Sexual Health (young people)
The contraceptive injection
There are four methods of long-acting reversible contraception (LARC) to choose from; contraceptive injection, the contraceptive implant, the intrauterine device (IUD or non hormonal coil) and the intrauterine system (IUS or hormonal coil). This page is about the contraceptive injection.
The key thing about long acting reversible contraception methods is that they are all “fit and forget” methods; this means once they are fitted or given, women are protected from pregnancy without having to do or think anything about it, until it needs replacing.
In the UK the contraception injection is Depo-Provera and it lasts for 12 weeks. There is another one called Noristerat that lasts for 8 weeks, but that is rarely used or available now.
“If used correctly, the contraceptive injection is more than 99% effective. This means that less than one woman in 100 who use the injection will become pregnant in a year”- NHS Choices 2015
The injection contains progesterone. This stops ovulation ( the release of an egg every month), thickens the mucus in the cervix (stopping sperm reaching an egg), and thins the womb lining.
Chloe describes what happened at her GP surgery and what its like to have the contraceptive...
One of the main advantages of injections is that women don't have to worry about remembering to take anything, so they are good method for people who are a bit forgetful. It is important to remember that the LARCs do not offer any protection against sexually transmitted infections. If there is any possibility of infection, condoms should be used as well.
Explains that her main motivation as a teenager was to avoid pregnancy rather than STIs - but...
You said you had some information about sexual health for instance about safe sex, prevention of unwanted pregnancies, sexually transmitted infections?
I think infections aren't so, I mean pregnancy is a bigger worry than infections to a lot of teenagers and that's something that's not so widely spoken about, for me anyway.
When I was a teenager I think that pregnancy was the main issue rather than infections and I found myself with an infection once and I had to go and sort it out and I didn't really have a lot of support from you know, people to talk to, I didn't talk to my peers about it.
I felt like I'd been an idiot and it was just stupid of me for being lax you know, and since I've made sure that you know, there's absolutely no contact before the condom went on you know because you think well, the most important thing is to make sure that he doesn't ejaculate you know what I mean, and you can have as much contact then, and that's something I think that I wasn't really aware of as much, I was more concerned about not getting pregnant, you know at that stage, and then after that things changed.
There can be many reasons for a woman to choose a LARC method, including concerns about side effects of other methods, wanting to stop using condoms, having trouble remembering to take the pill, concerns about the effectiveness of the pill when sick, irregular painful periods and bleeding or to reduce the risk of pregnancy. People may want to change because they have had problems with other methods.
The one thing that helped Stefanie with her painful periods was the Depo Provera injection.
When I turned, it must have been about 14 or 15 and I was very young I started with very, very painful periods. And they tried numerous methods to try and help me. First of all painkillers and finally they switched to trying me with the pill because they thought that would help. And what I found was that it was making me ill at night. So eventually at the age of 14, 15 they put me on the depo [Depo-Provera] injection which wasn’t widely spoken about when I was younger and not a lot of research had been done for it.
It was only when I turned 18 that research came out that suggested you might be susceptible to osteoporosis if you have it before 17. So that made me feel a bit nervous but I have to say I loved the injection because it stopped my periods completely which as a girl and anyone can relate to, it was great.
Hannah knows that if she is drunk and then sick, the effectiveness of the pill is reduced and she...
Some of the women interviewed chose to use injections as their method of contraception after trying the pill or condoms.
Describes how she realised she needed a more reliable method of contraception and discusses the role of her...
You were sort of not using condoms or anything?
No I wasn't. I just had unprotected sex every now and again but it was with the same guy because I was still with him, but then we got a bit worried and I'm thinking oh no, what if I fall pregnant, what am I gonna do then. So that's when I went to the doctor and said 'Look seriously I need something.'
Because I kept on going for the morning after pill. Most of the time I went for the morning after pill and they'd say "the morning after pill's not really good, you're not supposed to really take it more than three times in a year", and I did take it more than three times in a year, you know what I mean' Yeah seriously, I did.
That's when they said to me you know 'You seriously need to think about long term, contraception'. So then yeah that's when Depo came in to it.
