"Pearl" for the week of November 4, 2008

Injectable "Grace" Period

In our clinic, despite our best efforts to remind women using injectables that they should return for their next injection in 3 months, a substantial number return later than that. Also, once in a while we have stock-outs of contraceptives and do not always have injectables on hand. How late can we provide reinjections?

4 weeks for DMPA (Depo-Provera) and 2 weeks for NET-EN. W.H.O. recently extended the recommendation for DMPA from 2 weeks to 4 weeks. This recommendation was largely based on research conducted by FHI, that showed the probability of a woman becoming pregnant in the first 4 weeks following the initial 3 month period was extremely low.

And even if a woman is more than 4 weeks, she can still receive a reinjection if the provider can be reasonably sure she is not pregnant (for example if she has been using condoms consistently.)

(Of course this does not mean the regular DMPA injection interval can be extended to 4 months.)


References:

1. Steiner MJ, Kwok C, Stanback J et al. Injectable contraception: What should the longest interval be for reinjections? Contraception 2008; 77:410-4.


2. WHO. Selected practice recommendations for contraceptive use. 2008 update. (accessed 10/31/08.)

The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)