Progestin-only contraceptives include the implants just described, injectables, and pills. s their primary contraceptive action, these progestins suppress luteinizing hormone (LH) and in turn block ovulation. As other efects, cervical mucus is thickened to retard sperm passage, and atrophy renders the endometrium unfavorable for implantation. Fertility is restored rapidly following cessation of progestin-only contraception. n exception is DMPA, as described on page 693 (Mansour, 201l).
For all progestin-only methods, irregular or heavy uterine bleeding is a distinct disadvantage. It is the most frequently reported adverse event leading to method discontinuation. Often, counseling and reassurance is suicient. Troublesome bleeding may be improved by one to two cycles of combination oral contraceptives, by a 1-to 3-week course of estrogen alone, or by a short course of NSAIDs combined with the established method (Abdel-Aleem, 2013). Fortunately, with prolonged use, progestins induce endometrial atrophy, which leads to sustained amenorrhea. For the well-counseled patient, this is often an advantage.
Most progestin-only contraceptive methods do not signiicantly afect lipid metabolism, glucose levels, hemostatic factors, liver function, thyroid function, or blood pressure (DorRinger, 2002). However, the increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterolrlevels seen with DMPA may be less desirable for women with cardiac or vascular disease risks (Kongsayreepong, 1993).
Progestin-only methods do not impair milk production and are an excellent choice for lactating women. here are no increased risks of genital tract, liver, or breast neoplasia (Samson, 2016; Wilailak, 2012; World Health Organization, 1991a,b, 1992). Weight gain and bone fracture are not prominent side efects of this contraceptive group, except for depot progesterone, discussed on page 693 (Lopez, 2012a, 2013a). Functional ovarian cysts develop with a greater frequency in women using progestin-only agents, although they do not usually necessitate intervention (European Society of Human Reproduction and Emblyology, 2001; Hidalgo, 2006; Nahum, 2015). Last, an association between depression and DMPA or POPs is unclear (Civic, 2000; Pagano, 2016; Svendal, 2012; Westhof, 1995). Women with depression may be prescribed these methods, but surveillance following initiation is reasonable.