Progestin Contraceptives (Oral, Parenteral)

Progestin contraceptives or taken orally or by injection to prevent fertilization of the egg in the patient taking the treatment. No contraceptive treatment is 100% effective.

Overview

Progestin contraceptives are hormone-based oral treatments used to prevent the patient from becoming pregnant. They work to prevent the female from becoming pregnant by reducing the chances of fertilization and are taken daily on a schedule throughout the menstrual cycle. Alternatively the medication can be administered as an injection or can be taken as emergency contraception. The appropriate brand of medication must be used in each case.

They work in a number of different ways to prevent pregnancy in the female. Progestins can prevent the female's egg from developing properly and preventing pregnancy by doing so. Progestins can also have other effects that reduce the risk of pregnancy occurring. These effects can include a thickening of the cervical mucus that will make it much more difficult for the sperm to reach the egg for fertilization. This thickening of mucus can also make it more difficult for a fertilized egg to attach to the walls of the uterus, increasing the difficulty of the occurrence of pregnancy.

No contraceptive treatment is ever 100% effective, but Progestin contraceptives are one of the more effective treatments that can be used to prevent pregnancy. Studies have shown fewer than 1 in 100 women becoming pregnant during use of the treatment by injection and fewer than 10 in 100 women becoming pregnant while taking the treatment orally. Progestin contraceptives are more effective forms of contraception than condoms, diaphragms or spermicides. Ensure that you have discussed all options for effective birth control with your doctor before use.

Progestin contraceptives are available only with a prescription form your doctor. They are prescribed as tablets in the following forms:

  • Provera
  • Plan B One-Step
  • Plan B
  • Ovrette
  • Nora-BE
  • Nor-QD
  • Next Choice
  • My Way
  • Lyza
  • Jolivette
  • Errin
  • Camila
  • Aygestin

Certain diets can limit the effective use of this treatment. You should inform your doctor of any specific dietary plans that you follow before using this treatment as a contraceptive.

Condition treated

Pregnancy, prevention of

Type Of Medicine

  • Hormone treatment
  • Progestin

Side Effects

In addition to the desired contraceptive effects of the use of progestin contraceptives, other unwanted side effects may also occur. These side effects can sometimes require that you seek urgent medical attention, but in other cases they may be mild and have limited impact. Not all side effects may occur, but the following are possible:

The following side effects can be serious and should be reported to your doctor if they occur:

Occurring more commonly:

  • Cessation of occurrence of menstrual periods
  • Changes in volume of blood produced during periods
  • Increased uterine bleeding occurring between your regular monthly periods
  • Lighter uterine bleeding occurring between your menstrual periods

Occurring less commonly:

  • Increased flow of breast milk
  • Mental depression or extreme sadness
  • Skin rash
  • Unexpected flow of breast milk

Frequency of incidence not known:

  • Coughing
  • Decrease in height
  • Difficulty with swallowing
  • Hives, itching, puffiness, or swelling occurring in the following areas:
    • Around the eyes
    • Eyelids
    • Face
    • Lips
    • Tongue
  • Increased heartbeat
  • Pains occurring in the back, ribs, arms or legs
  • Pains or swelling occurring in the arms or legs without any injury
  • Shortness of breath
  • Skin rash
  • Tightness across the chest
  • Wheezing

Other side effects can occur that do not necessitate medical attention in most cases. If they become bothersome or are ongoing, however, then you should report them to your doctor and they may be able to help alleviate the side effects:

Occurring more commonly:

  • Abdominal pains
  • Changes in mood
  • Cramping
  • Diarrhea
  • Dizziness
  • Fatigue
  • Mild headaches
  • Nausea
  • Nervousness
  • Swollen face, ankles, or feet
  • Unusual tiredness
  • Unusual weakness
  • Vomiting
  • Weight gain

Occurring less commonly:

  • Acne
  • Appearance of brown spots skin
  • Breast pain
  • Breast tenderness
  • Hot flashes
  • Lack of sexual desire
  • Loss or gain of body, facial or scalp hair
  • Trouble with sleeping

Other side effects that have not been listed herein can also occur. If you experience other side effects from use then you should inform your doctor and seek advice.

Not all of the side effects listed herein may occur with all of the treatments available. All side effects have, however, been reported for at least one of the treatments and could, in theory, occur from the use of any of the progestin contraceptive treatments.

