From the Guidelines
You can start Depo-Provera (medroxyprogesterone acetate) injections immediately after taking your last active oral contraceptive pill, with no gap needed between methods, as long as the provider is reasonably certain that the patient is not pregnant. This is based on the most recent guidelines from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1.
Key Considerations
- The provider should be reasonably certain that the patient is not pregnant before starting Depo-Provera.
- If started more than 7 days after the last menstrual period, the patient should abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days.
- No examination or test is needed before initiation of Depo-Provera, according to the guidelines 1.
Transitioning from Oral Contraceptives
- Simply schedule your first Depo-Provera injection within 7 days of taking your last active pill to ensure continuous contraceptive coverage without requiring backup contraception.
- If you're switching from combination OCPs, the estrogen and progestin in your pills will continue providing protection while the Depo-Provera begins working.
- Depo-Provera is a progestin-only injectable contraceptive given as a 150 mg intramuscular injection every 12-13 weeks (3 months).
Backup Contraception
- If you delay starting Depo-Provera beyond 7 days after your last active pill, you should use backup contraception (like condoms) for 7 days after the injection.
- This recommendation ensures you maintain contraceptive protection during the transition between methods, as Depo-Provera takes approximately 7 days to become fully effective when not started during your menstrual period, as indicated in the guidelines 1.
From the FDA Drug Label
To ensure the patient is not pregnant at the time of the first injection, the first injection MUST be given ONLY during the first 5 days of a normal menstrual period; The FDA drug label does not answer the question.
From the Research
Switching from Oral Contraceptive Pills to Depo-Provera
To switch from oral contraceptive pills (OCPs) to Depo-Provera (medroxyprogesterone acetate), it is essential to consider the timing and potential interactions between the two methods.
- The studies 2, 3, 4, 5, 6 do not provide specific guidance on when to start Depo-Provera after taking OCPs.
- However, it is generally recommended to start Depo-Provera when the next menstrual period is due, or within 5 days of taking the last active OCP pill 3.
- Women should be aware that switching from OCPs to Depo-Provera may cause changes in menstrual bleeding patterns, which can be a common side effect of progestin-only contraceptives 4.
- Clinicians should provide adequate counseling and information to women considering switching from OCPs to Depo-Provera, including potential effects on weight, mood, and bone mineral density 3.
Important Considerations
- Depo-Provera is a highly effective, long-acting contraceptive method that can be used by most women in most circumstances 4.
- The effectiveness of Depo-Provera is not affected by the timing of the switch from OCPs, but women should be aware of the potential for delayed return of fertility after stopping Depo-Provera 4.
- Women with premenstrual dysphoric disorder (PMDD) should be cautious when switching to Depo-Provera, as progestin-only methods may negatively affect mood symptoms 5.