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
• 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.
Choose the most effective method the woman will accept, and 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 or weight > 70 kg • Ineffective beyond 96 hours • Safe in breastfeeding |
Source: FSRH
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