Understanding Combined Contraceptive Injections

A combined contraceptive injection is a monthly birth control shot that contains the combination of estrogen and progestin. Like Depo-Provera and the Noristerat shot, combined contraception injections are a type of hormonal birth control. Some of these injections include Cyclofem, Lunelle, and Mesigyna.

A patient getting a shot in the arm
 Ake Ngiamsanguan / Getty Images

When to Get Your Injection

Monthly combined contraceptive injections are very much like combination birth control pills. The estrogen and progestin hormones are injected into the muscle of your upper arm, thigh, or buttocks. After each shot, the hormone levels peak and then slowly decrease until the next injection.

In order to be effective, you must get a combined contraceptive injection every 28 to 30 days, and you cannot go past 33 days from the date of your last injection. When you get your shot within this timeframe, combined contraceptive injections have a failure rate of between less than 1 percent to 6 percent each year. This means that they are 94 percent to 99 percent effective at preventing pregnancy.

How the Injections Work

The hormones delivered by a combined contraceptive injection mainly work to prevent pregnancy for one month by:

  • preventing you from ovulating (releasing an egg).
  • thickening your cervical mucus which makes it harder for sperm to swim through.
  • thinning the lining of the uterus which makes it more difficult for implantation to take place.

It is also thought that monthly combined shots may provide additional non-contraceptive health benefits. If you get pregnant when on your combined contraceptive injection, this birth control shot will not hurt your baby.

It will also not cause your pregnancy to terminate. After stopping your combined contraceptive injection, there may be a delay in regaining fertility, meaning your ability to get pregnant. Your fertility, however, should return within a few months after your last injection.

Side Effects

Because they are so similar to other combination hormonal methods like the pill, the patch, and NuvaRing, combined contraceptive injections will typically have the same types of side effects. Monthly combined injections contain less progestin than Depo-Provera and Noristerat, which are progestin-only contraceptive shots.

If you use combination contraceptive shots, as compared to progestin-only injections, you:

  • are less likely to have spotting/irregular bleeding.
  • have a lower chance of amenorrhea (not having a period).
  • are more likely to have a regular bleeding pattern and less bleeding side effects.

Types of Injections

Lunelle was a monthly combined injection made up of pre-filled estradiol cypionate and medroxyprogesterone  syringes. It became available in the United States in 2000. The Lunelle syringes were voluntarily recalled in 2002 due to concern over potency and possible risk of contraceptive failure. In October 2003, Pfizer stopped making Lunelle, so it is no longer available in the United States.

A similar combined contraceptive injection is now sold under the name Cyclofem (also known as Lunelle, Cyclofemina, Feminena, Novafem, Lunella, and Cyclo-Provera). It is available mainly in Latin America, Africa, and Asia, but you cannot get it in the United States.

Mesigyna (also known as Norigynon, Mesigyna Instayect, Mesygest, and No 3 injectable Norigynon) is another type of combined contraceptive injection. It is made up of estradiol valerate and norethisterone enanthate. It just as effective as Cyclofem, but it is also not available in the United States. Mesigyna is primarily available in Latin America and Asia.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician. 2013;87(11):781-8.

  2. Drugs and Lactation Database (LactMed) [Internet]. Estradiol Cypionate. 2006-.  

  3. Dragoman MV, Gaffield ME. The safety of subcutaneously administered depot medroxyprogesterone acetate (104mg/0.65mL): A systematic review. Contraception. 2016;94(3):202-15. doi:10.1016/j.contraception.2016.02.003

Additional Reading

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.