·         Abnormal Babies
·         Abortion
·         Breast Milk
·         Cancer
·         Infertility
·         Menstrual Bleeding
·         Sexual Desire
·         Who Can Use the Method
Myth: Abnormal Babies
Many clients incorrectly believe that using injectables will cause them to have abnormal babies.
Good evidence shows that progestin-only injectables will not cause birth defects or otherwise harm the fetus if a woman becomes pregnant while using the injectables or accidentally starts using injectables when she is already pregnant. 
Similarly, good evidence from studies of other hormonal methods shows that monthly injectables will not cause birth defects or otherwise harm the fetus if a woman becomes pregnant or is already pregnant when she starts injectables.
Counseling Messages:
While pregnancies are extremely rare in women using progestin-only injectables, there have been some women who have conceived and have decided to continue their pregnancies. These babies showed no increased risk of abnormality beyond that seen in the general population. While an unintended pregnancy is often challenging regardless of what contraceptive method is used, the use of injectable contraception does not alter the focus of discussion around pregnancy choices or lead to an automatic recommendation for termination of such pregnancy. (Australia)
There is no evidence of an increased risk of an abnormal baby if you have had Depo Provera. (New Zealand)
Injectables are never associated with abnormal babies. These result from genetic abnormalities in the father or mother or other causes. (Nigeria)
Injectables are not associated with abnormal babies. Your fertility will be back after you stop using the injectable, and you can become pregnant and have a normal baby. Having an abnormal baby is caused by many factors, such as genetic abnormalities in the father or mother. (Indonesia)
Myth: Abortion
Some clients incorrectly believe that injectables prevent pregnancies by causing an abortion.
Research shows that neither progestin-only nor monthly injectables will disrupt an existing pregnancy.
Both types of injectables prevent pregnancy primarily by preventing ovulation. Injectables also thicken the cervical mucus which inhibits sperm penetration. These changes make fertilization extremely unlikely to occur. Injectables also make the endometrium unfavorable for implantation if fertilization does occur. 
Counseling Messages:
We do not give a contraceptive to a woman who is known to be pregnant. However, there is no report that injectables can cause abortion when they are used during pregnancy. (Indonesia)
The injectable only works to prevent pregnancy, not end it. (USA)
The injectable contraceptive does not cause abortion. (Bangladesh)
Injectables are given for women to prevent pregnancy. There is no abortion when there is no pregnancy. (Indonesia)
Myth: Breastmilk
Some clients incorrectly believe that using progestin-only injectables will have a harmful effect on their breastmilk or on the babies drinking their breastmilk.
There is no evidence that progestin-only injectables (POIs) negatively affect breastmilk quality or production or the duration of lactation. Infants whose mothers have received DMPA injections while breastfeeding develop similarly to infants of mothers who have not received DMPA.
The amounts of hormones transmitted in the milk and absorbed by the infant are known to be small. Short-term studies of children breastfed by mothers using progestin-only contraceptives have reassuring results, but longer-term studies are yet to be evaluated. Breastfeeding women should not start POIs until six weeks after giving birth.
There are no studies on the effects of monthly combined injectables on the quantity and quality of breastmilk or the duration of lactation. Until more data are available, women should wait until six months after delivery to start using monthly injectables if they are fully or nearly fully breastfeeding (which means that breastmilk is the baby’s main food). If a woman is partially breastfeeding and breastmilk is no longer the baby’s main food, she can start using monthly injectables as soon as six weeks after delivery.
