Clinical Considerations for Contraception During COVID: Patient Self-Administration
During the COVID-19 pandemic and beyond, patients may desire a contactless method of contraception. The subcutaneous (SQ) formulation of depot medroxyprogesterone acetate (DMPA), Depo-SubQ Provera, is an important option to offer patients. This may be of particular interest among patients who currently come in to the pharmacy or go to a clinic for their intramuscular (IM) injection.
Formulation Differences
While patients are able to self-administer both subcutaneous and intramuscular injections for a variety of purposes (e.g., insulin, fertility medications), patients may prefer the SQ formulation of DMPA since it is associated with less pain and higher continuation rates than the IM formulation.
Differences between the two formulations are summarized in the table below.
| Intramuscular (IM) | Subcutaneous (SQ) | |
| Dose | 150 mg | 104 mg |
| Duration | 13 weeks (up to 15 weeks) | 12-14 weeks |
| Generic Availability | Yes | No |
| Cost at Pharmacy | $70-100 | >$200 |
Another important consideration is insurance coverage of these products. Some health plans cover the IM formulation as a medical benefit but have not yet included it as a pharmacy benefit. Some health plans are now covering the SQ formulation as a pharmacy benefit due to COVID-19, while others cover it as a pharmacy benefit but require a prior authorization.
How to Initiate or Switch
There is no physical assessment or blood pressure measurement required for eligibility of DMPA.
If your patient is not currently using a method of hormonal contraception, they can begin using either the IM or SQ at any time during the menstrual cycle if it is reasonably certain that patient is not pregnant. A backup method of contraception should be used for 7 days.
If your patient is currently using IM DMPA, the SQ DMPA can be administered when she is due for her next injection. No backup contraception is needed.
If your patient is currently using any other hormonal contraception (i.e., progestin only-pill, hormonal IUD, combination hormonal pill, patch or ring) or a copper IUD, the DMPA should be administered 7 days before stopping the other method. No backup contraception is needed.
References
- Prescribing information for Depo-SubQ Provera and Depo-Provera.
- Reproductive Health Access Project. How to Switch Birth Control Methods. 2015.