What is the procedure for switching a patient from Nexplanon (etonogestrel implant) to Depo (medroxyprogesterone acetate)?

Switching from Nexplanon to Depo-Provera

Remove the Nexplanon implant and administer the first Depo-Provera injection on the same day to ensure continuous contraceptive protection without requiring backup contraception. 1

Timing and Procedure

Same-day transition is the preferred approach:

• Schedule the Nexplanon removal and first DMPA injection for the same visit 1
• The patient maintains immediate contraceptive coverage without any gap in protection 1
• No backup contraception (condoms or abstinence) is needed when switching on the same day 1

Depo-Provera Administration Details

Dosing schedule:

• Administer 150 mg depot medroxyprogesterone acetate (DMPA) by deep intramuscular injection 2
• Repeat injections every 12 weeks (13 weeks) 1
• The injection can be given up to 2 weeks late (15 weeks from last injection) without requiring additional contraceptive protection 1

If the patient presents more than 2 weeks late for reinjection:

• Treat as a new start 1
• Use backup contraception for 7 consecutive days 1
• Consider emergency contraception if recent unprotected intercourse occurred 1

Critical Pre-Switch Counseling

Discuss expected changes in bleeding patterns:

• Approximately 22% of Nexplanon users experience amenorrhea, while DMPA users have variable bleeding patterns that often lead to amenorrhea over time 3, 2
• Menstrual disturbances with DMPA are common but rarely require medical intervention 2
• Enhanced counseling about bleeding changes reduces discontinuation rates 3

Address key differences between methods:

• DMPA requires returning every 12 weeks for injections, unlike the 3-year duration of Nexplanon 3, 2
• DMPA is temporarily irreversible during its 3-month duration, so side effects cannot be immediately stopped 2
• Weight gain is a more common concern with DMPA compared to Nexplanon 2
• DMPA has no appreciable effects on blood pressure or thrombosis risk 2

Common Pitfalls to Avoid

Do not create a gap in contraceptive coverage:

• Never remove Nexplanon without immediately starting DMPA on the same day unless the patient desires pregnancy or another method 1
• If same-day administration is not possible, provide backup contraception for 7 days after the DMPA injection 1

Ensure proper patient education:

• Provide accurate, easily understood information about DMPA, as the method has historically suffered from poor public image and misinformation 2
• Counsel patients to seek advice early for menstrual disturbances rather than waiting for their next appointment 2
• Short courses of estrogen or shorter injection intervals can improve menstrual disturbances if needed 2

Alternative: Self-Administered Subcutaneous DMPA

Consider offering self-administered DMPA-SC as an option:

• Self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception 1
• The same timing principles apply: remove Nexplanon and administer first DMPA-SC injection on the same day 1
• This option improves contraceptive access and increases reproductive autonomy 1
• Provide instruction on self-injection technique and sharps disposal 1