An OB-GYN's Advice

Should You Take a Pregnancy Test Before Each Birth Control Shot?

Keep seeing those terrifying "I didn't know I was pregnant" stories on TikTok? Yep, you're not alone.

Taking a pregnancy test before each depo shot is sometimes necessary.
Ekaterina Goncharova/Getty Images

While no type of hormonal birth control is 100% foolproof, you might have some questions about how protected you truly are against pregnancy, especially with more and more people on TikTok sharing their low-key scary “I didn’t know I was pregnant” stories.

These #crypticpregnancy stories seem to be taking over social media, with many mamas revealing that they had myriad symptoms but never linked them to pregnancy, for various reasons. Some seem to have had no symptoms at all, unlocking fears in anyone who has wondered whether or not that bloated feeling might actually mean a baby’s on the way.

Accounts of people getting pregnant despite seemingly consistent birth control use can feel terrifying, so Scary Mommy reached out to Dr. Suzy Lipinski, a board-certified OB-GYN at Pediatrix Medical Group, to get the scoop on whether or not you should be stocking up on pregnancy tests just in case your tried-and-true method fails you.

When To Test for Pregnancy

You’re likely well aware by now, but in case it bears repeating, per Lipinski: “No contraceptive method is 100% effective.” But how do you know if something going on in your body is pregnancy-related or not? Lipinski recommends testing at any time “if anything seems out of the ordinary for you and your body.”

“It is challenging with contraceptives that also stop periods as pregnancy may not be as obvious,” she says. “However, if you experience new symptoms like unexplained nausea, extreme fatigue, irregular bleeding, or breast tenderness, taking a pregnancy test is the safest way to rule out pregnancy. Any person on birth control with new onset pelvic pain, especially on only one side, should do a pregnancy test to rule out an ectopic pregnancy. Patients with ectopic pregnancies can also have bleeding, so bleeding doesn’t necessarily mean someone isn’t pregnant.”

These guidelines ring especially true if you’re just starting a new birth control method, even if you’re switching from a different one. “The most likely time to see birth control failures is in the first month of use,” says Lipinski. “If a patient has already ovulated prior to starting the contraceptive, then pregnancy is possible during that first cycle. Some contraceptives need additional time to become effective, so pregnancy in the first few weeks is a risk. When someone is starting a new contraceptive, it is important to discuss backup forms of birth control with their provider.”

The Story With the Shot

One of the common threads among the TikTok stories is that patients were on the Depo-Provera shot, a contraceptive injection given every three months. As Lipinski explains: “Depo-Provera has an efficacy of 99% with perfect use and 96% with average use. This means that even with perfect use, 1 in 100 women will get pregnant in a year of using Depo-Provera.”

So should patients be requesting a pregnancy test before they get their routine shot to ensure they are not, in fact, pregnant? Lipinski says that they’re not required, but there are some reasons why taking an occasional test isn’t the worst idea if you rely on the shot. “The key is that the first Depo-Provera be given within the five days after a period (aka before ovulation),” she explains. “If periods are irregular or there is any question about possible pregnancy, then a pregnancy test should be done before starting it. If someone is further into their cycle, they should wait for the period and use alternate contraceptives. For those with irregular periods, two pregnancy tests two weeks apart with abstinence or additional contraception in between can be effective.”

“Once a patient has started the Depo-Provera — as long as they’re on time for each subsequent shot — then additional pregnancy tests are not necessary. Follow-up Depo-Provera shots should be given 10-13 weeks apart. If you receive the shot late, then pregnancy testing is necessary. One caveat is that Depo-Provera is most effective in patients who weigh less than 150 pounds. For those above this weight, Depo-Provera may be less effective, and additional pregnancy tests may be needed.” Yep, while it’s absolute garbage that certain contraceptive methods don’t protect patients over a certain weight, it’s crucial information to know if it’s your birth control method of choice.

Efficacy of Other Birth Control Methods

Before you panic, breathe easy knowing that most birth control methods on the block today really are highly effective at preventing pregnancy. “IUDs have a higher efficacy at >99%, but a small number of patients will still get pregnant each year,” says Lipinski. “Compare this efficacy to no birth control, and 85% of patients will get pregnant in a year. With condoms alone, about 20 patients in 100 will get pregnant within a year, and with traditional birth control, 3-10 people in 100 will get pregnant.”

As with any body-related concerns you might have, Lipinski strongly recommends discussing your options with your doctor. “When deciding on a birth control choice, you should discuss any other health issues and/or lifestyle factors that may interrupt use and personal preferences to find the contraceptive that best fits your needs.” Having a couple of extra tests on hand is never a bad idea, either, and you should always listen to your body. If something doesn’t feel right or you have new, unexplained symptoms, you deserve care and the appropriate treatment that works best for you.