Hormones Involved in Pregnancy Testing

Pregnancy testing relies on the detection of specific hormones in the body. One such hormone is human chorionic gonadotropin (hCG), which is secreted by the syncytiotrophoblast of a developing embryo after implantation in the uterus. The unique subunit of hCG, β, is targeted by antibodies in blood and urine tests, allowing for early detection of pregnancy. Luteinising hormone (LH) and follicle-stimulating hormone (FSH) also play important roles in female reproductive function, but are not measured in over-the-counter pregnancy tests. Progesterone, while important in pregnancy, is not specific to it and therefore not useful in diagnosis. The hCG subunit α is shared with other hormones and is not specific to pregnancy testing.

Anatomy of the Pelvis: Palpable Bones and Structures

The pelvis is a complex structure composed of several bones and joints. In this scenario, a doctor is examining a patient and can feel a specific bone. Let’s explore the different bones and structures of the pelvis and determine which one the doctor may be palpating.

Pubis:
The pubis is one of the three bones that make up the os coxa, along with the ilium and ischium. It is the most anterior of the three and extends medially and anteriorly, meeting with the opposite pubis to form the pubic symphysis. Given the position of the doctor’s hand, it is likely that they are feeling the pubic symphysis and adjacent pubic bones.

Coccyx:
The coccyx is the lowest part of the vertebral column and is located inferior to the sacrum. It is composed of 3-5 fused vertebrae and is a posterior structure, making it unlikely to be palpable in this scenario.

Ilium:
The ilium is the most superior of the three bones that make up the os coxa. It is a lateral bone and would not be near the position of the doctor’s palm in this scenario.

Sacrum:
The sacrum is part of the vertebral column and forms the posterior aspect of the pelvis. It is formed by the fusion of five vertebrae and articulates with the iliac bones via the sacroiliac joints bilaterally. Although it is found in the midline, it is a posterior structure and would not be palpable.

Ischium:
The ischium forms the posteroinferior part of the os coxa. Due to its position, it is not palpable in this scenario.

In conclusion, the doctor is most likely palpating the pubic symphysis and adjacent pubic bones during the examination. Understanding the anatomy of the pelvis and its structures is important for medical professionals to accurately diagnose and treat patients.

The addition of a progesterone to HRT raises the likelihood of developing breast cancer, making this the accurate response.

Adverse Effects of Hormone Replacement Therapy

Hormone replacement therapy (HRT) is a treatment that involves the use of a small dose of oestrogen, often combined with a progesterone in women with a uterus, to alleviate menopausal symptoms. While it can be effective in reducing symptoms such as hot flashes and vaginal dryness, HRT can also have adverse effects and potential complications.

Some common side-effects of HRT include nausea, breast tenderness, fluid retention, and weight gain. However, there are also more serious potential complications associated with HRT. For example, the use of HRT has been linked to an increased risk of breast cancer, particularly when a progesterone is added. The Women’s Health Initiative study found a relative risk of 1.26 at 5 years of developing breast cancer with HRT use. The risk of breast cancer is also related to the duration of use, and it begins to decline when HRT is stopped.

Another potential complication of HRT is an increased risk of endometrial cancer. Oestrogen by itself should not be given as HRT to women with a womb, as this can increase the risk of endometrial cancer. The addition of a progesterone can reduce this risk, but it is not eliminated completely. The British National Formulary states that the additional risk is eliminated if a progesterone is given continuously.

HRT has also been associated with an increased risk of venous thromboembolism (VTE), particularly when a progesterone is added. However, transdermal HRT does not appear to increase the risk of VTE. Women who are at high risk for VTE should be referred to haematology before starting any treatment, even transdermal, according to the National Institute for Health and Care Excellence (NICE).

Finally, HRT has been linked to an increased risk of stroke and ischaemic heart disease if taken more than 10 years after menopause. It is important for women considering HRT to discuss the potential risks and benefits with their healthcare provider and make an informed decision based on their individual circumstances.

Smoking doubles the risk of cervical cancer in women compared to non-smokers. Other risk factors include increased parity, use of oral contraceptives, early first intercourse, and HPV vaccination does not eliminate the need for cervical screening.

