What is the recommended wait time to switch from Depo-Provera (medroxyprogesterone) to Nexplanon (etonogestrel)?

Switching from Depo-Provera to Nexplanon: Timing Recommendations

Nexplanon can be inserted immediately at any time when switching from Depo-Provera with no waiting period required, as long as it is reasonably certain the woman is not pregnant. 1

Timing Guidelines for Switching

• When switching from Depo-Provera to Nexplanon, the implant can be inserted immediately regardless of when the last Depo-Provera injection was given 1
• If the Nexplanon is inserted within 14 weeks (the effective period) of the last Depo-Provera injection, no additional contraceptive protection is needed 1, 2
• If more than 14 weeks have passed since the last Depo-Provera injection, Nexplanon can still be inserted, but additional contraceptive protection (barrier method) or abstinence will be needed for 7 days after insertion 1

Specific Scenarios Based on Timing

Within Effective Period of Depo-Provera

• If switching within 14 weeks of the last Depo-Provera injection (when Depo is still effective), Nexplanon can be inserted immediately with no gap in contraceptive coverage 1, 2
• No backup contraception is needed in this scenario as the woman is still protected by Depo-Provera 1

After Effective Period of Depo-Provera

• If more than 14 weeks have passed since the last Depo-Provera injection, Nexplanon can still be inserted if it's reasonably certain the woman is not pregnant 1
• In this case, additional contraceptive protection is needed for 7 days after Nexplanon insertion 1

Important Considerations

• Depo-Provera has a prolonged effect on fertility - MPA can be detected in serum for up to 9 months after a single injection, and return to fertility is often delayed 3
• Nexplanon begins releasing etonogestrel immediately after insertion, but takes approximately 7 days to establish contraceptive effectiveness if inserted outside the first 5 days of the menstrual cycle 1
• Both methods work primarily by suppressing ovulation, but the transition between methods should account for the different pharmacokinetics 4, 3

Common Pitfalls to Avoid

• Waiting unnecessarily between discontinuing Depo-Provera and inserting Nexplanon increases the risk of unintended pregnancy 5
• Failing to use backup contraception when needed (if >14 weeks since last Depo-Provera injection) 1
• Not considering that Depo-Provera may delay return to fertility for several months even after its contraceptive effect has waned 3

Algorithm for Switching

1. Determine timing of last Depo-Provera injection
2. If ≤14 weeks since last injection: Insert Nexplanon immediately with no backup method needed 1, 2
3. If >14 weeks since last injection:
   • Confirm reasonable certainty that woman is not pregnant 1
   • Insert Nexplanon immediately 1
   • Use backup contraception or abstain from intercourse for 7 days 1

This approach ensures continuous contraceptive coverage while transitioning between these two highly effective methods 1, 5.