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Delayed or late progestogen only injectable contraceptive

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Advice in relation to late progestogen-only contraceptive injections (1,2,3)

Timing of injection

Has UPSI occurred?

Is there a risk of pregnancy?

Can EC be offered?

Can the injection be given?

Is additional contraception required?

Is a pregnancy test required?

Up to 14 weeks since last DMPA injection

Yes

No

NA

Yes

No

No

Up to 10 weeks since last NETEN injection

Yes

No

NA

Yes

No

No

14 weeks + 1 day or more since last IM or SC DMPA injection OR

10 weeks + 1 day or more since last NETEN injection

No (no sex or used barrier method)

No

NA

Yes

Yes (7 days after injection)

No

14 weeks + 1 day or more since last IM or SC DMPA injection OR

10 weeks + 1 day or more since last NETEN injection

Yes, but only in the last 5 days (sex that occurs up to Week 14 or Week 10 is protected)

Yes

Yes. Consider Cu-IUD or LNG EC. The effectiveness of UPA EC could theoretically be reduced by residual circulating progestogen (a)

Yes* (if bridging method not acceptable).(a)

* After LNG EC injection can be given immediately. After UPA EC, delay injection for 5 days (a)

Yes(until 7 days after injection)

Yes>=3 weeks since last episode of UPSI

14 weeks + 1 day or more since last IM or SC DMPA injection OR

10 weeks + 1 day or more since last NETEN injection

Yes - multiple episodes <5 days ago and >5 days ago

Yes

Yes. The effectiveness of UPA EC could theoretically be reduced by residual circulating progestogen (a)

Yes* (if bridging method not acceptable).(a)

* After LNG EC injection can be given immediately. After UPA EC, delay injection for 5 days (a)

Yes (until 7 days after injection)

Yes, prior to administering the injection and >=3 weeks since last episode of UPSI

14 weeks + 1 day or more since last IM or SC DMPA injection OR

10 weeks + 1 day or more since last NETEN injection

Yes - multiple episodes >5 days ago and <=3 weeks ago

Yes

No

Yes (if bridging method not acceptable).

Yes (until 7 days after injection)

Yes, prior to administering the injection and >=3 weeks since last episode of UPSI

14 weeks + 1 day or more since last IM or SC DMPA injection OR

10 weeks + 1 day or more since last NETEN injection

Yes - multiple episodes >3 weeks ago

Yes

No

Perform a pregnancy test and if negative administer injectable

Yes (until 7 days after injection)

Yes, prior to administering the injection

(a) See FSRH guidance on Emergency Contraception

CHC, combined hormonal contraception; Cu-IUD, copper intrauterine device; DMPA, depot medroxyprogesterone acetate; EC, emergency contraception; IM, intramuscular; LNG, levonorgestrel; NA, not applicable; NET-EN, norethisterone enantate; POP; progestogen-only pill; SC, subcutaneous; UPA, ulipristal acetate; UPSI, unprotected sexual intercourse.

 

The summary of product characteristics must be consulted before prescribing any of the drugs described.

Reference:

  1. Prescriber (2001);12 (5): 83-95.
  2. Guillebaud J. Contraception: your questions answered. 3 rd edition. London: Churchill Livingston, 1999
  3. FSRH (April 2019). Progestogen-only Injectable Contraception

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