Understanding Cervical Cancer: Risk Factors and Mechanism of HPV

Cervical cancer is a type of cancer that affects the cervix, which is the lower part of the uterus. It is most commonly diagnosed in women under the age of 45, with the highest incidence rates occurring in those aged 25-29. The cancer can be divided into two types: squamous cell cancer and adenocarcinoma. Symptoms may include abnormal vaginal bleeding, postcoital bleeding, intermenstrual bleeding, or postmenopausal bleeding, as well as vaginal discharge.

The most important factor in the development of cervical cancer is the human papillomavirus (HPV), particularly serotypes 16, 18, and 33. Other risk factors include smoking, human immunodeficiency virus, early first intercourse, many sexual partners, high parity, and lower socioeconomic status. While the association between combined oral contraceptive pill use and cervical cancer is sometimes debated, a large study published in the Lancet confirmed the link.

The mechanism by which HPV causes cervical cancer involves the production of oncogenes E6 and E7 by HPV 16 and 18, respectively. E6 inhibits the p53 tumour suppressor gene, while E7 inhibits the RB suppressor gene. Understanding the risk factors and mechanism of HPV in the development of cervical cancer is crucial for prevention and early detection. Regular cervical cancer screening is recommended for all women.

Common Genital Skin Conditions: Symptoms and Treatment Options

Lichen sclerosus, candidiasis, contact dermatitis, lichen planus, and psoriasis are some of the most common skin conditions that affect the genital area. Each condition has its own set of symptoms and treatment options.

Lichen Sclerosus: This chronic inflammatory condition can affect any part of the body but is most commonly found in the genital area. It presents with pruritus, skin irritation, hypopigmentation, and atrophy. Treatment involves topical steroids and good hygiene.

Candidiasis: This fungal infection is associated with pruritus, burning sensation, erythema, and oedema of the vestibule. The most common characteristic is a thick, curd-like, white vaginal discharge.

Contact Dermatitis: This condition is often caused by changes to shower gel or washing detergent. It presents with pruritus, erythematosus skin, excoriations, and skin breaks, leading to ulceration and superimposed infection. Chronic contact dermatitis can lead to lichenoid changes.

Lichen Planus: This condition presents with purple, red plaques usually on the labia, with central erosion and overlying lacy, white, striated patch. It can cause scarring and narrowing of the introitus and dyspareunia.

Psoriasis: This condition is rare in the genital area but can appear in the inguinal creases and the labia majora. It presents with erythematous plaques with minimal white scale and is associated with itching and excoriations.

It is important to seek medical attention if you suspect you have any of these conditions. Treatment options may include topical or oral medications, good hygiene practices, and lifestyle changes.

Starting hormonal contraception immediately after using levonorgestrel emergency contraceptive pill is safe. However, if ulipristal was used, hormonal contraception should be started or restarted after 5 days, and barrier methods should be used during this time. Waiting for 7 or 30 days before starting hormonal contraception is unnecessary as levonorgestrel does not affect its efficacy. A pregnancy test is only recommended if the patient’s next period is more than 5-7 days late or lighter than usual, not routinely after taking levonorgestrel.

Emergency contraception is available in the UK through two methods: emergency hormonal contraception and intrauterine device (IUD). Emergency hormonal contraception includes two types of pills: levonorgestrel and ulipristal. Levonorgestrel works by stopping ovulation and inhibiting implantation, while ulipristal primarily inhibits ovulation. Levonorgestrel should be taken as soon as possible after unprotected sexual intercourse, within 72 hours, and is 84% effective when used within this time frame. The dose should be doubled for those with a BMI over 26 or weight over 70kg. Ulipristal should be taken within 120 hours of intercourse and may reduce the effectiveness of hormonal contraception. The most effective method of emergency contraception is the copper IUD, which can be inserted within 5 days of unprotected intercourse or up to 5 days after the likely ovulation date. It may inhibit fertilization or implantation and is 99% effective regardless of where it is used in the cycle. Prophylactic antibiotics may be given if the patient is at high risk of sexually transmitted infection.

Understanding Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a condition that affects women during the luteal phase of their menstrual cycle. It is characterized by emotional and physical symptoms that can range from mild to severe. PMS only occurs in women who have ovulatory menstrual cycles and does not occur before puberty, during pregnancy, or after menopause.

