Managing Late Injections

• If the client is less than 4 weeks late for a repeat injection of DMPA, or less than 2 weeks late for a repeat injection of NET-EN, she can receive her next injection. No need for tests, evaluation, or a backup method.
• A client who is more than 4 weeks late for DMPA, or more than 2 weeks late for NET-EN, can receive her next injection if:
  • She has not had sex since 2 weeks after she should have had her last injection, or
  • She has used a backup method or has taken emergency contraceptive pills (ECPs) after any unprotected sex since 2 weeks after she should have had her last injection, or
  • She is fully or nearly fully breastfeeding and she gave birth less than 6 months ago.
  She will need a backup method for the first 7 days after the injection.
• If the client is more than 4 weeks late for DMPA, or more than 2 weeks late for NET-EN, and she does not meet these criteria, additional steps can be taken to be reasonably certain she is not pregnant (see Further Options to Assess for Pregnancy, p. 370). These steps are helpful because many women who have been using progestin-only injectables will have no monthly bleeding for at least a few months, even after discontinuation. Thus, asking her to come back during her next monthly bleeding means her next injection could be unnecessarily delayed. She may be left without contraceptive protection.
• Discuss why the client was late and solutions. Remind her that she should keep trying to come back every 3 months for DMPA, or every 2 months for NET-EN. If coming back on time is often a problem, discuss using a backup method when she is late for her next injection, taking ECPs, or choosing another method.

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