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Home Formulary 7.0 Contraception, Gynaecology and Urinary Tract Disorders 7.3 Contraceptives 7.3.5 Emergency contraception

7.3.5 Emergency contraception

ChoiceDrugDosage

Also refer to Prescribing notes below

1st choicesCopper IUD

(within 120 hours of UPSI or up to 5 days after predicted day of ovulation)

     see section 7.3.4 

Or
Ulipristal 30mg tablet

(within 120 hours of UPSI)

30mg to be taken as soon as possible following UPSI, but no later than 120 hours

 

Note: progestogen/progesterone including hormonal contraception and HRT should be avoided for 5 days after ulipristal 30mg

Note: For EC due to missed pills or those on progestogen/progesterone containing HRT, consider levonorgestrel, see notes below

Or
2nd choiceLevonorgestrel 1.5 mg tablet

(within 72 hours of UPSI)

1.5mg to be taken as soon as possible following UPSI, preferably within 12 hours but no later than 72 hours

 

Consider double dose (3mg) if

-BMI>26 kg/m2/weight >70kg or

-taking an enzyme inducer, see DSU

Prescribing Notes

  • Refer to FSRH guidance: Emergency Contraception (see algorithms 1 and 2).Copper IUD is the most effective method of EC and should be offered first line (20x more effective than oral EC).
  • If IUD insertion is not available locally then consider referral to a service which can provide insertion of IUD. Oral emergency contraception should be provided in the interim.
    • Patients should be informed that oral ECs are ineffective if taken after ovulation.
  • Ulipristal is first line oral EC as it is more effective than levonorgestrel for most people.
  • Oral emergency contraceptives are available under the Pharmacy First service for women and young people aged 13 years and over, from participating pharmacies, see Pharmacy First service provider list.
  • If EC is required in women already using hormonal contraception or HRT, see FSRH.
    • FSRH advise that the effectiveness of ulipristal could be reduced by progestogen taken in the week prior to EC. Use of levonorgestrel rather than ulipristal may be considered for those taking progestogen contraceptives or HRT, including those presenting due to missed pills.
  • Additionally, FSRH advise that all products containing progestogen or progesterone [whether for contraceptive purposes, EC, gynaecological indications or HRT] are avoided for 5 days after the use of ulipristal. The MHRA have issued advice on the risk factors for uterine perforation with intra-uterine contraception, including copper intra-uterine devices and levonorgestrel-releasing intra-uterine systems, see MHRA.

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