What backup birth control options are available if a Depo (medroxyprogesterone acetate) shot is missed?

Backup Birth Control After Missed Depo-Provera Injection

If you are less than 2 weeks late for your Depo-Provera injection (less than 15 weeks since your last shot), you can receive the injection without needing any backup contraception. 1, 2

Timing-Based Recommendations

If Less Than 2 Weeks Late (< 15 weeks since last injection)

• Proceed with the injection immediately 1, 2
• No backup contraception is needed 1, 2
• You remain protected against pregnancy 1

If 2 Weeks or More Late (≥ 15 weeks since last injection)

• You can still receive the injection if reasonably certain you are not pregnant 1
• Use backup contraception (condoms or abstinence) for 7 consecutive days after the injection 1
• Consider emergency contraception if you had unprotected intercourse in the previous 5 days 1

Backup Contraception Options

When backup contraception is needed, the following methods are recommended:

Barrier Methods

• Condoms are the preferred backup method because they provide dual protection against both pregnancy and sexually transmitted infections 1
• Condoms should be used consistently for the full 7-day period after a late injection 1

Abstinence

• Complete abstinence from sexual intercourse for 7 days after the injection is an alternative to barrier methods 1

Emergency Contraception

• Consider emergency contraception if unprotected intercourse occurred within 5 days before receiving a late injection 1
• Ulipristal (Ella) may be more effective than levonorgestrel, especially after 72 hours and in women who are overweight or obese 1
• Copper IUD insertion within 5 days is the most effective emergency contraception option 1

Critical Timing Considerations

The CDC guidelines establish clear thresholds based on pharmacokinetic data showing that DMPA maintains contraceptive effectiveness for up to 14 weeks after injection 2. After this window:

• Ovulation can resume when MPA levels fall below 0.1 ng/mL, which typically occurs several months after injection but can vary between individuals 3
• The 7-day backup period allows sufficient time for the new injection to re-establish contraceptive levels 1

Common Pitfalls to Avoid

• Do not assume you need backup contraception if you are within the 15-week window - this creates unnecessary barriers to effective contraception 1, 2
• Do not delay receiving a late injection - you can receive it at any time if reasonably certain you're not pregnant, though backup contraception will be needed 1
• Do not forget that Depo-Provera provides no STI protection - condoms should be used consistently regardless of injection timing for STI prevention 1, 2

Pregnancy Testing Considerations

If uncertain whether you might be pregnant when presenting for a late injection:

• The benefits of starting DMPA likely exceed any risk 1
• Proceed with the injection and arrange follow-up pregnancy testing in 2-4 weeks 1
• Use backup contraception for 7 days after the injection 1

Alternative Long-Acting Options

If you frequently miss injection appointments, consider discussing alternative contraceptive methods with your provider:

• IUDs or contraceptive implants (Nexplanon) provide longer-acting protection without requiring regular appointments 1
• These methods have higher continuation rates than injectable contraception 1
• Switching from Depo-Provera to Nexplanon can be done immediately if within 14 weeks of last injection, with no gap in coverage 4