GPAtlas🧭 When to offer emergency contraception
Offer emergency contraception (EC) to any woman who does not wish to conceive after unprotected sexual intercourse (UPSI) or a contraceptive failure – a split or slipped condom, missed combined or progestogen-only pills, or a late or missed depot injection. There is no day of a natural cycle that is risk-free, so EC is potentially indicated after UPSI at any point in the cycle.
EC is also indicated from day 21 post-partum (unless the woman is fully breastfeeding, amenorrhoeic and less than 6 months post-partum – the lactational amenorrhoea criteria), and from day 5 after miscarriage, abortion or ectopic pregnancy.
The two clinical skills are to choose the most effective method the woman will accept, and to remember that oral EC works mainly by delaying ovulation – it is ineffective once ovulation has occurred, and the copper IUD is the only method that works after ovulation.
| Method | When it can be used | Key points |
|---|---|---|
| Copper IUD (Cu-IUD) | Up to 120 hours after the first UPSI, or up to 5 days after the earliest estimated ovulation | Most effective (failure rate < 0.1%); unaffected by weight/BMI or enzyme-inducing drugs; becomes ongoing contraception; the only method effective after ovulation. Offer to all women. |
| Ulipristal acetate (ellaOne) 30 mg | Up to 120 hours (5 days) after UPSI | First-line oral if Cu-IUD declined; more effective than levonorgestrel, especially close to ovulation. Avoid with recent progestogen or enzyme-inducers. |
| Levonorgestrel (Levonelle) 1.5 mg | Up to 72 hours (3 days); off-label to 96 hours | Second-line oral; double dose (3 mg) if on an enzyme-inducer or BMI > 26 / weight > 70 kg. Ineffective beyond 96 hours. Safe in breastfeeding. |
Source: FSRH
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