Switching from Oral Birth Control to Depo-Provera
You can start Depo-Provera immediately while the patient is taking oral contraceptives without waiting for a menstrual period, and no backup contraception is needed if it has been ≤7 days since her last menstrual period started. 1
Timing of the Switch
Administer the first DMPA injection immediately when switching from oral contraceptives—waiting for the next menstrual period is unnecessary. 1
The optimal timing is to give the injection on the day after the last active oral contraceptive tablet, or at the latest, on the day following the final inactive tablet. 2
If you are reasonably certain the patient is not pregnant, you can start DMPA at any time during the oral contraceptive cycle. 1
Backup Contraception Requirements
The need for backup contraception depends on timing relative to menses:
No backup needed: If the injection is given within 7 days of menstrual bleeding starting. 1
Backup required for 7 days: If it has been >7 days since menstrual bleeding started, the patient must abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days after the injection. 1
If switching directly from active oral contraceptives (without a pill-free interval), consider this as continuous hormonal coverage and no backup is typically needed. 2
Clinical Approach When Pregnancy Status is Uncertain
In situations where you are uncertain whether the patient might be pregnant, the benefits of starting DMPA likely exceed any risk—therefore, start DMPA and perform a follow-up pregnancy test in 2-4 weeks. 1
Studies found that bridging options (using 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
Pre-Injection Requirements
No examination or laboratory tests are required before initiating DMPA. 1
You do not need to perform a pelvic exam, pregnancy test, or any other testing if you are reasonably certain the patient is not pregnant. 1
Practical Considerations for the Switch
Consider continuing the oral contraceptive for 7 days after DMPA injection if the patient needs to use additional contraceptive protection, rather than relying solely on barrier methods. 1
Prior oral contraceptive use before switching to Depo-Provera results in decreased duration of irregular bleeding during the first six months, which may improve patient satisfaction. 3
Counsel patients that DMPA is given every 3 months (13 weeks) and can be given up to 2 weeks late (15 weeks from last injection) without requiring additional contraceptive protection. 1
Common Pitfalls to Avoid
Do not delay the injection waiting for menses—this increases pregnancy risk and is medically unnecessary. 1
Do not require unnecessary testing such as pregnancy tests or pelvic exams in patients where you are reasonably certain pregnancy is not present, as this creates barriers to contraceptive access. 1
Do not forget to counsel about menstrual changes—most women experience menstrual irregularities initially, with 57% becoming amenorrheic by one year of use. 4, 5
Do not overlook bone density counseling—DMPA is not recommended for longer than 2 years unless other options are inadequate due to reversible bone mineral density loss. 2