Because like my GP, I've known her for a long time and she's been my childhood GP, she knew when I left home and everything so she knew she has to be there as an extra support for me as well to explain everything to me.
And then obviously you go to see the nurse for contraception and things like that, so she transferred me to a nurse who explained all the procedure to me.
So like if I had a problem the first person I would go and see would be my GP because I can really, really trust her, she's like a friend to me, someone I can really openly talk to, so that's nice.
Explains why she changed from the mini-pill to the Depo Provera injection.
Okay, and how long did you keep using the injection?
I'm still on the injection now.
So you have been for 5 years?
Yes, 5 years is a long time, a long time.
I'm extremely happy with the injection, extremely happy. I've had no headaches, no major problems.
Explains how her acute thrush problem disappeared after she started on the Depo Provera injection...
Well I got it from my family planning clinic, basically they gave it to me because I was suffering really badly from thrush and whatever I did I just couldn't get rid of it. The doctor said that she had some success giving people Depo Provera to get rid of thrush and you know, she said I could try it, thankfully it did work, you know, it was great, it stopped me having periods as well which I was quite keen on.
What I thought was quite interesting was alot of my friends thought it was silly not knowing when you're getting your period, because you couldn't be sure you weren't pregnant, but I quite liked it.
Do you feel that you have had sufficient information about contraception and at the right time for you?
Yeah , I mean I don't think I was ever left in the dark about it, I mean you do kind of learn things, don't you, but I didn't know about this Depo Provera, but if I had, I would probably gone and got changed onto that sooner
Well I mean if I'd known about Depo Provera I would of gone sooner to the family planning clinic but it's not really well known is it. I mean I don't think people know it can help with thrush, I would of gone sooner if I'd of known.
Before changing contraception methods there are leaflets to read about what's available or health professionals to talk to at GP surgeries, Family Planning or Brook clinics. Remember, implants and injections do not suit everyone.
Women we spoke to had different experiences of contraceptive injections and, while women often reported being happy with the injection, some stopped taking it because of health concerns. Some used injections as contraception after childbirth. Although one woman thought two weeks after having her baby was too soon for an injection, it is safe to have the injection immediately after giving birth - if not breastfeeding. If breastfeeding, then it is an option six weeks or more after birth.
Talks about the beneficial side effects of Depo Provera. (Actor)
My moods are a lot better. I used to get quite depressed quite frequently, not like seriously depressed or anything but I used to feel low, quite a lot of the time. And I used to be a lot more concerned about my body shape and I'd get a lot of sort of water bloating coming up to my period.
And now that I'm on this injection and my hormone levels are straight, I don't get any of that. And I feel, I mean around the time when I would have been having my period I sleep a lot better and I don't get these irrational mood swings and I just think it's fantastic. I haven't, the only thing I've noticed, when I was on Dianette that's the one that's supposed to be good for your skin isn't it?
I was on that one a bit before I changed over so I noticed a bit of a change in my skin for the first couple of months when obviously the Dianette wore off. But it's settled down now and my weight's a lot more stable.
Explains why the Depo Provera injection was not suitable for her.
Then I went on the Pill and obviously they were regular then but I kept forgetting to take the Pill so I stopped doing that and they carried on being irregular for years and years and years, and then when I started Uni I tried the injection and that made things even worse.
Which one, Depo Provera?
Yes Depo Provera, and that made things even worse and I've just put up with it for the last ten years and it was only last year that I actually went to see a homeopath and actually she sorted it out.
Then I came off it completely, I wasn't on the Pill or anything and I just carried on using condoms and then I went on the Depo when I was twenty.
For how long?
That was for a year and I was still bleeding even when I was on the Depo so it wasn't right for me at all so I came off that and then I just said 'no more' hormones and stopped.
Describes erratic bleeding and pain while on the Depo Provera injection and how symptoms improved...
They changed my injection, I went on the progesterone only injection. So I used to be on Depo and now I'm on Noristerat and '
Okay, and how long have you been on the new one?
I've been on the new one now, they put me on that shortly after I went back to the Family Planning clinic with my clear results. I went back and they suggested that I go on to the Noristerat so it's been for about 4 months now.
