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IMPORTANT: A woman can start injectables any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist.
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| Woman's situation |
When to start |
| Having menstrual cycles |
Any time of the month
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| Switching from a hormonal method |
- If she has been using the other hormonal method consistently and correctly or if it is otherwise reasonably certain she is not pregnant, she can start immediately (no need to wait for her next monthly bleeding) and there is no need for a backup method.
- If she is switching from another injectable, she can have the new injectable when the repeat injection would have been given. There is no need for a backup method.
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Fully or nearly fully breastfeeding
Less than 6 months after giving birth
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- If she gave birth less than 6 weeks ago, delay her first injection until at least 6 weeks after giving birth.
- If her monthly bleeding has not returned, she can start injectables any time between 6 weeks and 6 months, if it is reasonably certain she is not pregnant. There is no need for a backup method.
- If her monthly bleeding has returned, she can start injectables as advised for women having menstrual cycles.
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| More than 6 months after giving birth |
- If her monthly bleeding has not returned, she can start injectables any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after the injection.
- If her monthly bleeding has returned, she can start injectables as advised for women having menstrual cycles.
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Partially breastfeeding
Less than 6 weeks after giving birth
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- Delay her first injection until at least 6 weeks after giving birth.
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| More than 6 weeks after giving birth |
- If her monthly bleeding has not returned, she can start injectables any time if it is reasonably certain she is not pregnant.† She will need a backup method* for the first 7 days after the injection.
- If her monthly bleeding has returned, she can start injectables as advised for women having menstrual cycles.
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Not breastfeeding
Less than 4 weeks after giving birth
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- She can start injectables at any time. No need for a backup method.
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| More than 4 weeks after giving birth |
- If her monthly bleeding has not returned, she can start injectables any time if it is reasonably certain she is not pregnant.† She will need a backup method* for the first 7 days after the injection.
- If her monthly bleeding has returned, she can start injectables as advised for women having menstrual cycles.
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| No monthly bleeding (not related to childbirth or breastfeeding) |
- She can start injectables any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after the injection.
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| After miscarriage or abortion |
- If she is starting within 7 days after first- or second-trimester miscarriage or abortion, she can start immediately and there is no need for a backup method.
- If it is more than 7 days after first- or second-trimester miscarriage or abortion, she can start injectables any time if it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after the injection.
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| After taking emergency contraceptive pills (ECPs) |
After taking progestin-only or combined ECPs:
- She can start or restart injectables on the same days as taking the ECPs. There is no need to wait for the next monthly bleeding to have the injection. She will need a backup method* for the first 7 days after the injection.
- If she does not start immediately but returns for injectables, she can start at any time if it is reasonably certain she is not pregnant.
After taking ulipristal acetate (UPA) ECPs:
- She can start or restart injectables on the 6th day after taking UPA-ECPs, so make an appointment for her to return for the injection on the 6th day or as soon as possible after that. There is no need to wait for the next monthly bleeding to have the injection. The progestin in the injectables and UPA interact with each other. If the injectable is started sooner, and both are thus present in the body, one or both of the medications may be less effective.
- She will need a backup method* from the time she takes UPA-ECPs until 7 days after the injection.
- If she does not start on the 6th day but returns later for injectables, she may start at any time if it is reasonably certain she is not pregnant.
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* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.
† Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to obtain contraception are limited, some providers and programs may give the first injection at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned.
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