When starting and stopping the use of these treatments, the body will require time to adjust to the new hormone levels that it is experiencing. How long this takes can vary between individuals and will depend on the period of time for which you have been using the treatment. You should continue to look out for the side effects listed herein for a reasonable period after ceasing use of the treatment.

Dosage

Each type of progestin contraceptive will be provided with a medication guide. This will explain how the treatment works and also how the patient should take it to achieve the best effect. You should ensure that you read this carefully and understand it before you begin use.

This treatment does not in any way protect the woman from contraction of sexually transmitted diseases. Use of this contraception alone will leave the patient open to risks of contracting HIV, AIDS and other STDs. The use of condoms is recommended as a better and more effective protection against these infections.

You should take this treatment only as directed to by your doctor. You should not take it for any longer than ordered and should not in any way alter the dose. For best effect, the oral treatment should be taken at the same time daily. This will reduce the side effects that occur from use and allow it to work to best effect.

Methods of use of this treatment will vary depending on the brand and the method of use:

When taking levonorgestrel as a form of emergency contraceptive:

  • This tablet can be taken at any time during the menstrual cycle for the prevention of pregnancy after intercourse has occurred.

When taking medroxyprogesterone as an injection for the purposes of contraception:

  • This treatment must be administered by a doctor.
  • Treatment must be given once every three months.
  • Cessation of treatment relies only on missing the next injection that you are due.
  • Patients will be protected from pregnancy as soon as the injection is given as long as it is administered within 5 days of your period.
  • If you have just had a baby then treatment can be given five days after birth. If you are breastfeeding your baby, however, then you will need to wait for up to six weeks before receiving the injection and you will be at risk of pregnancy in this period.
  • Protection from this injection will last for three months. After three months you will need to be given another dose to continue protection.

When using an oral progestin contraceptive:

  • Take one dose of the treatments every day at the same time every day.
  • The treatment should be taken on a strict schedule to ensure effective use and to reduce the side effects experienced. If you take the tablet three hours late then this is the same as missing a dose and can expose you to risk of pregnancy.
  • The tablets will be packaged in a container with a daily schedule that will help you to keep track of your dosage. Keep the treatment in this package to help you remember to take the treatment.
  • If you are switching to the use of a progestin contraceptive from an estrogen and progestin contraceptive then you should begin use immediately after taking the last active treatment from your previous pill. This means skipping the 7 inert tablets and beginning this treatment on the 22nd day.
  • Note that when you are changing contraceptives full protection may not begin for 48 hours. You may need to use other contraceptives during this period.
  • When starting a new treatment you should use other contraceptives for three weeks to ensure full protection from pregnancy.
  • You will not be fully protected from pregnancy if you miss a treatment. Frequently missed treatments will make this treatment ineffectual.

You should always take this treatment as directed to by your doctor. The following dosing information is a guideline only and you should not change your dose of treatment unless directed to by your doctor. These doses will not take your personal circumstances into account:

For treatment with levonorgestrel for emergency contraceptive treatment in the form of oral tablets:

  • Adults and Teenagers “ Take a dose of 0.75mg within 72 hours of intercourse. A second dose is taken 12 hours later.

For treatment with medroxyprogesterone for prevention of pregnancy in the form of muscular injection:

  • Adults and teenagers “ 150mg injected every three months. Injection is made into the upper arm or the buttocks.

For treatment with medroxyprogesterone for prevention of pregnancy in the form of subcutaneous injection:

  • Adults and teenagers 104mg injected under the skin of thigh or abdomen every three months.

For treatment with norgestrel for prevention of pregnancy in the form or tablets:

  • Adults and teenagers “ 75 micrograms taken every 24 hours at the same time every day. Treatment begins on the first day of the menstrual cycle regardless of the occurrence of menstrual bleeding.

For treatment with norethindrone for prevention of pregnancy in the form or tablets:

  • Adults and teenagers “ 0.35mg taken every 24 hours at the same time every day. Treatment begins on the first day of the menstrual cycle regardless of whether menstrual bleeding occurs.

If you miss a dose then you should follow the following instructions depending on the treatment you are taking.