The majority of women will have less frequent bleeding or none at all when using the contraception injection. A few women get frequent or heavy bleeding especially with the first injections. This usually settles down but if it doesn’t, it is advisable to talk to a doctor or nurse.
We talked to women who had stopped using LARC and started using other methods such as one of the contraceptive pills, and they said that they find it difficult to remember taking it every day. Stefanie has an alarm on her phone to remind her to take her pills and keeps them next to her toothbrush.
We also spoke to women who decided to stop using LARC or had never used LARC. They had a number of reasons for their decision including: experiences of relatives or friends, ‘horror’ stories reported by the media, concerns about LARCs' impact on fertility, possible link between long term use of Depo-Provera and osteoporosis (fragile bones) and also the perception of losing control over their own bodies.
Stefanies GP sent her a letter informing her of the possible link between Depo Provera and...
Chloe stopped using the Depo Provera injection because she was worried about its possible effects...
The injection is linked with a small loss of bone density, which usually goes back to normal after stopping the injection. There is no available evidence on the effect of long term injection use on the risk of breaking bones. When considering options, other factors that can reduce the density of bones may be taken into account (such as weight, smoking, other medical conditions, and a family history of osteoporosis).
When injections are stopped, there can be a delay in returning to regular periods and fertility for up to a year. There is no evidence they reduce fertility in the long term.
Women we interviewed commented that the amount of information they got from their GPs regarding LARC was variable and that, often, they were given leaflets to read rather than the time to talk about the different options available to them.
Katies GP gave her leaflets to read about implants and IUDs but there was little discussion...
The young women we talked to advised others to get as much information as they could find about long acting reversible contraception and other forms of contraceptives before deciding which one to use. They also reminded people that everyone reacts differently so not to be swayed by the experiences of family members or friends. One of the women we talked to who had used the injection thought that it was better to delay its use until the age of 17 or older and not to use it continuously.
Chloe advises young women not to be influenced by others, or to start LARCs too young, or to use...
With using the injection as a contraceptive, I would just say make sure that you are comfortable within yourself and you’re doing it for you and you understand the risks. It does have different effects on different people so you can’t go by someone else’s experience to judge whether you want to but if you are to try it, I would say probably have the breaks and not for long periods of time because that’s when obviously the worser side effects are more likely to have an affect but I don’t think it’s a bad form of contraception, in moderation. And for younger women, I think that maybe they should think even more about it especially like how I was fourteen to, in the, like when you’re developing and things like that. I don’t know exactly scientifically if it does have this effect or that effect but just knowing generally that any substance that’s not supposed to be there when you’re developing or have an effect on your body.
Natasha advises women to make an informed choice and if in a relationship, to discuss their...
If you decided to become sexually active or if for some reason your doctor said that you need to go on contraception to regulate blood flow or to control your really bad skin or something then ask your doctor for all the potential options. Ask them for all the options that you can have be it the pill, the patch, there’s the injection, the IUD, all of them. Really find out about the options that are available to you because what someone tells you is usually only part of what is out there. And once someone tells you what is out there find out for yourself. Go online because it is completely anonymous. No one is going to know. Find out about these different things. Ask your friends. If you have a sister ask your sister, ask your cousins, you know, but just remember that you’re. I think it’s really hard for girls because you feel like you are alone and you’re not and you’re really, really not because I think there is a certain stigma attached to it if you go on contraception it means, ‘Oh well she is clearly spreading it around isn’t she’. Probably she is not, she’s probably trying to be safe and that is a good thing.
And if you are in a relationship talk to your boyfriend because that’s the person who should be supporting you when you do something like this You know and if you do have a really good stable loving relationship where there is mutual respect and trust have him go to the clinic with you. Have him go through the options with you like saying ‘Well I’m going to get this. Do you feel comfortable with that or would you prefer that I got this or I feel happy with this?’ You know like make it be a really collaborative process about what you are doing because at the end of the day it’s your body but if you are in a relationship with someone, you know.
LARCs are over 99% effective against unwanted pregnancies BUT only condoms or not having sex offers protection against sexually transmitted infections, including HIV.
Last reviewed January 2016.
Last updated January 2016.