Provenance
Written by SPS and the College of Sexual and Reproductive Health (CoSRH), with the support of specialist stakeholders working within clinical practice, for use within reproductive services.
Templates available
Version 3.0 of this PGD template, valid from May 2026, has been published to allow organisations to undertake local governance processes in a timely manner. The planned valid from date has been brought forward from 1st August 2026 to align with the valid period of the SC DMPA template.
Version 2.3 of this PGD template remains currently valid and will be removed from this page on its expiry (31st July 2026).
PGD template attachment
The template PGD is attached below to download and use in conjunction with our implementation advice (SPS page).
More reproductive health PGD templates
- Combined hormonal contraceptive vaginal ring
- Medroxyprogesterone acetate (SC-DMPA) injection for contraception
- Combined hormonal contraceptive transdermal patch
- Combined oral hormonal contraceptive (COC) in reproductive health
- Lidocaine injection for subdermal etonogestrel in contraception
- Etonogestrel (e.g. Nexplanon®) implant for contraception
- Progestogen-Only Intra-Uterine Device (LNG-IUD) for contraception
- Copper Intrauterine Device (Cu-IUD)
- Lidocaine plus prilocaine cream for IUD insertion or removal
- Lidocaine 10mg/ml spray for IUD insertion or removal
- Ulipristal acetate 30mg tablets for emergency contraception
- Progestogen only pill (POP) for contraception
- Levonorgestrel 1500 microgram tablets for emergency contraception
All PGD templates
National PGD, protocol and written instructions templates
National templates are developed with experts for clinical specialties. They reduce duplication and variation, and improve consistency of care.
Update history
- New Version 3.0 published
- Planned review detail added
- Information added regarding name change of FSRH to CoSRH
- Updated version 2.3 added. Updated contraindications and cautions in line with Sayana Press® SPC. Reworded to align with the PGD for administration of DMPA via the subcutaneous route.
- Updated PGD template published - statement added regarding a suggested link between the prolonged use of medroxyprogesterone acetate and a small increased risk of intracranial meningioma in line with FSRH statement. Added exclusion of meningioma as per SPC.
- Version 2.1 published - minor updates to reflect updated FSRH guidance
- V1 removed as expiring 31/7/23
- Title, URL and summary amended.
- New V2.0 template added
- Published