How to Give Sayana Press
Sayana Press (DMPA-SC 104 mg) should be administered as a subcutaneous injection into the anterior thigh, abdomen, or upper arm every 3 months (13 weeks), and can be given either by a healthcare provider or through self-administration after proper training. 1
Administration Sites and Technique
The injection can be administered at three approved sites:
- Anterior thigh (original FDA-approved site)
- Abdomen (original FDA-approved site)
- Upper arm (newer option with demonstrated safety and effectiveness) 2
Research shows the upper arm produces 42% higher drug exposure (AUC) and 24% higher peak concentrations compared to thigh/abdomen, though trough levels at 3 months remain similar across all sites, maintaining contraceptive effectiveness 2.
Dosing Schedule
- Standard interval: Every 3 months (13 weeks)
- Grace period: Can be given up to 2 weeks late (15 weeks from last injection) without requiring backup contraception 1
- Extended interval: Research demonstrates 100% contraceptive effectiveness when given every 4 months, though this remains off-label 3
Self-Administration vs. Provider Administration
Self-administration should be offered as an option alongside provider administration, based on CDC's 2021 adoption of WHO guidance 1. This approach:
- Improves contraceptive continuation rates
- Increases reproductive autonomy
- Maintains equivalent pregnancy rates, side effects, and adverse events compared to provider administration
Critical Implementation Elements for Self-Administration:
- Training: Provide instruction (in-person or via telemedicine) on proper injection technique
- Practice: Have patients demonstrate competence on prosthetics before home injection 4
- Resources: Supply instruction booklet and reinjection calendar
- Sharps disposal: Ensure proper disposal access
- Follow-up access: Maintain availability for questions or method switching
- Reinjection reminders: Implement reminder systems 1
Studies from Uganda show 88% of women demonstrated injection competence after training, with 95% reinjecting on time at 3 months 4.
Important Clinical Considerations
Note that self-administration is technically "off-label" since FDA labeling states DMPA-SC should only be administered by healthcare professionals, though providers may prescribe FDA-approved drugs for off-label use when medically indicated 1.
No routine follow-up is required, but patients should contact providers to:
- Discuss side effects or problems
- Request method change (including switching to provider administration)
- Address questions about reinjection 1
The same eligibility criteria from U.S. Medical Eligibility Criteria for Contraceptive Use apply to both DMPA-SC and intramuscular DMPA 1.
Shared Decision-Making
Self-administration must be offered through noncoercive shared decision-making that focuses on:
- Patient preferences
- Equitable access to full range of contraceptive methods
- User control and reproductive autonomy 1