When taking an oral dose:

  • If you are 3 hours late in taking your dose of medication then you will be at risk of pregnancy. It is recommended that you take the treatment as soon as possible and then return to your previous schedule. You should use an alternative contraceptive for two days following a missed dose.
  • This is a different response to that used in cases of different forms of oral contraceptive.

When taking an injected dose:

  • If you wait longer than 13 weeks for an injection then you will be at risk of pregnancy. Your doctor may require you to use an alternative medication for some weeks to ensure that you are not pregnant before administering another dose of this contraceptive.
  • If you miss a period following a missed dose of this treatment then you may need to be treated for possible pregnancy and should inform your doctor.

Interactions

Certain medications can interact with one another in the body. In some cases, the use of multiple medications in conjunction with one another can cause severe unwanted side effects. In other cases, certain treatments may prevent one another from working. In the case of contraceptives other treatments may make them ineffectual and may expose you to a risk of pregnancy once again. You should inform your doctor of all medications that you use before receiving a prescription for a progestin contraceptive. This includes any herbal remedies, vitamin supplements, over the counter treatments or other prescribed medications that you are taking. This is especially important in the following cases:

The use of progestin contraceptives in conjunction with the following medication is not recommended. Your doctor may decide not to prescribe this treatment or may need to change the other treatment:

  • Tranexamic Acid

The use of progestin contraceptives in conjunction with the following medications would not normally be recommended. In some cases, however, both medications may be prescribed. Your doctor may change the dose of one or more of the treatments in this case:

  • Ulipristal
  • Tizanidine
  • Theophylline
  • Sugammadex
  • Pitolisant
  • Lumacaftor
  • Lixisenatide
  • Lesinurad
  • Isotretinoin
  • Idelalisib
  • Eliglustat
  • Darunavir
  • Dabrafenib
  • Ceritinib
  • Carbamazepine

Interactions with other medications can also occur that have not been listed. Ensure that you inform your doctor of all treatments that you are taking before beginning use.

Medical conditions can also impact the safe and effective use of progestin contraceptives. You should inform your doctor of your full medical history before use. This is particularly important if you suffer from any of the following medical conditions.

The following conditions can be worsened by the use of progestin contraceptives:

  • Asthma
  • History of epilepsy
  • Problems with circulation of the heart
  • Severe kidney disease
  • Migraine headaches
  • Breast disease
  • Disorders of the central nervous system
  • High levels of cholesterol
  • Osteoporosis

Diagnosis of the following conditions can be limited by the use of progestin contraceptives:

  • Undiagnosed bleeding problems.

Effects of the treatment may be intensified in patients with the following conditions:

The level of blood sugar in the body may be affected in patients suffering from the following condition:

  • Diabetes mellitus

Other medical conditions not listed herein may also effect the use of this treatment. Ensure that you have informed your doctor of all conditions that you are currently taking before beginning use.

Warnings

Before you begin use of this treatment you should consider the benefits of doing so in relation to the risks that are posed by use. You will need to consider everything herein with your doctor and pay particular attention to the following factors:

Allergies “ You must inform your doctor of any allergies from which you suffer. This is particularly important if you have ever suffered an allergy to medication in the past. Allergies to certain substances may prohibit use.

Pediatric “ This treatment is effective for use in teenagers and adults. It should not be taken before the first menstruation and should never be used for the prevention of pregnancy in children. It is not known if injected forms of this medication can cause bone growth defects in teenagers and young women. Patients should be checked for signs of this by the doctor on a regular basis and this is particularly important if the patient uses this treatment for a period of 2 years or more.

Geriatric “ This medication is safe and effective for use in elderly patients as well as in adults.

Pregnancy “ If pregnancy is suspected then treatment with progestin contraceptives should be ceased and you should contact your doctor for advice. When progestin contraceptives have been used by accident during pregnancy, however, problems have not occurred.

Breastfeeding “ Progestins can pass into the breast milk but they have not been shown to cause problems for nursing babies. Discuss risks in relation to the benefits of use with your doctor.

When using this treatment it is important that you visit your doctor for regular check ups to ensure that no unwanted side effects are occurring. You should check with your doctor every 12 months during treatment with this medication unless treatment requires more regular visits. For those receiving treatment by injection you will need to attend every 3 months for treatment and every 12 months for a physical check up.

Progestins can make you dizzy. Ensure that you are safe to drive or to operate machinery before doing so and remember that it is your legal responsibility to ensure your safety and the safety of those around you.

