delayed or late progestogen only injectable contraceptive
Last edited 08/2019
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:
- Prescriber (2001);12 (5): 83-95.
- Guillebaud J. Contraception: your questions answered. 3 rd edition. London: Churchill Livingston, 1999
- FSRH (April 2019). Progestogen-only Injectable Contraception