Emergency post coital contraception is an occasional method, and should not replace regular contraception. The copper-containing IUD is the most effective method of emergency contraception and provides ongoing contraceptive cover. If a copper IUD is not appropriate or not acceptable, oral emergency contraception should be taken as soon as possible if unprotected intercourse has occurred within the last 5 days.
Ulipristal acetate can be taken up to 120 hours after unprotected intercourse and should be considered the first-line oral option for a woman who has had unprotected intercourse 96–120 hours ago. Levonorgestrel can be taken up to 72 hours after unprotected intercourse. For women who have used enzyme-inducing drugs during the previous 4 weeks, a copper IUD is recommended; alternatively, the dose of levonorgestrel should be doubled although the effectiveness of this regimen is unknown. Ulipristal acetate is not recommended.
Suitable regular hormonal contraception should be started immediately after taking levonorgestrel emergency contraception and 5 days after taking ulipristal acetate. Women should be advised to ensure abstinence from intercourse or careful use of barrier methods until their regular contraception becomes effective.
Both ulipristal acetate and levonorgestrel can be offered again within the same cycle if unprotected intercourse takes place again, but levonorgestrel should not be taken for 5 days after ulipristal acetate.
If pregnancy occurs despite use of emergency contraception, the possibility of ectopic pregnancy should be considered.