Emotional symptoms of PMS include anxiety, stress, fatigue, and mood swings. Physical symptoms may include bloating and breast pain. The severity of symptoms varies from woman to woman, and management options depend on the severity of symptoms.

Mild symptoms can be managed with lifestyle advice, such as getting enough sleep, exercising regularly, and avoiding smoking and alcohol. Specific advice includes eating regular, frequent, small, balanced meals that are rich in complex carbohydrates.

Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP), such as Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg). Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI), which can be taken continuously or just during the luteal phase of the menstrual cycle (for example, days 15-28, depending on the length of the cycle). Understanding PMS and its management options can help women better cope with this common condition.

The development of atypical hyperplasia of the endometrium is caused by excessive stimulation of the endometrium by oestrogen, and it is classified as a premalignant condition. Hormone production is increased in sex cord stromal tumours such as Thecomas, Fibromas, Sertoli cell and granulosa cell tumours, which are associated with this condition.

Endometrial hyperplasia is a condition where the endometrium, the lining of the uterus, grows excessively beyond what is considered normal during the menstrual cycle. This abnormal proliferation can lead to endometrial cancer in some cases. There are four types of endometrial hyperplasia: simple, complex, simple atypical, and complex atypical. Symptoms of this condition include abnormal vaginal bleeding, such as intermenstrual bleeding.

The management of endometrial hyperplasia depends on the type and severity of the condition. For simple endometrial hyperplasia without atypia, high dose progestogens may be prescribed, and repeat sampling is recommended after 3-4 months. The levonorgestrel intra-uterine system may also be used. However, if atypia is present, hysterectomy is usually advised.

Anorexia as a Cause of Secondary Amenorrhoea

This young woman is experiencing secondary amenorrhoea, which is the absence of menstrual periods for at least three months after previously having regular cycles. Her low BMI and weight loss suggest that anorexia is the most likely cause of her amenorrhoea. Anorexia is an eating disorder characterized by a distorted body image and an intense fear of gaining weight, leading to severe calorie restriction and weight loss.

In this case, the anorexia has likely caused a hypogonadotropic hypogonadism, which is a condition where the pituitary gland fails to produce enough hormones to stimulate the ovaries to produce estrogen. This hormonal imbalance can lead to a range of symptoms, including amenorrhoea, infertility, and osteoporosis.

It is important to address the underlying cause of secondary amenorrhoea, as it can have long-term health consequences. Treatment for anorexia may involve a combination of therapy, nutritional counseling, and medication. Once the underlying cause is addressed, menstrual cycles may resume, but it may take several months for regular cycles to return.

Understanding Vaginal Discharge: Common Causes and Key Features

Vaginal discharge is a common symptom experienced by many women, but it is not always a sign of a pathological condition. There are various causes of vaginal discharge, including physiological factors and infections. Some of the common causes of vaginal discharge include Candida, Trichomonas vaginalis, and bacterial vaginosis. However, less common causes such as gonorrhea, chlamydia, ectropion, foreign body, and cervical cancer can also lead to vaginal discharge.

It is important to note that the key features of each cause of vaginal discharge can vary. For instance, Candida infection may present with a discharge that resembles cottage cheese, accompanied by vulvitis and itch. On the other hand, Trichomonas vaginalis infection may cause an offensive, yellow/green, frothy discharge, along with vulvovaginitis and a strawberry cervix. Bacterial vaginosis, another common cause of vaginal discharge, may present with an offensive, thin, white/grey, ‘fishy’ discharge.

Common Causes of Vaginal Discharge: Symptoms, Diagnosis, and Treatment

Vaginal discharge is a common symptom experienced by women, and it can be caused by various infections. Here are some of the most common causes of vaginal discharge, along with their symptoms, diagnosis, and treatment options.

Candidiasis: This infection is caused by Candida fungi, particularly Candida albicans. Symptoms include vaginal itch, thick discharge with a consistency similar to cottage cheese, vaginal discomfort, and pain during sexual intercourse. Diagnosis is usually clinical, and treatment includes good hygiene, emollients, loose-fitting underwear, and antifungal cream or pessary, or oral antifungal medication.

Trichomoniasis: This infection is caused by the parasite Trichomonas vaginalis. Symptoms include dysuria, itch, and yellow-green discharge that can have a strong odor. Up to 50% of infected individuals are asymptomatic.

