Emergency Contraception

🔍 When to Suspect

A patient presents after unprotected sexual intercourse (UPSI) or contraceptive failure and wishes to prevent pregnancy

From the full topic in The Ocean Library: Emergency Contraception

🧭 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

---