Management of Missed Depo-Provera Injection
If you are less than 2 weeks late for your Depo-Provera injection (less than 15 weeks since your last injection), proceed with the injection immediately—no backup contraception or emergency contraception is needed. 1, 2
Timing-Based Management Algorithm
Less Than 2 Weeks Late (< 15 weeks total)
- Receive your injection as soon as possible 1, 2
- No backup contraception required 1, 2
- No emergency contraception needed 1
- Continue with your regular 12-week (every 3 months) injection schedule 1
2 Weeks or More Late (≥ 15 weeks total)
- Treat this as a new start of contraception 1, 2
- Receive the injection, but you must use backup contraception (condoms, abstinence) for 7 consecutive days after the injection 1, 2
- Consider emergency contraception if you had unprotected intercourse in the past 5 days, particularly if intercourse occurred recently 1
- The copper IUD is the most effective emergency contraception option, and ulipristal acetate (Ella) may be more effective than levonorgestrel formulations after 72 hours 3
Critical Clinical Considerations
Before Administering the Late Injection
- Rule out pregnancy if you are ≥ 2 weeks late—ensure reasonable certainty that you are not pregnant 4, 5
- Check for unexplained vaginal bleeding, which is a contraindication to DMPA 4
- Verify no contraindications exist: known pregnancy, liver disease, or unexplained vaginal bleeding 4
Understanding the Grace Period
The CDC guidelines provide a 2-week grace period (total of 15 weeks from last injection) because medroxyprogesterone acetate remains detectable in serum and maintains contraceptive efficacy during this window. 1, 6 After 15 weeks total, serum MPA levels may fall below the threshold needed to reliably prevent ovulation, necessitating backup contraception. 6
Common Pitfalls to Avoid
- Do not assume you are protected if you are ≥ 2 weeks late—pregnancy risk increases significantly, and 19% of adolescent discontinuers became pregnant in one study 7
- Do not skip backup contraception if you are ≥ 2 weeks late, even if you receive the injection immediately—you need 7 full days of backup 1
- Do not forget about emergency contraception—if you had recent unprotected intercourse and are late for your injection, emergency contraception should be strongly considered 1
Return to Fertility Considerations
If you are considering discontinuing Depo-Provera, understand that return to fertility is delayed—most women who wish to conceive after stopping DMPA become pregnant within 18 months after their last injection, regardless of how long they used the method. 5 MPA can be detected in serum for up to 9 months after a single 150 mg injection in some women. 6