11/13/24, 8\:17 PM Guide | Depot counselling

Depot counselling

Table of contents

Introduction

Contraceptive counselling often features in OSCEs and it’s therefore important to be familiar with the various types of
contraception available. This article focuses on counselling patients about the progesterone depot injection including the
common questions patients ask, the answers you’ll be expected to articulate and how best to structure the consultation.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Check the patient’s understanding of the types of contraception available.
Explore the reasons why the patient wants the progesterone depot injection.

Ideas, concerns and expectations

It is important to explore the patient’s ideas, concerns and expectations early in the consultation, as you may need to correct
any misconceptions about the progesterone depot injection and address the patient’s concerns. When exploring concerns, it is
important to do so in a sensitive and honest manner.
It’s also important to clarify the patient’s expectations of the progesterone depot injection because if these are unrealistic, other
forms of contraception may be better able to meet their needs.
Ideas
Explore what the patient currently understands about the progesterone depot injection\:
“ H a v e y o u h e a r d o f t h e p r o g e s t e r o n e d e p o t i n j e c t i o n ?”
“ W h a t d o y o u a l r e a d y k n o w a b o u t t h e p r o g e s t e r o n e d e p o t i n j e c t i o n ?”
Concerns
Ask if the patient has any concerns about the progesterone depot injection\:
“ I s t h e r e a n y t h i n g t h a t w o r r i e s y o u a b o u t t h e p r o g e s t e r o n e d e p o t i n j e c t i o n”
Expectations
Explore the patient’s expectations of the progesterone depot injection\:
" W h a t a r e y o u h o p i n g t h e p r o g e s t e r o n e d e p o t i n j e c t i o n c a n d o f o r y o u ?"
" W h y d o y o u t h i n k t h e p r o g e s t e r o n e d e p o t i n j e c t i o n i s t h e b e s t c h o i c e f o r y o u ?"

What is the depot Injection?

Using patient-friendly language, explain that the progesterone depot injection contains a hormone called progesterone.
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“ T h e p r o g e s t e r o n e d e p o t i n j e c t i o n c o n t a i n s a h o r m o n e c a l l e d p r o g e s t e r o n e . n a t u r a l h o r m o n e t h a t i s p r o d u c e d b y y o u r o v a r i e s .
”
1
T h i s h o r m o n e i s a l m o s t e x a c t l y t h e s a m e a s t h e

Types of depot

The main types of depot injections available in the UK include\:
Depo-Provera (most commonly used)
Sayana Press

How does the depot Injection work?

Explain that the depot injection works by inhibiting ovulation, thickening cervical mucus and thinning the lining of the
endometrium, making it di
2
“ T h e d e p o t i n j e c t i o n w o r k s b y p r e v e n t i n g y o u r o v a r i e s f r o m r e l e a s i n g a n e gg e v e r y m o n t h . I t a l s o c a u s e s t h i c k e n i n g o f m u c u s a t
t h e e n t r a n c e o f y o u r w o m b w h i c h s t o p s s p e r m f r o m m o v i n g t h r o u gh i t . L a s t l y , i t t h i n s t h e l i n i n g o f y o u r w o m b , s o e v e n i f a n e gg
i s f e r t i l i s e d , i t w o u l d n o t b e a b l e t o i m p l a n t .
”

How e

Patients understandably want to know how e
which type of contraception they want to use. As a result, it’s useful to know some basic statistics on e
unsure, signpost the patient to a reliable source and don’t guess!
The depot injection is 99% e
1
“ I f y o u h a v e y o u r i n j e c t i o n s a t t h e r i g h t t i m e , t h e n t h e d e p o t i n j e c t i o n i s 9 9 % e
”

