Women who are currently not using any hormonal contraceptives or a copper intrauterine device (IUD), and are:

• Having menstrual cycles and are not postpartum, post-abortion, or post-miscarriage:
• The woman can have the first injection up to and including day 5 after the start of menstrual bleeding:
• No additional contraceptive protection is needed.
• She can also have the first injection after day 5, if it is reasonably certain that she is not pregnant.
• This use is unlicensed.
• She must abstain from sex or use additional contraceptive protection (such as condoms) for the next 7 days.
• Amenorrhoeic:
• The woman can have the first injection at any time, if it is reasonably certain that she is not pregnant (this is an unlicensed use).
• She must abstain from sex or use additional contraceptive protection (such as condoms) for the next 7 days.
• Postpartum:
• Principles of starting hormonal contraception postpartum:
• No method should be started before day 21 unless there are good reasons to do so.
• If a hormonal method is to be used post birth, it can be started on day 21 without the need for any additional contraception.
• If started after day 21, then additional contraception should be used for 7 days.
• Postpartum and not breastfeeding:
• Depot medroxyprogesterone acetate can be used immediately after birth. However, if depot medroxyprogesterone acetate is started in the puerperium, there is a risk of prolonged heavy bleeding. Therefore, if practical delay starting it until 3 weeks after birth. Otherwise, start within the first 5 days.
• Norethisterone enantate can be used immediately after birth.
• Breastfeeding (primarily or fully) and less than 6 weeks postpartum:
• Use of depot medroxyprogesterone acetate is not recommended, unless other, more appropriate methods are not available or not acceptable; this is an unlicensed use. If, because of the risk of pregnancy, it must be used before 6 weeks postpartum, it should ideally be delayed until at least day 21 postpartum.
• Norethisterone enantate can be used immediately after birth, although breastfeeding should be withheld from neonates with severe or persistent jaundice requiring medical treatment.
• Breastfeeding (primarily or fully) and 6 weeks to 6 months postpartum, and amenorrhoeic:
• The woman can have her first injection at any time.
• If she is fully or nearly fully breastfeeding, no additional contraceptive protection is needed.
• Breastfeeding, more than 6 weeks postpartum, and menstrual periods have returned:
• The woman can have the first injection as advised for other women having menstrual cycles.
• Post-abortion or post-miscarriage:
• The woman can receive an injection immediately after miscarriage (unlicensed use) or abortion (unlicensed use for depot medroxyprogesterone acetate):
• If started on the day of surgical, or the second part of a medical, abortion (induced or spontaneous at less than 24 weeks), no additional contraceptive method is required.
• If started more than 5 days after abortion (unlicensed use), an additional contraceptive method is required for 7 days.

• These recommendations are those issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2002; FFPRHC, 2005a; FSRH, 2008c] and are in line with those issued by the National Institute for Health and Clinical Excellence [National Collaborating Centre for Women's and Children's Health, 2005].