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Emergency contraception following late depot progesterone contraception

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Summary of indications for emergency contraception following late progestogen-only injectable injections

Timing of injection

Has unprotected sex occurred?

Can the injection be given?

Is emergency contraception indicated? (a)

Is additional contraception or abstinence advised?

Should a pregnancy test be performed?

  • Up to 14 weeks since last IM DMPA injection
  • Up to 10 weeks since last NET-EN injection

Not applicable, as long as next injection is given 14 weeks since last IM DMPA injection or 10 weeks since last NET-EN injection or before

YES

NO

NO

NO

When an injection is overdue, e.g.

  • 14 weeks +1 day or more since last IM DMPA injection
  • 10 weeks +1 day or more since last NET-EN injection

NO (abstained or used barrier methods)

YES

NO

YES, for the next 7 days

NO, if abstained YES, if used barrier methods but at least 21 days later

When an injection is overdue, e.g.

  • 14 weeks +1 day or more since last IM DMPA injection
  • 10 weeks +1 day or more since last NET-EN injection

YES, but only in the last 3 days (b)

YES

YES, should offer progestogen-only EC or a copper IUD

YES, for the next 7 days

YES, at least 21 days later

When an injection is overdue, e.g.

  • 14 weeks +1 day or more since last IM DMPA injection
  • 10 weeks +1 day or more since last NET-EN injection

YES, but only in the last 4-5 days (b)

YES

YES, should offer a copper IUD

NO, if opts for copper IUD

YES, at least 21 days later

When an injection is overdue, e.g.

  • 14 weeks +1 day or more since last IM DMPA injection
  • 10 weeks +1 day or more since last NET-EN injection

YES, more than 5 days ago (b)

NO

NO

YES, for 21 days until a pregnancy test is confirmed negative and for a further 7 days after giving progestogen-only injectable

YES, at the initial presentation and at least 21 days later

(a) If EC is refused, decisions about ongoing use of DMPA should be tailored to the individual woman. Alternative methods if required should then be considered

(b) Not applicable if unprotected sex occurred within 14 weeks of last DMPA injection or 10 weeks of last NET-EN injection. DMPA, depot medroxyprogesterone acetate; EC, emergency contraception; IM, intramuscular; IUD, intrauterine device; NET-EN, norethisterone enantate.

Ulipristal acetate (UPA) has the potential to reduce the efficacy of hormonal contraception. For women using the progestogen-only injectable, additional precautions are advised for 14 days after taking UPA for emergency contraception (outside product licence) (2)

Reference:


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