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Contraceptive Pearl: Can you Quickstart with Depo?

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.

 

Helpful Resources

Algorithm for Quickstart

Birth Control Choices handout

Emergency Contraception handout

 

Do you have a contraception management question you’d like us to answer? Send it to pearls@reproductiveaccess.org. If we use your question in a Pearl, we will send you a copy of the latest edition of Managing Contraception.

We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.

 

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.