Switching from Depo-Provera to Seasonale

Timing of the Switch

• The Centers for Disease Control and Prevention recommends starting Seasonale immediately when the next Depo-Provera injection is due (at 13 weeks), and using backup contraception (condoms or abstinence) for 7 days after starting the combined oral contraceptive 1
• Initiate Seasonale at the time the next Depo injection would be due (13 weeks from the last injection), as this represents the standard reinjection interval for DMPA 2, 3, 4
• Seasonale can be started up to 2 weeks after the scheduled injection date (up to 15 weeks from the last injection) without additional pregnancy risk during the transition, as DMPA maintains contraceptive efficacy during this window 2, 3, 4
• If starting Seasonale more than 15 weeks after the last Depo injection, verify the patient is not pregnant before initiating the combined oral contraceptive 1

Backup Contraception Requirements

• The patient must use backup contraception (condoms or abstinence) for 7 days after starting Seasonale, regardless of when in the cycle she begins the pill 1
• This 7-day backup period is necessary because combined oral contraceptives require time to suppress ovulation when initiated outside the first 5 days of menses 1

Key Clinical Considerations

• Inform patients about return to fertility, as switching to Seasonale provides immediate reversibility once the combined oral contraceptive is stopped, whereas DMPA can delay return to fertility for 9-18 months after discontinuation 5, 6, 7

Common Pitfalls to Avoid

• Do not wait for a menstrual period to return before starting Seasonale, as many Depo-Provera users are amenorrheic, and waiting for menses is unnecessary and increases pregnancy risk 1
• Do not assume contraceptive coverage is continuous without backup, even though DMPA provides coverage up to 15 weeks, the 7-day backup period is still required when initiating any combined oral contraceptive 1
• Do not forget to verify the patient has no contraindications to estrogen-containing contraceptives, such as history of thromboembolism, migraine with aura, uncontrolled hypertension, or smoking over age 35 1