Can a Patient Take Depot Shot and Emergency Contraceptive Ella Together?
Yes, a patient can take both depot medroxyprogesterone acetate (Depo-Provera) and ulipristal acetate (Ella), but the timing and sequence matter significantly for maintaining contraceptive effectiveness.
Key Timing Considerations
If Ella is Needed After Depo-Provera
- If the depot shot is late (≥2 weeks): Emergency contraception with Ella should be considered if unprotected intercourse occurred, and the patient should receive the depot injection as soon as possible 1.
- If the depot shot is on time (< 2 weeks late): No emergency contraception is typically needed, as contraceptive protection remains intact 1.
If Starting Depo-Provera After Using Ella
This is the critical scenario that requires careful management:
- Wait 14 days after taking Ella before starting depot medroxyprogesterone acetate 1.
- During these 14 days, the patient must use barrier contraception or abstain from intercourse 1.
- This extended waiting period (compared to 7 days for other hormonal methods) is necessary because ulipristal acetate is a progesterone receptor modulator that may theoretically reduce the effectiveness of progestin-based contraceptives like Depo-Provera 1.
Why Ella May Be Preferred Over Levonorgestrel
- Ulipristal acetate is more effective than levonorgestrel when taken 72-120 hours after unprotected intercourse 1, 2, 3.
- Ella maintains effectiveness throughout the full 5-day window, with a 42% lower pregnancy risk compared to levonorgestrel within 72 hours, and 65% lower risk in the first 24 hours 3.
- For women who are overweight or obese (BMI >25 kg/m² or weight >75 kg), ulipristal acetate is preferable to levonorgestrel, which may have reduced efficacy in this population 1, 4.
Mechanism and Safety
- Ulipristal acetate works by delaying or inhibiting ovulation, even when administered just before ovulation when levonorgestrel is no longer effective 2, 5.
- Both medications are safe to use together when properly timed, with no direct drug interactions that compromise safety 1.
- The tolerability profile of Ella is similar to levonorgestrel, with menstrual onset typically delayed by 2-3 days 2.
Common Pitfall to Avoid
The most critical error is starting Depo-Provera too soon after Ella use. Starting the depot shot within 14 days of taking ulipristal acetate may compromise contraceptive effectiveness due to the progesterone receptor modulator effects of Ella 1. Always counsel patients to use backup contraception during this waiting period.