Counseling Messages:
Your quality and quantity of breastmilk depends on what you eat and drink, and how often you breastfeed your baby. Studies have found no clinically measurable effects on the health of breastfed babies at six weeks postpartum, so progestin-only injectables can be used from this time onwards. (Indonesia)
The injectable will not influence the quantity and quality of breastmilk. And it can be used for women who will give breastmilk to their baby as soon as six weeks after childbirth. (Indonesia)
The injectable does not decrease the yield of mother’s milk. It can be used for women who give breastmilk to their baby as soon as six weeks after childbirth and you have to watch the nutrition in your food. (Indonesia)
Studies have shown that there is no change in the amount or quality of breastmilk. They have followed babies whose mothers used injection six weeks after delivery while breastfeeding and the babies grew up perfectly normal. (New Zealand)
Injectables do not alter the quality or quantity of breastmilk. They cause no problem whatsoever with breastmilk. (South Africa)
The injectable does not alter the quantity and quality of breastmilk, because there is no hormone in the injectable which will affect the breastmilk produced. (Indonesia)
This injectable (Depo Provera) does not contain estrogen and thus can be used during breastfeeding. A small amount of progestin will be secreted in the breastmilk. However, progestin will not cause any adverse effect on the health and development of the baby. It will not affect the amount and quality of breastmilk produced and will not shorten the duration of lactation. But as a matter of precaution, as the liver function of a neonate is not yet mature enough to metabolize the drug, progestin-containing injectables should not be started until six weeks after delivery. (Hong Kong)
If your baby is skinny that is not due to the injectables but has to do with other problems. Injectables do not decrease breastmilk. (Cambodia)
If your baby is skinny that is not due to the injectable. Your quality and quantity of breastmilk depends on what you eat and drink, and how often you breastfeed your baby. (Indonesia)
Breastfeeding is important to help your baby’s growth and health. The injectable is safe for your breastmilk production. (Indonesia)
Myth: Cancer
Many women do not want to use injectable contraceptives because they incorrectly believe that injectables cause cancer.
Many studies show that DMPA injectables do not cause cancer. DMPA use helps protect against cancer of the lining of the uterus (endometrial cancer). Findings of the few studies on DMPA use and breast cancer are similar to findings with combined oral contraceptives: Women using DMPA were slightly more likely to be diagnosed with breast cancer while using DMPA or within 10 years after they stopped. It is unclear whether these findings are explained by earlier detection of existing breast cancers among DMPA users or by a biologic effect of DMPA on breast cancer.
A few studies on DMPA use and cervical cancer suggest that there may be a slightly increased risk of cervical cancer among women using DMPA for five years or more. Cervical cancer cannot develop because of DMPA alone, however. It is caused by persistent infection with certain strains of the human papillomavirus.
Little information is available about NET-EN injectables. It is expected to be as safe as DMPA and other contraceptive methods containing only a progestin, such as progestin-only pills and implants.
There is limited evidence about the long-term health risks and benefits of monthly injectables, but researchers expect that they are similar to combined oral contraceptives. Combined oral contraceptives help protect against endometrial cancer and cancer of the ovary.
Counseling Messages:
The injectable does not cause cancer; it reduces the incidence of ovarian and endometrial cancer. (Bangladesh)
Injectables do not cause cancer, but rather lower your risk for some types of cancer [such as ovarian and endometrial cancer]. (South Africa)
Injectables do not cause cancer, but rather prevent some types of cancer from occurring. Yes, people were worried and there were rumors, but they have been scientifically disproved. (Solomon Islands)
Thousands of women use injectables without getting cancer. Cancer attacks anyone-- not necessarily clients on injectables. (South Africa)
Injectables do not cause cancer to women except where they have a cancer trace in their body. In fact it could help prevent women from having uterine tumors and [endometrial] cancer. (Indonesia)
Some cancers could be triggered by the hormones, but the injectables, which contain only the progestin, could protect women from ovarian and endometrial cancer. (Indonesia)
Injectables do not actually cause any cancer but may result in faster detection of tumors. It is important that women are examined regularly to detect any abnormalities. Breast cancer is a hormonally sensitive tumor, and the prognosis of women with current or recent breast cancer may worsen [with the use of hormonal contraceptive methods]. However, while awaiting treatment for endometrial cancer, ovarian cancer, and cervical cancer, women may use injectables. (South Africa)
Myth: Infertility
Some women who seek family planning incorrectly believe that injectables cause women to be unable to have children in the future.
Fertility returns after women stop using injectables, but there is a delay. The average time it takes for fertility to return depends on the type of injectables.
