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Summary of indications for emergency contraception following late progestogen-only injectable injections
Timing of injection | Has unprotected sex occurred? | Can the injection be given? | Is emergency contraception indicated? (a) | Is additional contraception or abstinence advised? | Should a pregnancy test be performed? |
| Not applicable, as long as next injection is given 14 weeks since last IM DMPA injection or 10 weeks since last NET-EN injection or before | YES | NO | NO | NO |
When an injection is overdue, e.g.
| NO (abstained or used barrier methods) | YES | NO | YES, for the next 7 days | NO, if abstained YES, if used barrier methods but at least 21 days later |
When an injection is overdue, e.g.
| YES, but only in the last 3 days (b) | YES | YES, should offer progestogen-only EC or a copper IUD | YES, for the next 7 days | YES, at least 21 days later |
When an injection is overdue, e.g.
| YES, but only in the last 4-5 days (b) | YES | YES, should offer a copper IUD | NO, if opts for copper IUD | YES, at least 21 days later |
When an injection is overdue, e.g.
| YES, more than 5 days ago (b) | NO | NO | YES, for 21 days until a pregnancy test is confirmed negative and for a further 7 days after giving progestogen-only injectable | YES, at the initial presentation and at least 21 days later |
(a) If EC is refused, decisions about ongoing use of DMPA should be tailored to the individual woman. Alternative methods if required should then be considered
(b) Not applicable if unprotected sex occurred within 14 weeks of last DMPA injection or 10 weeks of last NET-EN injection. DMPA, depot medroxyprogesterone acetate; EC, emergency contraception; IM, intramuscular; IUD, intrauterine device; NET-EN, norethisterone enantate.
Ulipristal acetate (UPA) has the potential to reduce the efficacy of hormonal contraception. For women using the progestogen-only injectable, additional precautions are advised for 14 days after taking UPA for emergency contraception (outside product licence) (2)
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