Progestins are hormones that affect the body more widely than simply preventing pregnancy. There is a risk that temporary thinning of the bones may occur because of a hormone imbalance when you begin use of this treatment. This can increase your risk of osteoporosis and you should be cautious if you have other factors that may also add to this risk. Such factors can include:

  • Smoking tobacco
  • Abusing alcohol
  • Consuming large amounts of caffeine
  • Family history of osteoporosis
  • Taking steroids
  • Taking anticonvulsants

It is particularly important that you consider this if you are beginning use of Depo-Provera or Depo-SubQ Provera 104 as these contraceptives will cause a reduction in bone mineral density on a greater scale.

Varied amounts of vaginal bleeding can occur in between regular periods when you are using this treatment. This is likely to occur in the first 3 months of use and is normal. Patients should continue use but you should inform your doctor if you experience this for longer than 3 months. If you have not had any bleeding for 45 days then you may be pregnant and need to be treated for possible pregnancy.

You should inform your doctor straight away if you suspect that you are pregnant.

Inform any medical professionals that you are taking this treatment as progestin tablets and injections can affect the results of certain tests.

If you regurgitate the oral tablet once taken then this must be counted as a missed dose. Do not take an additional dose and follow guidance for missed doses. Use backup contraceptive systems for 48 hours after this missed dose.

If you regurgitate the emergency contraceptive tablet then you should contact a doctor or pharmacist to determine whether a second dose should be taken. Do not take a second dose without first discussing this with a trained healthcare professional.

Progestin contraceptives of all forms are ineffective as protection from sexually transmitted infections. Alternative contraceptives such as condoms should be used to protect you from infection from these. If you are having regular sexual contact with multiple partners then you should have regular sexual health checks too to ensure that you are free from infection and are not spreading infections to sexual partners.

Storage

This medication should be stored out of the reach of children. It should be stored in the original packaging to help you keep track of use.

Keep out of direct light and away from heat and moisture.

This medication should be disposed of if it is unwanted or outdated.

Summary

Progestin contraceptives are a form of birth control that prevents the patient from becoming pregnant. The treatment can be taken as a daily tablet, as an injection or as an emergency tablet for the treatment of potential pregnancy after intercourse has occurred. The treatment is available in a range of forms and brands but all must be prescribed by a doctor.

Progestin contraceptives work by interfering with the development of the egg, increasing the viscosity or vaginal mucus and making the conditions in the patient less amenable to successful impregnation. These treatments use hormones to create these changes in the body and the body will take some time to adjust to the changes. Patients may take up to 3 months of use to settle into the treatment and return to normal cycles and feelings.

Progestin contraceptives can have a range of different side effects on the patient. These may include mood changes, weight gain and other unwanted effects. Patients should understand these potential side effects before beginning use.

No contraceptive is 100% effective, but when used properly this treatment is one of the more effective contraceptives against pregnancy. Progestin contraceptives are more effective when used properly than condoms or other contraceptives.

Progestin contraceptives do not, however, offer any protection against sexually transmitted infections that may occur in the patient. Other means of contraception must be used in order to protect against the risk of HIV, AIDS and STIs. This is significantly more important in patients with different sexual partners. If you have unprotected sex when using this treatment then you should also have a sexual health check in the period afterwards to ensure that you have not got an infection from the intercourse.

When taking the oral tablets for protection from pregnancy it is essential that the treatment is taken consistently and regularly. Doing so will ensure that the treatment is effective and will reduce the side effects experienced too. If a treatment is taken 3 hours late then this is the same as missing a treatment and protection from pregnancy will be compromised. Alternative contraceptives will then need to be used for a 48 hour period of regular dosing to protect from pregnancy.

When taking the emergency contraceptive treatment use should occur within 72 hours of intercourse. The second dose should then be taken 12 hours later. If vomiting occurs after taking a dose then you must contact a doctor to determine your options. An additional dose may need to be taken in some cases.

For use of the injected treatment patients will need to attend an appointment on a 3 monthly cycle. The patient should then also receive a physical check up every 12 months to ensure that no unwanted side effects are occurring.

Teenagers and young children taking this treatment may be at risk of bone growth defects. This occurs only rarely but patients should be alert to this particularly when using the treatment for a period of 2 years or longer.