Starting Depo Provera post-partum

Depo-Provera can be started within 5 days of childbirth or abortion. However if Depo-Provera is started so soon after childbirth then this may cause heavy bleeding and so waiting until 6 weeks post partum is thought to be better (1,2)

Note that current NICE guidance suggests that (3):

• provided that it is reasonably certain that the woman is not pregnant, the use of injectable contraceptives may be started:
  • up to and including the fifth day of the menstrual cycle without the need for additional contraceptive protection
  • at any other time in the menstrual cycle, but additional barrier contraception should be used for the first 7 days after the injection
  • immediately after first- or second-trimester abortion, or
  • at any time thereafter
  • at any time post-partum

Women who are breast feeding should wait until 6 weeks post partum before starting Depo Provera because medroxyprogesterone acetate and its metabolites are excreted in breast milk. At 6 weeks of age the infant's enzyme system should be more mature (1,2).

Reference:

• Prescriber 2001; 12 (5):83-95.
• Drug and Therapeutics Bulletin 1996;34 (12): 93-5.
• NICE (September 2014). Long-acting reversible contraception (update)