Login
Search

Search
Search

Emergency Contraception (EC)

FSRH Clinical Guideline: Emergency Contraception (March 2017, amended July 2023)

Background Information

3 types of EC are currently licensed in the UK:
 

Method Class MoA Timing Effectiveness
Copper intrauterine device Non-hormonal Toxic to sperm and ova

+/- Inhibit implantation		 ≤120 hours after UPSI or ovulation >99%
Levonorgestrel (oral) Progesterone Delays ovulation (pre-LH surge only) ≤72 hours after UPSI ~85%
Ulipristal acetate (oral) Progesterone receptor modulator Delays ovulation (pre- and post-LH surge) ≤120 hours after UPSI ~98%

Guidelines

Note that if UPSI occurred >5 days ago, and >5 days after the likely date of ovulation, emergency contraception is no longer considered effective.
 

FSRH guidelines recommend to always offer copper intrauterine device as it is the most effective EC overall.

Criteria:
  • UPSI ≤5 days ago, or
  • Up to 5 days after ovulation, and
  • No contraindication (some important UKMEC 4 listed below)
    • Severe uterine distortion (e.g. large fibroids, congenital anomaly)
    • Unexplained vaginal bleeding
    • Current symptomatic pelvic infection (e.g. PID or purulent cervicitis)

Oral levonorgestrel / ulipristal acetate should be considered if copper intrauterine device is not appropriate or refused by the patient.
 
  • Criteria for levonorgestrel: UPSI ≤72 hours ago
 
  • Criteria for ulipristal acetate: UPSI ≤120 hours (5 days) ago and no contraindications
    • Severe asthma managed with oral steroids
    • Concurrent use of liver enzyme inducers (e.g. rifampicin, anti-epileptic drugs, St John's worts)

If vomiting occurs within 3 hours after taking oral EC (levonorgestrel / ulipristal acetate):
  • Repeat dose ASAP
  • Consider anti-emetics if ongoing nausea

1st line: copper intrauterine device if appropriate (unaffected by weight and BMI)

If BMI >26 kg/m2 or weight >70kg:
  • Offer double dose levonorgestrel (3mg), or
  • Ulipristal acetate (normal dose)

Liver enzyme inducers (e.g. rifampicin, carbamazepine, phenytoin, St John's wort) can reduce the efficacy of oral contraceptives. 

If current or past 28 days use of liver enzyme inducers:
  • 1st line: copper intrauterine device
  • 2nd line: levonorgestrel 3mg (off-label)
  • Ulipristal acetate is NOT recommended 

Both levonorgestrel and ulipristal acetate can both be used for more than once in the same cycle if needed:
  • Using the same product is preferred if repeat EC is needed
  • i.e. If levonorgestrel has been used before, use levonorgestrel again in the same cycle, instead of ulipristal acetate

1st line: copper intrauterine device
  • FSRH notes a higher relative risk of uterine perforation during insertion than in non-breastfeeding women
  • But the absolute risk (6 per 1,000) is low and it does not constitute a contraindication

2nd line: levonorgestrel 
  • Considered safe during breastfeeding
  • Offer to optionally avoid breastfeeding for at least 8 hours after taking levonorgestrel to minimise exposure (but not strictly required)
 
 

Ulipristal acetate should be avoided in breastfeeding women:

  • If a women took ulipristal acetate → advise not to breastfeed for 1 week 
  • It can only be used if  the woman is willing to stop breastfeeding for 1 week

EC method used When to start hormonal contraception
Copper intrauterine device Already provides ongoing contraception
Levonorgestrel  Can be started immediately (same day)
Ulipristal acetate Start 5 days later (≥120 hours)
 


While restarting hormonal contraception, make sure to advise the use of condoms or abstain from sex until the chosen method becomes effective:

  • POP: 2 days
  • CHC: 7 days
  • DMPA: 7 days

Pregnancy testing is NOT routinely required after EC.

However, women should be advised to take a urine pregnancy test 21 days (3 weeks) after UPSI if any of the following:
  • Next period delayed by >1 week 
  • Next period lighter / shorter than normal
  • Unusual lower abdominal pain
 

If the woman gets a normal menstrual period at the expected time, with no further UPSI in the same cycle → a pregnancy test is not required.

References

Author: Adams Lau
Reviewer:
Last edited: 30/06/25