Women who stop using DMPA injectables wait about four months longer on average to become pregnant than women who stop using other methods. The average time between the last DMPA injection and conception is about 10 months. Women who stop using NET-EN injectables have to wait about one month longer on average to become pregnant than women who stop using other methods, or six months after their last injection, on average.
Women who stop using combined monthly injectables wait about five months after their last injection to become pregnant, on average.
Counseling Messages:
For some women the return of fertility may be delayed [about one to four months, compared with women who stop using other methods]. You have to wait until ovulation occurs when the level of hormone in the body drops. (Indonesia)
When you stop your injection it can take some time for your period to return to normal. This may temporarily interfere with your fertility but in the long term it has no effect. (Ireland)
Injectables do not cause infertility but can cause a delay in conception due to the delayed return of normal function of the ovaries and uterus. (Malaysia)
This is only temporary. The ovaries ‘sleep’ and rest during injection taking. They start functioning again soon after you stop taking injections. (South Africa)
Injectables do not have a negative effect on your ovaries. (Mongolia)
There is no relation between injectables and infertility. (Mongolia)
There can be a delay in the return of periods and a delay in getting pregnant when you stop the injections, from women who get pregnant right away to those who take up to two years. However, studies have shown that there is no long-term infertility after taking injectables. There are some women who can’t get pregnant easily so if they had used injectables they might think that was the reason, but studies show that they are no different from the women who did not use injectables. The delay in periods returning and fertility is much the same after one injection as it would be after several injections. (New Zealand)
Contraceptive methods can only cause temporary infertility for women and there are many reasons which can make women infertile. (Indonesia)
There are many women who do not use injectables who also have problems getting pregnant. (Solomon Islands)
Although it can take up to one to four months longer for your fertility to return, compared with women who stop using other methods, there is no long-term impact on your fertility. Also, there are many things that impact your fertility in you AND your partner. There are things you can do to protect your fertility: practice safe sex to protect yourself from sexually transmitted infections, minimize or cease use of tobacco, alcohol, and illegal drugs, and have regular health checks. (Australia)
There are many women who don’t use injectables who also have problems getting
pregnant. For example, the situation can be caused by infections if treatment is delayed or no treatment is provided. (Malaysia)
Failure to conceive or have children is not a result of any family planning injectables, but due to other causes of infertility like sexually transmitted infections. (Malawi)
The problem could also be due to the husband, so both must undergo investigations and treatment. (Malaysia)
There are many rumors that infertility is caused by injectables. The infertility is actually caused by many reasons such as lack of husband sperm, infection, and other conditions that cause infertility. (Indonesia)
The dosage in these injectables is so low that it is easy to get pregnant if you desire to do so. Just stop taking it and know when you are ovulating or when the egg is coming down and encourage your spouse to have sex with you and you could become pregnant. (Trinidad and Tobago)
It can take some time for your periods to return to normal. This may temporarily interfere with your fertility but in the long term it has no effect. (Solomon Islands)
Infertility is caused by a number of things, including infection [but not by injectable contraceptives]. If you can, it is good to use condoms as well as hormonal contraception until you are in a long-term relationship, and have no concerns about the possibility of infection. (Australia)
Infertility can be caused by infection if not treated. (Solomon Islands)
Infertility can be caused by many things, including infection, but definitely not by the injectables/contraceptives. (Nigeria)
Infertility is cause by many reasons, such as infections, lack of husband’s sperm, etc. (Indonesia)
Injectable contraceptives are highly effective--about 99% [if used correctly and consistently]. However, most women who have the injectables have a tendency to experience a delay of [about one to four months, compared with women who stop using other methods],before returning to normal fertility, depending on individual differences or body make-up. (Nigeria)
Injectables are usually recommended for those women who have children, especially those who do not want any more or require longer spacing. So this slight delay in return of fertility may be more acceptable. There are new contraceptive methods, for example implants (Implanon), for which the return of fertility is almost immediate. (Malaysia)
Myth: Menstrual bleeding
Some women who seek family planning incorrectly believe that changes in menstrual bleeding, which are common side effects of injectable contraceptives, are harmful.                          
