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New Problems That May Require Switching Methods

May or may not be due to the method.

Unexplained vaginal bleeding (that suggests a medical condition not related to the method)

• Refer or evaluate by history and pelvic examination. Diagnose and treat as appropriate.
• She can continue using monthly injectables while her condition is being evaluated.
• If bleeding is caused by sexually transmitted infection or pelvic inflammatory disease, she can continue using monthly injectables during treatment.

Migraine headaches (see Identifying Migraine Headaches and Auras)

• Regardless of her age, a woman who develops migraine headaches, with or without aura, or whose migraine headaches become worse while using monthly injectables, should stop using injectables.
• Help her choose a method without estrogen.

Circumstances that will keep her from walking for one week or more

• If she is having major surgery, or her leg is in a cast, or for other reasons she will be unable to move about for several weeks, she should:
  • Tell her doctors that she is using monthly injectables.
  • Stop injections one month before scheduled surgery, if possible, and use a backup method during this period.
  • Restart monthly injectables 2 weeks after she can move about again.

Certain serious health conditions (suspected heart or liver disease, high blood pressure, blood clots in deep veins of legs or lungs, stroke, breast cancer, or damage to arteries, vision, kidneys, or nervous system caused by diabetes). See Signs and Symptoms of Serious Health Conditions.

• Do not give the next injection.
• Give her a backup method to use until the condition is evaluated.
• Refer for diagnosis and care if not already under care.

Suspected pregnancy

• Assess for pregnancy.
• Stop injections if pregnancy is confirmed.
• There are no known risks to a fetus conceived while a woman is using injectables (see Question 3).

Starting treatment with lamotrigine or ritonavir

• Combined hormonal methods, including monthly injectables, can make lamotrigine less effective. Unless she can use a different medication for seizures than lamotrigine, help her choose a method without estrogen.
• Ritonavir and ritonavir-boosted protease inhibitors may make monthly injectables less effective. She can use progestin-only injectables, implants, the LNG-IUD, or any nonhormonal method.

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