Pros and cons

Always give patients as much information as possible so that they can make an informed decision. It is useful to do this by
discussing the pros and cons of the progesterone depot injection.
“ I f i t i s o k a y w i t h y o u , I’ d l i k e t o t e l l y o u a b o u t t h e b e n e
”
t h e n h o p e f u l l y y o u w i l l h a v e
Advantages of the depot injection
Long-acting contraception
“ T h e d e p o t i n j e c t i o n i s a l o n g-a c t i n g c o n t r a c e p t i v e m e t h o d , l o n g a s t h e i n j e c t i o n l a s t s .
”
t h i s m e a n s t h a t y o u d o n’ t h a v e t o t h i n k a b o u t c o n t r a c e p t i o n f o r a s
E
“ T h e d e p o t i n j e c t i o n i s 9 9 % e
”
Not associated with ovarian cysts
“ U n l i k e s o m e o t h e r c o n t r a c e p t i v e m e t h o d s , t h e d e p o t i n j e c t i o n i s n o t a s s o c i a t e d w i t h o v a r i a n c y s t s a s i t p r e v e n t s o v u l a t i o n .
”
Less painful periods
“ Y o u r p e r i o d s m a y b e c o m e l e s s p a i n f u l .
”
Useful if oestrogens can’t be taken
“ T h e d e p o t i n j e c t i o n i s u s e f u l i f y o u c a n’ t t a k e o e s t r o ge n-c o n t a i n i n g c o n t r a c e p t i v e s s u c h a s t h e c o m b i n e d o r a l c o n t r a c e p t i v e
p i l l .
”
Safe during breastfeeding
“ T h e d e p o t i n j e c t i o n w i l l n o t h a r m y o u r b a b y i f y o u c h o o s e t o b r e a s t f e e d .
”
Disadvantages of the depot injection
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Side e
“ T o s t a r t o
”
1
n a u s e a , a c n e , m o o d c h a n ge s a n d b r e a s t
Change in periods
“ W h e n y o u t a k e t h e d e p o t i n j e c t i o n , y o u r p e r i o d s m a y c h a n g e . Y o u m a y e x p e r i e n c e i r r e gu l a r , T h e r e i s a l s o a c h a n c e t h a t y o u r p e r i o d s m a y l a s t l o n ge r a n d b e c o m e h e a v i e r .
”
1
l i gh t o r m o r e f r e q u e n t p e r i o d s .
Protection from STIs
“ U n f o r t u n a t e l y , t h e d e p o t i n j e c t i o n d o e s n o t p r o t e c t y o u f r o m s e x u a l l y t r a n s m i t t e d i n f e c t i o n s .
”
Weight gain
“ D e p o-P r o v e r a a n d S a y a n a P r e s s a r e a s s o c i a t e d w i t h w e i gh t g a i n , s t a r t i n g t h e d e p o t i n j e c t i o n s .
”
e s p e c i a l l y i f y o u a r e u n d e r 1 8 o r h a v e a h i g h B M I b e f o r e
Fertility
“ A f t e r s t o p p i n g t h e d e p o t i n j e c t i o n , p r e g n a n t .
”
t h e r e c a n b e u p t o a o n e y e a r d e l a y b e f o r e y o u r f e r t i l i t y r e t u r n s a n d y o u a r e a b l e t o b e c o m e
Risks of the depot injection
It is important to explain the risks of the depot injection so that the patient is aware and can make an informed decision.
Osteoporosis
“ D e p o-P r o v e r a o r S a y a n a P r e s s m a y c a u s e t h i n n i n g o f y o u r b o n e s . I f y o u a r e a t h i g h e r r i s k o f d e v e l o p i n g o s t e o p o r o s i s ( l o n g-
t e r m s t e r o i d u s e , f a m i l y h i s t o r y o f t h e c o n d i t i o n ) t h e n w e w o u l d n o r m a l l y a d v i s e y o u t o c h o o s e a n o t h e r t y p e o f c o n t r a c e p t i o n .
”
Breast cancer
“ R e s e a r c h s h o w s t h a t t h e r e m a y b e a v e r y s l i gh t i n c r e a s e i n t h e r i s k o f b r e a s t c a n c e r i f y o u u s e t h e d e p o t i n j e c t i o n .
”
Infection
“ A l l i n j e c t i o n s c o m e w i t h a v e r y s m a l l r i s k o f i n f e c t i o n . I n m o s t c a s e s , t h i s c o u l d b e e a s i l y t r e a t e d w i t h s o m e a n t i b i o t i c s .
”

Contraindications

A patient should not have the depot injection if they\:
2
are pregnant
are thinking of becoming pregnant within the next year
have breast cancer
have severe cirrhosis
have liver tumours
have a history of severe arterial disease
have risk factors for osteoporosis
are experiencing unexplained vaginal bleeding

How is the depot Injection given?

Depo-Provera
“ T h e D e p o-P r o v e r a i n j e c t i o n i s a d m i n i s t e r e d i n t o t h e m u s c l e , o f t e n v i a y o u r b u t t o c k o r t h e s i d e o f y o u r t h i gh .
”
Sayana Press
“ S a y a n a P r e s s i s i n j e c t e d b e n e a t h t h e s k i n v i a t h e f r o n t o f y o u r t h i gh o r a b d o m e n . a d m i n i s t e r t h e s e i n j e c t i o n s t h e m s e l v e s a t h o m e .
”
S o m e w o m e n c a n b e t a u gh t h o w t o
Timing
Depo-Provera and Sayana Press injections are given once every 13 weeks.
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Closing the consultation

Summarise the key points back to the patient.
Ask the patient if they have any further questions or concerns that haven’t been addressed.
Throughout the consultation you should check the patient’s understanding at regular intervals, using phrases such as “C a n
y o u j u s t r e p e a t b a c k t o m e w h a t w e’ v e j u s t d i s c u s s e d r e g a r d i n g …
”
.
It may also be useful to direct the patient to any websites or lea
O
Encourage the patient to use condoms if they are not currently using contraception.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

Common patient questions

Below are some common questions that patients may have regarding the depot injection. Sometimes, in an OSCE situation,
they may ask you one or two questions at the end of your consultation. Having a good answer can demonstrate to the examiner
that you have a solid understanding of the topic.
When can the patient start using the contraceptive injection?
The patient can start using the injection at any time of their menstrual cycle as long as they are not pregnant. However, if they
start on any day other than the
What should the patient do if they want to try and become pregnant?
Patients are usually advised to omit further injections once they have decided they want to get pregnant. There can be up to a
one year delay between stopping the depot injection and normal fertility resuming. Don’t forget to advise the patient on pre-
pregnancy care such as folic acid and smoking cessation.
Can the patient restart depot injections after having a baby?
Patients can restart the injection after having a baby. If the injection is started after day 21 advise them to use condoms for
seven days.

References

1. Fpa.org.uk. (2018). Your guide to Contraceptive Injections [online] Available at\: [LINK].
2. Payne, J (2015). Progestogen-onlyI Injectable Contraceptives. Patient. [online] Patient.info. Available at\: [LINK].
Source\: geekymedics.com
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