Some women using injectables experience amenorrhea, or no monthly bleeding. This is only a possible side effect and not a mechanism of action. When a woman is not using hormonal contraceptives, the endometrial lining (lining of the uterus) builds up every few weeks and then breaks down and causes menstrual bleeding. With injectables, the endometrial build-up does not occur so there is no breakdown or resulting bleeding. Blood does not collect in the body.
Women using injectables may also experience irregular bleeding, heavy bleeding, or prolonged bleeding. These bleeding changes are not harmful and usually become less or stop after the first few months of use. Women experiencing heavy or prolonged bleeding may want to increase their iron intake to prevent anemia.
The bleeding pattern a woman had before she used injectables generally returns several months after the last injection.
Counseling Messages:
Menstrual change, like no monthly bleeding, spotting, and irregular bleeding, is not harmful for women's health. Rather, it is beneficial because it protects against anemia. (Bangladesh)
The doctor who first prescribed this for you would have explained that you may have some irregular bleeding with this method of contraception. It is important to remember that the longer that you use this method, the less bleeding you will get, until you don't have any at all. This is normal because of the way this hormone works—it does not build up the lining of your uterus. In some casesthe lining may be non-existent. It is this lining which is shed as a period. (Trinidad and Tobago)
There is no or minimal blood made by the womb because of the injection. This is not dangerous. If you are bleeding, it is temporary, and it will stop as soon as the body gets used to the injection. (South Africa)
You don’t need to worry about using an injectable method because the hormone contained in the injectable could change the endometrial layer, or the inner layer of the womb, and it will cause menstrual change like no monthly bleeding, spotting, and irregular bleeding. This change is not harmful for women's health. (Indonesia)
When you use the injection, the lining of the womb does not form each month so there is nothing to come away—there is not a build up of the lining. (New Zealand)
There is nothing to fear and soon after the method is discontinued the cycle will return to a normal pattern. (Bahamas)
Amenorrhea [no monthly bleeding] does not mean accumulation of dirty blood in the uterus. (Malawi)
Many women believe that menstrual blood is 'bad blood' and has to leave the body every month. Menstrual blood is actually like putting sheets on a bed for a welcome visitor. The visitor doesn't come and the sheets are taken off the bed, not because they are soiled or dirty, but to put them away. The bed is the uterus, the sheets are the lining of the uterus, and the visitor is the fertilized ovum. (Solomon Islands)
Note: The medical reviewer was not able to state that this message is medically accurate because it is a metaphor. Many people liked this message, however, so it remains in the database.
Amenorrhea [no monthly bleeding] does not mean that the old menstrual blood collects in your womb or any other part of your body. (South Africa)
The effect of the injectable could make the endometrial layer [lining of the uterus] not grow, that’s why women often have do not have monthly bleeding. (Indonesia)
Amenorrhea [no monthly bleeding] does not mean the accumulation of any blood (dirty or clean) in the uterus. (Trinidad and Tobago)
There is nothing to fear, once you discontinue taking the injections your periods should return to normal within a year. (Trinidad and Tobago)
You don’t need to worry using an injectable method, because the hormone which is contained in the injectable could make the endometrial layer or the inner layer of the womb change, and it will make your menstruation’s pattern also change. Your menstrual cycle will return to its normal pattern when you stop using it. (Indonesia)
Irregular menses is just one of the reactions of the body to the hormones. If the bleeding problems persist to be too heavy, the method may not be suited for you and we may shift to another method. Soon after the method is discontinued the cycle will return to a normal pattern. (Philippines)
The cells on the inner wall of the womb are not formed in women who use the injectable contraception. For some women, after a few months the menstruation will be normal. You do not need to try some herbal medicine. (Indonesia)
The lining of your uterus (endometrium) does not grow and that is the main reason for the changes to your bleeding. (Australia)
The injectable will stop ovulation as long as you are using it, and it also could make your cycle pattern change through the effect of hormone, which influences the layer of the womb. (Indonesia)
Myth: Sexual Desire and Sexual Pleasure
Some women who seek family planning believe incorrectly that injectables affect a woman’s sexual desire.
