed
for the safe use of injectables. |
| Routine, mandatory lab tests
(e.g., cholesterol, glucose, liver function tests) |
D |
CICs do not modify cholesterol,
glucose or affect the liver function. |
| Proper infection prevention
procedures |
A |
Proper infection prevention
procedures are important to minimize the risk of infection to clients and providers (see Question 4). |
Specific counseling points for
CIC use:
- efficacy
- common side effects, including alterations in bleeding
patterns (e.g., frequent or irregular bleeding, anemia evaluation with heavy bleeding,
extended amenorrhea, break-through bleeding)
- correct use of method (including date of next injection and
instructions for late injections)
- signs and symptoms for which to see a health provider
- need for STD protection (when/as appropriate)
|
A |
- Proper counseling is important to ensure informed consent.
- Appropriate counseling about common contraceptive side
effects at the time of method selection can lead to improved client satisfaction and
contraceptive continuation.
- The woman should be encouraged to return if she has any
problems or at any time she has questions or concerns.
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KEY:
Class A = essential and mandatory or otherwise
important in all circumstances, for safe and effective use of the contraceptive method
Class B = medically/epidemiologically rational in
some circumstances to optimize the safe and effective use of the contraceptive method, but
may not be appropriate for all clients in all settings
Class C = may be appropriate for good preventive
health care, but not materially related to safe and effective use of the contraceptive
method
Class D = not materially related to either good
routine preventive health care or to the safe and effective use of the contraceptive
method
Citations for Procedures Table:
- World Health Organization. Improving
access to quality care in family planning: medical eligibility criteria for contraceptive
use. Geneva: WHO, 1996.
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