Bacterial vaginosis: This infection is caused by an overgrowth of anaerobes in the vagina, most commonly Gardnerella vaginalis. Symptoms include a thin, white discharge, vaginal pH >4.5, and clue cells seen on microscopy. Treatment of choice is oral metronidazole.

Streptococcal infection: Streptococcal vulvovaginitis presents with inflammation, itch, and a strong-smelling vaginal discharge. It is most commonly seen in pre-pubertal girls.

Chlamydia: Although Chlamydia infection can present with urethral purulent discharge and dyspareunia, most infected individuals are asymptomatic. Chlamydia-associated discharge is typically more purulent and yellow-clear in appearance, rather than cheese-like.

In conclusion, proper diagnosis and treatment of vaginal discharge depend on identifying the underlying cause. It is important to seek medical attention if you experience any symptoms of vaginal discharge.

When choosing a contraceptive method, individual preferences and any cautions or contraindications must be taken into account. In this case, the priority is to find a method that won’t be affected by carbamazepine’s enzyme-inducing effect, such as the intrauterine system. While the combined oral contraceptive pill (COCP) could help with heavy bleeding, its failure rate would be high due to enzyme induction. Nexplanon may cause heavy bleeding and its low progesterone dose would also be affected by enzyme induction. Depo-Provera is an option, but prolonged use in young individuals could lead to reduced bone density. The Mirena intrauterine system would be effective in reducing heavy bleeding and providing reliable contraception alongside the anti-epileptic medication.

Contraception for Women with Epilepsy

Women with epilepsy need to consider several factors when choosing a contraceptive method. Firstly, they need to consider how the contraceptive may affect the effectiveness of their anti-epileptic medication. Secondly, they need to consider how their anti-epileptic medication may affect the effectiveness of the contraceptive. Lastly, they need to consider the potential teratogenic effects of their anti-epileptic medication if they become pregnant.

To address these concerns, the Faculty of Sexual & Reproductive Healthcare (FSRH) recommends that women with epilepsy consistently use condoms in addition to other forms of contraception. For women taking certain anti-epileptic medications such as phenytoin, carbamazepine, barbiturates, primidone, topiramate, and oxcarbazepine, the FSRH recommends the use of the COCP and POP as UKMEC 3, the implant as UKMEC 2, and the Depo-Provera, IUD, and IUS as UKMEC 1.

For women taking lamotrigine, the FSRH recommends the use of the COCP as UKMEC 3 and the POP, implant, Depo-Provera, IUD, and IUS as UKMEC 1. If a COCP is chosen, it should contain a minimum of 30 µg of ethinylestradiol. By considering these recommendations, women with epilepsy can make informed decisions about their contraceptive options and ensure the safety and effectiveness of their chosen method.

Understanding Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is a potential complication that can occur during infertility treatment. This condition is believed to be caused by the presence of multiple luteinized cysts in the ovaries, which can lead to high levels of hormones and vasoactive substances. As a result, the permeability of the membranes increases, leading to fluid loss from the intravascular compartment.

OHSS is more commonly seen following gonadotropin or hCG treatment, and it is rare with Clomiphene therapy. Approximately one-third of women undergoing in vitro fertilization (IVF) may experience a mild form of OHSS. The Royal College of Obstetricians and Gynaecologists (RCOG) has classified OHSS into four categories: mild, moderate, severe, and critical.

Symptoms of OHSS can range from abdominal pain and bloating to more severe symptoms such as thromboembolism and acute respiratory distress syndrome. It is important to monitor patients closely during infertility treatment to detect any signs of OHSS and manage the condition appropriately. By understanding OHSS and its potential risks, healthcare providers can work to minimize the occurrence of this complication and ensure the safety of their patients.

Pelvic floor muscle training is the most effective and cost-efficient treatment for stress urinary incontinence in women. Ring pessaries can also be used as a non-surgical option for pelvic organ prolapse. Oxybutynin is typically used for urge incontinence, but in this scenario, the woman only experiences stress incontinence. While a referral to urogynaecology may be considered for further investigation or surgery, it is not necessary to do so urgently. Pelvic floor exercises should be attempted for at least 3 months under the guidance of a continence adviser, specialist nurse, or women’s health physiotherapist. As the woman’s symptoms persist despite 6 months of trying this approach, it would be inappropriate to suggest continuing with the same strategy.

