I have a patient interested in starting the Depo shot. She has been having unprotected sex recently, and there is a chance she may be pregnant. Can the Quickstart method be used to initiate Depo?
Dr. Geoffrey Pechinsky Cambridge, MA
Contraceptive Pearl Answer:
Neither levonorgestrel (One-Step, Next Choice™, Plan B™) nor Depo is teratogenic. If your patient gets pregnant despite EC, these hormones will cause no harm to the patient or the pregnancy. However, if she stops having periods and attributes this to the Depo, her pregnancy diagnosis may be delayed. Therefore, patients who begin Depo after taking EC should have a pregnancy test (either at home or in your office) in 2 to 4 weeks. They should also use a back-up birth control method for the first week on Depo.
What about using ulipristal (ella ®) for EC? Ulipristal has higher efficacy than levonorgestrel, especially when used 4-5 days after unprotected intercourse. But unlike levonorgestrel, ulipristal may lower the efficacy of hormonal contraceptives. We do not yet know how long this effect lasts. Patients who start Depo right after ulipristal should use a back-up contraceptive method for about two weeks.
Bottom line: Don’t wait for your patient’s next menses — give Depo today! Using Quickstart with Depo prevents pregnancies that can occur while waiting.
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