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Starting progestogen-only injectable contraception post other form of contraception

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Advice in relation to switching from other form of contraception to progestogen-only contraceptive injections (1,2,3)

Situation

Starting

Additional contraceptive protection required?

Additional information

Switching from combined hormonal contraception (CHC) (if taken correctly)

Day 1-2 of the hormone free interval (HFI)

No

Switching from CHC (if taken correctly)

Day 3-7 of HFI OR week 1 following the HFI

Yes (7 days). If unprotected sexual intercourse (UPSI) has occurred after Day 3 of the HFI, advise continuing the CHC method for at least 7 days

When switching after a 7-day HFI there are no data to confirm that suppression of ovulation is maintained

Switching from CHC (if taken correctly)

Week 2-3 of pill/ring/patch

No, providing the CHC method has been used consistently and correctly for 7 consecutive days before switchin

There is evidence to suggest that taking hormonally active pills for 7 consecutive days prevents ovulation. Therefore as long as there have been 7 days of CHC use, 7 hormone-free days can occur without any effect on contraceptive efficacy

Switching from traditional POP (if taken correctly) OR LNG-IUS

Any time

Yes (7 days) If UPSI in last 7 days, retain LNG IUS for 7 days after starting injectable

The continuing method provides contraceptive cover while the effects of the injectable are established

Switching from desogestrel POP (if taken correctly) OR progestogen-only implant (<=3 years since implant insertion)

Any time

No

>3 years since implant insertion

Any time

Yes (7 days)

If there has been a risk of pregnancy consider the need for emergency contraception (EC) and a pregnancy test (PT) no sooner than 3 weeks after the most recent incidence of UPSI

Switching from Cu-IUD

Day 1-5 of menstrual cycle

No

Switching from Cu-IUD

Any other time

Yes (7 days). If UPSI in last 7 days, retain Cu-IUD for 7 days

CHC, combined hormonal contraception; Cu-IUD, copper intrauterine device; EC, emergency contraception; HFI, hormone free interval; POP, progestogen-only pill; PT, pregnancy test; UPSI, unprotected sexual intercourse

Consideration of EC and a pregnancy test no sooner than 3 weeks after the most recent incidence of UPSI may be required if there has been a risk of pregnancy (3).

The summary of product characteristics must be consulted before prescribing any of the drugs described.

Reference:

  1. Prescriber (2001);12 (5): 83-95.
  2. Guillebaud J. Contraception: your questions answered. 3 rd edition. London: Churchill Livingston, 1999
  3. FSRH (April 2019). Progestogen-only Injectable Contraception

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