Understanding Urinary Incontinence: Causes, Classification, and Management

Urinary incontinence (UI) is a common condition that affects around 4-5% of the population, with elderly females being more susceptible. Several risk factors contribute to UI, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. UI can be classified into different types, such as overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.

Initial investigation of UI involves completing bladder diaries for at least three days, vaginal examination, urine dipstick and culture, and urodynamic studies. Management of UI depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures such as retropubic mid-urethral tape procedures may be offered. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be used as an alternative to surgery.

In summary, understanding the causes, classification, and management of UI is crucial in providing appropriate care for patients. Early diagnosis and intervention can significantly improve the quality of life for those affected by this condition.

Differential Diagnosis for Severe Iliac Fossa Pain in Reproductive-Age Women

Severe, sudden-onset pain in the right or left iliac fossa is a common symptom of ectopic pregnancy in reproductive-age women. This pain may be accompanied by vaginal bleeding, shoulder tip pain, syncopal episodes, and shock. To rule out pregnancy, a urinary beta human chorionic gonadotrophin hormone (b-HCG) test should be performed, followed by a transvaginal ultrasound scan to confirm the diagnosis.

Ovarian torsion may also cause iliac fossa pain, but it is unlikely to cause referred shoulder pain. Appendicitis is not a consideration in this scenario, as the patient does not have an appendix. Irritable bowel syndrome and inflammatory bowel disease are also unlikely diagnoses, as the patient’s tachycardia and right iliac fossa tenderness and guarding are not consistent with these conditions. Overall, a thorough evaluation is necessary to differentiate between these potential causes of severe iliac fossa pain in reproductive-age women.

If a patient’s cervical cancer screening sample is positive for high-risk HPV and shows cytological abnormalities, the next step according to guidelines is to refer the patient for a colposcopy. During this procedure, the cervix is closely examined to identify any disease. If significant abnormalities are found, loop excision of the transformation zone may be necessary. It is not appropriate to return the patient to normal recall without further investigation. Repeating the sample in 3 months is not necessary for a patient with high-risk HPV and requires specialist assessment. However, repeating the sample in 3 months may be considered if the initial sample was inadequate. Similarly, repeating the sample in 12 months is not the next step and may only be recommended after colposcopy. At this stage, the patient needs further assessment. Repeating the sample in 12 months may be considered if the patient has high-risk HPV with normal cytological findings.

The cervical cancer screening program has evolved to include HPV testing, which allows for further risk stratification. A negative hrHPV result means a return to normal recall, while a positive result requires cytological examination. Abnormal cytology results lead to colposcopy, while normal cytology results require a repeat test at 12 months. Inadequate samples require a repeat within 3 months, and two consecutive inadequate samples lead to colposcopy. Treatment for CIN typically involves LLETZ or cryotherapy. Individuals who have been treated for CIN should be invited for a test of cure repeat cervical sample 6 months after treatment.

Ultrasound imaging may reveal a whirlpool sign in cases of ovarian torsion, which is strongly indicated by the patient’s history and examination. The beads-on-a-string sign is typically associated with chronic salpingitis, while hypoechoic masses are often indicative of fibroids. A snow-storm appearance is a characteristic finding in complete hydatidiform mole.

Understanding Ovarian Torsion

Ovarian torsion is a medical condition that occurs when the ovary twists on its supporting ligaments, leading to a compromised blood supply. This condition can be partial or complete and may also affect the fallopian tube, which is then referred to as adnexal torsion. Women who have an ovarian mass, are of reproductive age, pregnant, or have ovarian hyperstimulation syndrome are at a higher risk of developing ovarian torsion.

The most common symptom of ovarian torsion is sudden, severe abdominal pain that is colicky in nature. Patients may also experience vomiting, distress, and in some cases, fever. Upon examination, adnexal tenderness may be detected, and an ultrasound may show free fluid or a whirlpool sign. Laparoscopy is usually both diagnostic and therapeutic for this condition.

