Switching from Depo-Provera to Seasonale
Start Seasonale immediately when the next Depo-Provera injection is due (at 13 weeks from the last injection) and use backup contraception for 7 days. 1
Timing of Initiation
Initiate Seasonale at 13 weeks from the last Depo-Provera injection, which is when the next injection would normally be due. 1
You can start up to 15 weeks after the last Depo injection without additional pregnancy risk during the transition, as DMPA maintains contraceptive efficacy during this 2-week grace period. 1
If more than 15 weeks have elapsed since the last Depo injection, you must verify the patient is not pregnant before starting Seasonale using a pregnancy test. 1
Do not wait for menstrual bleeding to return before initiating Seasonale—many Depo users are amenorrheic, and waiting for menses is unnecessary and increases pregnancy risk. 2, 1
Backup Contraception Requirements
Require 7 days of backup contraception (condoms or abstinence) after starting Seasonale, regardless of timing in the cycle. 2, 1
This 7-day backup period is necessary because combined oral contraceptives need time to suppress ovulation when started outside the first 5 days of menses. 2
Do not assume continuous contraceptive coverage without backup—even though DMPA provides coverage up to 15 weeks, the 7-day backup period is still mandatory when initiating any combined hormonal contraceptive. 1
Medical Eligibility Screening
Before prescribing Seasonale, verify the patient has no contraindications to estrogen-containing contraceptives, including: 1
- History of venous thromboembolism
- Migraine with aura
- Uncontrolled hypertension
- Smoking in women over age 35
- Other conditions classified as U.S. MEC 3 or 4 for combined hormonal contraceptives
Patient Counseling Points
Inform patients about return to fertility differences: Seasonale provides immediate reversibility once stopped, whereas Depo-Provera can delay return to fertility for 9-18 months after discontinuation. 1
Discuss menstrual pattern changes: Patients switching from Depo (which often causes amenorrhea) to Seasonale will experience different bleeding patterns, with Seasonale designed to provide only 4 menstrual periods per year. 3
Address weight concerns: Weight gain is common with Depo-Provera; patients may experience stabilization or weight loss after switching to combined oral contraceptives. 3, 4
Common Pitfalls to Avoid
Do not delay the switch waiting for a menstrual period—this is the most common error and increases unintended pregnancy risk in amenorrheic Depo users. 1
Do not forget the 7-day backup rule—even though there is contraceptive overlap from the Depo injection, combined hormonal contraceptives still require this safety period. 1
Do not assume all patients can use estrogen—always screen for contraindications before switching from progestin-only to combined hormonal contraception. 1