Switching from Oral Contraceptive Pills to Depo-Provera
A patient can receive the Depo-Provera injection immediately when switching from OCPs without any waiting period, as long as it is reasonably certain she is not pregnant. 1
Timing of DMPA Injection
- The first DMPA injection can be given immediately when switching from another contraceptive method, including OCPs. 1
- Waiting for the next menstrual period is unnecessary. 1
- The key requirement is reasonable certainty that the woman is not pregnant (using standard pregnancy assessment criteria). 1
Need for Backup Contraception
The need for additional contraceptive protection depends on timing relative to menstrual bleeding:
If it has been ≤7 days since menstrual bleeding started: No additional contraceptive protection is needed. 1
If it has been >7 days since menstrual bleeding started: The woman needs to abstain from sexual intercourse or use additional contraceptive protection (e.g., condoms) for the next 7 days after the injection. 1
Mechanism and Rationale
- DMPA causes profound changes in cervical mucus within 24 hours of injection, with 90% of women showing poor cervical mucus scores by this time. 2
- However, DMPA injections given after day 7 of the menstrual cycle may not reliably inhibit ovulation in all women initially. 1
- The 7-day backup contraception recommendation accounts for this variability in ovulation suppression. 1
Practical Approach When Uncertainty Exists
- If the healthcare provider is uncertain whether the woman might be pregnant, the benefits of starting DMPA likely exceed any risk. 1
- In such cases, start DMPA and perform a follow-up pregnancy test in 2-4 weeks. 1
- Consider continuing the previous contraceptive method (OCPs) for 7 days after DMPA injection if additional contraceptive protection is needed. 1
Common Pitfall to Avoid
The most important pitfall is delaying DMPA initiation unnecessarily by requiring women to wait for their next menstrual period. Studies have shown that bridging options (requiring women to use another contraceptive method until DMPA could be initiated) did not help women initiate DMPA and was associated with more unintended pregnancies than immediate receipt of DMPA. 1