Types
| Cyclofem®: |
25 mg depot-medroxyprogesterone acetate and 5 mg estradiol cypionate
injected (IM) once a month
|
| Mesigyna®: |
50 mg norethindrone enanthate and 5 mg estradiol valerate injected (IM)
once a month |
Mechanisms of Action
- Suppress ovulation
- Thicken cervical mucus, preventing sperm penetration
- Change endometrium, making implantation less likely
- Reduce sperm transport in upper genital tract (fallopian tubes)
Benefits
Contraceptive
- Highly effective (0.1–0.4 pregnancies per 100 women during the first year of use)
- Effective immediately
- Pelvic examination not required prior to use
- Do not interfere with intercourse
- Few side effects
- No supplies needed by client
- Can be provided by trained nonmedical staff
Noncontraceptive
- Decrease menstrual flow (lighter, shorter periods)
- Decrease menstrual cramps
- May improve anemia
- Protect against ovarian and endometrial cancer
- Decrease benign breast disease and ovarian cysts
- Prevent ectopic pregnancy
- Protect against some causes of PID
Limitations
- Cause changes in menstrual bleeding pattern (irregular bleeding/spotting initially) in
some women
- Some nausea, dizziness, mild breast tenderness or headaches (usually disappear within 2
or 3 injections)
- User-dependent (client must return for injection every 30 days)
- Effectiveness may be lowered when certain drugs for epilepsy (phenytoin and
barbiturates) or tuberculosis (rifampin) are taken
- Serious side effects (e.g., heart attack, stroke, blood clots in lung or brain, liver
tumors), though rare, are possible
- Resupply must be available
- Do not protect against STDs (e.g., HBV, HIV/AIDS)
Who Can Use CICs
- Women of any reproductive age
- Women of any parity including nulliparous women
- Women who want highly effective protection against pregnancy
- Women who are breastfeeding (6 months or more postpartum)
- Women who are postpartum and not breastfeeding
- Women who are postabortion
- Women with anemia
- Women with severe menstrual cramping
- Women with irregular menstrual cycles
- Women with histories of ectopic pregnancy
- Women who cannot remember to take a pill every day
Conditions Requiring Precautions
CONDITION |
RECOMMENDATION |
| High blood pressure |
Initiate and resupply after careful evaluation of
condition. Women with BP > 160/100 but < 180/110 can use CICs. |
| Diabetes |
CICs can be used with uncomplicated diabetes or
diabetes of less than 20 years duration. |
| Migraines |
If no focal neurologic symptoms are associated with
the headaches, CICs can be used. |
Taking medication
for epilepsy or tuberculosis |
Provide high dose estrogen (50 µg ethinyl estradiol)
pills or help client choose another method. |
Who Should Not Use CICs
- Women who are pregnant (known or suspected)
- Women who are breastfeeding and fewer than 6–8 weeks postpartum
- Women with unexplained vaginal bleeding (until evaluated)
- Women with active liver disease (viral hepatitis)
- Women over age 35 who smoke
- Women with a history of heart disease, stroke or high blood pressure (>180/110)
- Women with a history of blood clotting problems or diabetes (> 20 years)
- Women with migraines and focal neurologic symptoms
- Women with breast cancer
When to Start
- Anytime during the menstrual cycle when you can be reasonably sure the client is not
pregnant
- Days 1 to 7 of the menstrual cycle
- Postpartum:
- after 6 months if using LAM
- after 3 weeks if not breastfeeding
- Postabortion (immediately or within 7 days)
Management of Common Side Effects
SIDE EFFECTS |
MANAGEMENT |
| Amenorrhea (absence of vaginal
bleeding or spotting) |
Check for pregnancy. If not
pregnant, explain that absent menses are most likely due to lack of buildup of uterine
lining. No treatment is required except counseling and reassurance. Advise client to
return to clinic if amenorrhea continues to be a concern or help her choose another
method.
If intrauterine pregnancy is confirmed, counsel client regarding options.
If pregnancy will be continued, stop the CIC and assure her that the small dose of
estrogen and progestin in the CIC will have no harmful effect on the fetus. |
High blood pressure
(> 160/100) |
If BP increases in a client with normal BP who is
using CICs, follow closely. If any warning signs (severe headaches, chest pain, blurred
vision) occur or BP >160/100, the method should be stopped. If CICs
are stopped, help client choose another (nonestrogen) method. Tell her that high BP due to
CICs usually goes away after 1–3 months. Take BP monthly to be sure it returns to
normal. If after 3 months it has not, refer for further evaluation. |
| Nausea/Dizziness/ Vomiting |
Check for pregnancy. If pregnant, manage as above. If not,
reassure that symptoms usually decrease after first 3 injections. |
| Vaginal bleeding/Spotting |
Check for pregnancy and other gynecological
conditions. Reassure that spotting/light intermenstrual bleeding is common during first 3
months of use and then decreases. If it persists and is a concern to the client, help her
choose another method. |
Client Instructions
- Return to the health clinic for an injection of Cyclofem or Mesigyna every month.
- If you miss 2 or more menstrual periods, you should come to the clinic to check if you
are pregnant.
General Information
- Some nausea, dizziness, mild breast tenderness and headaches as well as spotting or
light bleeding are common during the menstrual cycle (usually disappear within 2 or 3
injections).
- Certain drugs (rifampin and most anti-epilepsy drugs) may reduce the effectiveness of
CICs. For this reason, the client should tell her health care provider if she starts any
new drugs.
- CICs do not provide protection against STDs, including the AIDS virus. If either partner
is at risk, they should use condoms as well as CICs.
WARNING SIGNS
FOR COMBINED INJECTABLE CONTRACEPTIVE (CIC) USERS
- Severe chest pain or shortness of breath
- Severe headaches or blurred vision
- Severe leg pain
- Absence of any bleeding or spotting during 7 days before next injection may be a
sign of pregnancy
Contact a health care provider or clinic if you develop any of
the above problems. |
Who Can Provide
- Physicians
- Nurses, Midwives, Paramedics
- Community-based Workers
- Pharmacists
Where They Can Be Provided
- Hospitals
- Clinics
- Health Posts
- Community-based Distribution Programs
- Pharmacies
- Private Offices
 
|
