From the Guidelines
To transition from Depo-Provera to oral contraceptive pills, start the pill within 15 weeks (105 days) of your last Depo-Provera injection, even if you haven't had a period yet, as this timing ensures continuous contraceptive coverage since Depo-Provera's effectiveness typically lasts 12-14 weeks 1. When switching from Depo-Provera to oral contraceptive pills, it's essential to consider the type of pill and the timing of the switch.
- Choose either a combined oral contraceptive (containing estrogen and progestin) or a progestin-only pill based on your health needs and preferences.
- For combined pills, begin on the first day of your period or use the "Quick Start" method by taking the first pill immediately with backup contraception for 7 days, as recommended by the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1.
- For progestin-only pills, take them at the same time every day without breaks between packs, using backup contraception for the first 48 hours, as suggested by the same guidelines 1. Be aware that after stopping Depo-Provera, your fertility may take 6-12 months to return, and you might experience irregular bleeding patterns during the transition. If you miss a pill, follow the specific instructions for your pill type, and contact your healthcare provider if you have concerns about side effects or need guidance on the most appropriate oral contraceptive for your situation, as outlined in the provision of contraception: key recommendations from the CDC 1.
From the FDA Drug Label
If switching directly from another oral contraceptive, the first white tablet should be taken on the first day of menstruation which begins after the last ACTIVE tablet of the previous product.
The patient should start taking the oral contraceptive pill on the first day of menstruation after stopping Depo-Provera, which is an injectable contraceptive.
- Key consideration: The first day of menstruation after stopping Depo-Provera may be delayed due to the injectable contraceptive's effects on the menstrual cycle.
- Clinical decision: The patient should use a backup method of birth control if she has intercourse in the 7 days after starting the oral contraceptive pill 2.
From the Research
Changing from Depo Provera to Oral Contraceptive Pill
- The decision to switch from Depo Provera to an oral contraceptive pill (OCP) may be influenced by various factors, including the desire for a different contraceptive method or the need to manage side effects 3, 4.
- Extended-cycle OCPs, which involve taking active pills for 84 days followed by 7 days of placebo or a low-dose estrogen pill, have been shown to be effective in preventing pregnancy and may offer benefits such as reduced menstrual bleeding 3, 4.
- The pharmacokinetics and pharmacodynamics of ethinyl estradiol, a common estrogen component in OCPs, have been studied extensively, and newer formulations with lower doses of ethinyl estradiol have been developed to reduce the risk of venous thromboembolism and other adverse effects 5.
- However, the risk of pseudotumor cerebri syndrome, a rare but potentially serious condition, may be associated with certain types of hormonal contraceptives, including the etonogestrel/ethinyl estradiol vaginal ring and medroxyprogesterone suspension 6.
- Additionally, some progestin-based contraceptives, such as levonorgestrel and drospirenone, may be associated with an increased risk of sexual dysfunction in women of child-bearing age 7.
Considerations for Switching to an Oral Contraceptive Pill
- Women considering switching from Depo Provera to an OCP should discuss their individual needs and medical history with their healthcare provider to determine the best contraceptive option for them 3, 4.
- The choice of OCP formulation, including the type and dose of estrogen and progestin, may depend on various factors, such as the woman's age, medical history, and personal preferences 5.
- Regular monitoring and follow-up with a healthcare provider are essential to ensure the safe and effective use of any contraceptive method, including OCPs 6, 7.