May or may not be due to the method.

Migraine headaches (see Identifying Migraine Headaches and Auras)

  • If she has migraine headaches without aura, she can continue to use the method if she wishes.
  • If she has migraine aura, do not give the injection. Help her choose a method without hormones.

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.
  • If no cause of bleeding can be found, consider stopping progestin-only injectables to make diagnosis easier. Provide another method of her choice to use until the condition is evaluated and treated (not implants or a copper-bearing or LNG-IUD).
  • If bleeding is caused by sexually transmitted infection or pelvic inflammatory disease, she can continue using progestin-only injectables during treatment.

Certain serious health conditions (suspected blocked or narrowed arteries, serious liver disease, severe 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 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 12), or to a woman who receives an injection while pregnant.