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DHMH/FHA/CMCH MARYLAND FAMILY PLANNING & REPRODUCTIVE HEALTH PROGRAM CLINICAL GUIDELINES
Depot-Medroxyprogesterone Acetate – Revised 4/15/2012
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B. Trained clinic personnel may administer injections. Providers must be familiar with
proper injection procedures, timing of injections, and infection control guidelines.
C. Selection of DMPA formulation:
1. It is NOT acceptable to use the 400 mg/ml concentration for contraceptive
purposes.
2. SubQ injections: 0.65 ml of a 104 mg/0.65 ml solution of DMPA must be used.
3. For IM injections: 1.0 ml of a 150 mg/ml solution of DMPA must be used.
D. Giving the injection
1. Shake vial vigorously for at least one minute just prior to use
2. Give SubQ injection in the upper thigh or abdomen (do not use the arm), using the
safety needle provided (may follow the directions for injection from package insert).
3. Give deep IM injection in gluteus or deltoid, using 1 ½ inch 21-23 gauge needle.
4. Do not massage injection site whether IM or SubQ
5. Document the procedure in the clients medical record
6. Protocols must be in place for the management of vaso-vagal fainting episodes and
possible anaphylactic reactions.
VII. CLIENT EDUCATION/ INFORMED CONSENT
All clients being provided a DMPA should receive the following:
A. Information/counseling regarding all contraceptive options available
B. Information specific to oral contraceptive method of choice including effectiveness,
benefits, risks, use, danger signs, potential side effects, complications and
discontinuation issues (Appendix A and B).
C. DMPA users must be advised on the importance of regular weight bearing exercise,
not smoking and taking extra calcium, either through diet or by added Calcium and
Vitamin D supplements. Recommended daily amounts of Calcium (1300-1500 mg)
and Vitamin D (400 – 800 mg) should be encouraged.
D. Information that DMPA does not offer protection against STIs/HIV, the routine use of
condoms should be encouraged to decrease STI risk.
E. Informed consent (form attached to this guideline) should be reviewed and signed and
a copy of the same upon request
F. If DMPA is being provided/prescribed to a client with risk factors, then a Request for
Contraception in Women with Risk Factors form should be reviewed and signed.
G. Instruction/counseling on importance of reading the Patient Package Insert (PPI)
H. Emergency, 24-hour telephone number and location where emergency services can
be obtained
I. Clinic access information
VIII. MANAGEMENT OF SIDE-EFFECTS AND COMPLICATIONS
A. Irregular Bleeding Patterns:
1. Bleeding patterns tend to regularize after the first year of use.
2. Obtain/perform the following:
a. Interval history with focus on the possibility of pregnancy or genital tract
infection
b. Pelvic examination, as indicated, to exclude pregnancy, infection, or an
anatomic lesion