At my health center, if more than 13 weeks have passed since a patient’s most recent Depo injection, she is sent away and told to come back after her next period. Is there any reason for this clinical policy?
Family Physician, Community Health Center, New York, NY
Contraceptive Pearl Answer:
We are so glad you asked! Most clinicians suggest that patients return for their Depo injection every 12 weeks. Depo provides reliable contraception for 4 extra weeks — so for women whose last injection was less than 16 weeks ago, there is no need to require a pregnancy test or to delay today’s injection. Waiting for a patient’s next period would be counterproductive, as Depo-related amenorrhea can take many months to resolve, and your patient may be at risk for unintended pregnancy in the meantime.
If more than 16 weeks have passed since your patient’s last Depo injection, she should have a urine pregnancy test. If that test is negative, she may receive Depo the same day. She should get emergency contraception, too, if indicated.
There are no time restraints for early injections; injections should be provided early if convenient for the patient.
Your health center should update its protocol to remove barriers and enhance adherence to Depo.
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Centers for Disease Control and Prevention. U.S Selected Practice Recommendations for Contraceptive Use, 2013: Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition. June 21, 2013; 62(RR05): 1-46.
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