Usually, a woman with any of the conditions listed below should not use progestin-only injectables. In special circumstances, however, when other, more appropriate methods are not available or acceptable to her, a qualified provider who can carefully assess a specific woman's condition and situation may decide that she can use progestin-only injectables. The provider needs to consider the severity of her condition and, for most conditions, whether she will have access to follow-up.

  • Breastfeeding and less than 6 weeks since giving birth (considering the risks of another pregnancy and that a woman may have limited further access to injectables)
  • Severe high blood pressure (systolic 160 mm Hg or higher or diastolic 100 mm Hg or higher)
  • Acute blood clot in deep veins of legs or lungs
  • History of heart disease or current heart disease due to blocked or narrowed arteries (ischemic heart disease)
  • History of stroke
  • Multiple risk factors for arterial cardiovascular disease such as diabetes and high blood pressure
  • Unexplained vaginal bleeding before evaluation for possible serious underlying condition
  • Had breast cancer more than 5 years ago, and it has not returned
  • Diabetes for more than 20 years or damage to arteries, vision, kidneys, or nervous system caused by diabetes
  • Severe cirrhosis or liver tumor
  • Systemic lupus erythematosus with positive (or unknown) antiphospholipid antibodies and not on immunosuppressive treatment, or severe thrombocytopenia.

 

Progestin-Only Injectables for Women with HIV
  • Women who are living with HIV or are on antiretroviral (ARV) therapy can safely use progestin-only injectables.
  • The time between injections does not need to be shortened for women taking ARVs.
  • Urge these women to use condoms as well. Used consistently and correctly, condoms help prevent transmission of HIV and other STIs.
Counseling Women Who Want a Progestin-Only Injectable Where HIV Risk Is High

Some research has found that women who use a progestin-only injectable and are exposed to HIV are more likely than other women to get HIV infection (see Question 2). It is not clear whether this is due to the progestin-only injectable or to the way that the research was conducted.

In countries and programs where many family planning clients are at high risk of HIV, providers should discuss this finding with women interested in a progestin-only injectable. For counseling tips see Considering Progestin-Only Injectables Where HIV Risk Is High. Women who are at high risk for HIV can still choose a progestin-only injectable if they wish (MEC Category 2).