Medical treatment can be attempted for uterine fibroids that are smaller than 3 cm and not causing distortion in the uterine cavity. The most suitable option for this scenario would be the combined oral contraceptive pill (COCP). Other medical management options include the intrauterine system, oral progesterone, and gonadotropin-releasing hormone agonists like goserelin. Hysterectomy would not be recommended for patients who wish to have children in the future. Hysteroscopic resection of fibroids is not necessary for fibroids that are smaller than 3 cm and do not cause distortion in the uterine cavity. Myomectomy should only be considered after trying out medical therapies like COCP, tranexamic acid, and levonorgestrel intrauterine system. It may be a suitable treatment for larger fibroids.

Understanding Uterine Fibroids

Uterine fibroids are non-cancerous growths that develop in the uterus. They are more common in black women and are thought to occur in around 20% of white women in their later reproductive years. Fibroids are usually asymptomatic, but they can cause menorrhagia, which can lead to iron-deficiency anaemia. Other symptoms include lower abdominal pain, bloating, and urinary symptoms. Fibroids may also cause subfertility.

Diagnosis is usually made through transvaginal ultrasound. Asymptomatic fibroids do not require treatment, but periodic monitoring is recommended. Menorrhagia secondary to fibroids can be managed with various treatments, including the levonorgestrel intrauterine system, NSAIDs, tranexamic acid, and hormonal therapies.

Medical treatment to shrink or remove fibroids may include GnRH agonists or ulipristal acetate, although the latter is not currently recommended due to concerns about liver toxicity. Surgical options include myomectomy, hysteroscopic endometrial ablation, hysterectomy, and uterine artery embolization.

Fibroids generally regress after menopause, but complications such as subfertility and iron-deficiency anaemia can occur. Red degeneration, which is haemorrhage into the tumour, is a common complication during pregnancy.

When experiencing atrophic vaginitis, the dryness of the vaginal mucosa can cause pain, itching, and dyspareunia. The first-line treatment for this condition is topical oestrogen cream, which helps to restore the vaginal mucosa. However, lubricants and moisturisers can also provide short-term relief while waiting for the topical oestrogen cream to take effect. Oestrogen secreting pessaries are an alternative to topical oestrogen cream, but using them together would result in an excessive dose of oestrogen. Sitz baths are useful for irritation and itching of the perineum, but they do not address internal vaginal symptoms. Warm or cold compresses may provide temporary relief, but they are not a long-term solution.

Atrophic vaginitis is a condition that commonly affects women who have gone through menopause. Its symptoms include vaginal dryness, pain during sexual intercourse, and occasional spotting. Upon examination, the vagina may appear dry and pale. The recommended treatment for this condition is the use of vaginal lubricants and moisturizers. If these do not provide relief, a topical estrogen cream may be prescribed.

The method of contraception that is commonly linked to weight gain is injectable contraception, which includes Depo-Provera. The combined oral contraceptive pill has been associated with an increased risk of venous thromboembolic disease, breast cancer, and cervical cancer, but there is no evidence to suggest that it causes weight gain. Implantable contraceptives like Implanon are typically associated with irregular or heavy bleeding, but not weight gain. Intrauterine devices, such as the copper coil, are known to cause heavier and more painful periods, but they are not associated with weight gain.

Injectable Contraceptives: Depo Provera

Injectable contraceptives are a popular form of birth control in the UK, with Depo Provera being the main option available. This contraceptive contains 150 mg of medroxyprogesterone acetate and is administered via intramuscular injection every 12 weeks. It can be given up to 14 weeks after the last dose without the need for extra precautions. The primary method of action is by inhibiting ovulation, while secondary effects include cervical mucous thickening and endometrial thinning.

However, there are some disadvantages to using Depo Provera. Once the injection is given, it cannot be reversed, and there may be a delayed return to fertility of up to 12 months. Adverse effects may include irregular bleeding and weight gain, and there is a potential increased risk of osteoporosis. It should only be used in adolescents if no other method of contraception is suitable.

It is important to note that there are contraindications to using Depo Provera, such as current breast cancer (UKMEC 4) or past breast cancer (UKMEC 3). While Noristerat is another injectable contraceptive licensed in the UK, it is rarely used in clinical practice and is given every 8 weeks. Overall, injectable contraceptives can be an effective form of birth control, but it is important to weigh the potential risks and benefits before deciding on this method.