There is no evidence that progestin-only injectables or monthly injectables affect women’s sexual behavior. Some women using injectables report these complaints, but
the great majority of women using injectables do not report any such changes. It is difficult to tell whether such changes are due to injectables or to other reasons.
Counseling Messages:
Some women may experience less interest in sex while using injectables, but it is not necessarily related to the injections. Sometimes this may be due to changes in your relationship with your partner. It may be helpful for you to examine how you and your partner are getting along. Have there been other changes besides your unwillingness to have sex with your partner? How do you and your partner relate to each other? (Trinidad and Tobago)
Your libido may be affected by hormones, but it has no impact on the pleasure you experience or the feelings you have. Sexual desire involves many other aspects in a relationship. Maybe you need to look at aspects of your relationship and health, and if all of those things are positive, you may want to consider trying a change of method, to see if it makes a difference. (Australia)
Some women may find a decrease in sex drive while using injectables, but injectables are not necessarily the cause. You can keep and increase your sexual drive through other means such as erotic foreplay with your spouse. If this does not work, you might consider trying to change the method. (Indonesia)
The injectable will not directly disturb your sexual activity. Since you will be free from getting pregnant, you can express your sexual desire anytime and enjoy your sex life without fear of conception. (Indonesia)
You or your spouse can increase your sexual enjoyment because there is no need to worry about pregnancy. (Indonesia)
A few women will experience loss of libido on the injection and a few women report vaginal dryness. For the vaginal dryness, extra lubrication or estrogen cream can be used to help this. (New Zealand)
Myth: Who Can Use the Method
Many women incorrectly believe that only women of a certain age or with a certain number of children can use injectables.
Injectables are suitable for women of any age, regardless of whether they have had children or not. If a woman using injectables wishes to become pregnant, she can stop receiving injections and her fertility will return in a few months.
There is one potential concern for adolescents because DMPA use decreases bone density. Among adolescents, it is not clear whether the loss in bone density prevents them from reaching their potential peak bone mass. If available, combined injectables may be a more suitable option for women under 18 years of age.
Research has not found that DMPA users of any age are likely to have more broken bones, however. When DMPA use stops, bone density increases again for women of reproductive age. Among adults who stop using DMPA, after two to three years their bone density appears to be similar to that of women who have not used DMPA. No data are available on NET-EN and bone loss, but the effect is expected to be similar to that of DMPA.
Like other hormonal methods, injectables can mask the symptoms and signs of menopause and make it difficult to diagnose because a common side effect is not having monthly bleeding. Menopause usually occurs between the ages of 45 and 55.
To determine whether she has reached menopause, she can change to a nonhormonal contraceptive method. She no longer needs contraception once she has had no bleeding for 12 months in a row.
Counseling Messages:
Any woman regardless of age or number of children can use injectables, but be aware that there is a delay in fertility that is one to four months longer than for women who stop using other methods, so take this into consideration if you are planning to get pregnant soon. (Jordan)
Research has shown that injectables are safe for all healthy women. (The Gambia)
In the past we believed that women had to stop taking hormones after a certain age. However, new research shows that with a low dosage of hormones in the injections women can now continue to use them right into menopause, if there are no side effects during injectable use.(Indonesia)
The injection can be used at any age from after the first period until menopause. We do caution young womenabout the unproven possibility of not achieving peak bone mass on the injection and we do suggest for women in their 40s that there are other very effective contraceptive methods with less hormone such as the progestin-only pill. (New Zealand)
The criterion for one to be on injectables is that one has to have reached menarche [that is, experienced her first menstrual period]. It is not that one has to have a certain number of children. (Malawi)
You can use the injectable as long as there are no side effects, and it is beneficial to have an annual gynecology check to make sure that you are healthy. (Indonesia)
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