**4.6 Disadvantages**

There are several limitations to the use of DMPA. The main disadvantage of this type of contraception is its ability to engender changes in the bleeding pattern of a woman's menstrual cycle, potentially limiting its uptake. Indeed, discontinuation of DMPA is reported to be 25–50% in the first year of use [89, 90]. Moreover, POIs do not provide protection against STIs such as chlamydia, gonorrhea, and HIV. The client has to return to the clinic for follow-up injections and, once given, their contraceptive action cannot be stopped until the time of the next injection. Furthermore, there is some delay in return of fertility which takes approximately 7–10 months from the date of the last injection [79, 82].

Counseling is highly recommended to ensure that the possible side-effects and risks of POIs, described below, are explained to clients, particularly the reasons behind any menstrual changes.
