Contraception Guidelines

Initiating Depo-Provera

When starting Depo-Provera, backup contraception is required for 7 days unless the injection is given within the first 5 days of the menstrual cycle or within 2 weeks of the previous injection if late for a repeat dose, as recommended by the Centers for Disease Control and Prevention (CDC) and the American Academy of Family Physicians 1, 2

Postpartum women who are breastfeeding and less than 6 months postpartum, amenorrheic, and fully/nearly fully breastfeeding (≥85% of feeds) do not require backup contraception, according to the CDC guidelines 1
Postpartum women who are not breastfeeding should use backup contraception for 7 days unless Depo-Provera is started within 7 days of delivery, as recommended by the CDC 1
Women who receive Depo-Provera within 7 days of abortion or at the time of surgical abortion do not require backup contraception, according to the CDC guidelines 1

If a woman is late for a repeat injection, the following guidelines apply:
If the patient is postpartum and exclusively breastfeeding (≥85% of feedings are breastfeeding), she does not need additional protection if she is within the first 6 months postpartum and amenorrheic, according to the CDC 1
If the patient is switching from another contraceptive method to DMPA, she can receive the injection immediately, but may need additional protection for 7 days if more than 7 days have passed since the start of her menstrual bleeding, as recommended by the CDC 1

It is essential to educate the patient on the importance of maintaining the injection schedule, as recommended by the CDC and the American Academy of Family Physicians 1, 2
The patient should be scheduled for her next appointment before leaving the clinic, and consider text message or phone call reminders to ensure adherence to the schedule, as recommended by the American Academy of Family Physicians and the CDC 1, 2