Emergency Contraception

( Excerpts from the FSRH Guideline)

• Copper IUCD- Most effective method of EC . Acts by inhibiting implantation. Should be considered by ALL women who have had UPSI and do not want to conceive. The only method of EC that is effective after ovulation has taken place. Time of insertion for EC – within 5 days after the first UPSI in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later.
• The FSRH Guideline states – It is established practice that if a woman has had UPSI since her LMP and presents for EC more than 5 days later, a Cu-IUD can be inserted in good faith if she is still within 5 days of her earliest likely date of ovulation

• Oral EC- Unlikely to be effective if taken >120 hours after the last UPSI. Works by delaying ovulation – not effective after ovulation has taken place. UPA-EC is licensed for use up to 120 hours and LNG-EC for use up to 72 hours after UPSI

When a patient comes for EC- ask the following questions- ( The list is not exhaustive)

1. Time of Last UPSI – was it less than 5 days ago( < 120 hours ago) ?  

2. Additional UPSI in this cycle? -If Yes- was it also within this 120 hours ? If no- Calculate whether she is < 5 days within the earliest date of ovulation. ( For this you need to ask menstrual history also)

Date of ovulation= Date of LMP + Number of days in her shortest cycle Minus 14.  

3. If UPSI was 21 days or more ago- Do pregnancy test

4. Has she taken any medicines within the last 4 weeks( Any enzyme inducers) – If yes, consider double dose LNG

5. Any Hormonal Contraception in the last 1 week? – If CHC has been used in the 7 days prior to EC, the effectiveness of UPA-EC could theoretically be reduced.

6. Any asthma/ glucocorticoids within the last 1 month – UPA Cannot be given 

7. Lactating? – Breast milk to be expressed. Till 28 days of delivery Cu-IUD is UKMEC 3.

8. Examination- BMI ( Consider double-dose (3 mg) LNG if BMI >26 kg/m2 or weight >70 kg )

9. Known STI- Symptomatic Chlamydia/Neisseria- Complete treatment before Cu IUCD insertion.

If vomiting occurs within 3 hours of taking oral EC, a repeat dose should be given.

Regarding repeat use- The FSRH states as follows- The significant increased risk of pregnancy with further UPSI later in the cycle in which oral EC has been taken should be explained to women at the time that oral EC is first given. If a woman has already taken UPA-EC, LNG-EC should not be taken in the following 5 days. If a woman has already taken LNG-EC, UPA-EC could theoretically be less effective if taken in the following 7 days. ( If she took LNG- Avoid UPA for 7 days. If she took UPA-avoid LNG for the next 5 days)

After providing EC-

• Provide information regarding contraception
• Offer Quick start contraception
• Follow up Pregnancy test
• Screening for STI s

Quick start contraception- Offer immediately after LNG-EC or >5 days after UPA-EC.

The detailed guideline can be downloaded Here ( I must warn you- the download starts automatically, even if you do not want to – My own computer now has several copies of the guideline which got downloaded while attempting to insert the link).

Test your knowledge- Take the quiz on Emergency Contraception

Subscribe to Daily Quiz