Emergency contraception
Key Facts
Emergency contraception (EC) can prevent 95% of pregnancies when taken within 5 days of intercourse.
It can be used in the following situations: unprotected sex, fear of possible contraceptive failure, incorrect use of contraceptives, and sexual assault or rape in the absence of contraceptive coverage.
The methods used for emergency contraception are copper-bearing intrauterine devices (IUDs) and emergency contraceptive pills (ECPs).
Copper IUDs are the most effective form of emergency contraception available.
The emergency contraceptive pill regimens recommended by the WHO are ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) combining ethinyl estradiol and levonorgestrel.
What is emergency contraception?
Emergency contraception refers to contraceptive methods that can be used to prevent pregnancy after intercourse. It is recommended that these methods be used within 5 days of intercourse, but the earlier they are used, the more effective they are.
Mode of Action
Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and do not induce abortion. Copper intrauterine devices prevent fertilization by chemically altering the sperm and egg before they meet. Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo.
Who can use emergency contraception?
Any woman or girl of childbearing age may need emergency contraception to avoid an unwanted pregnancy. There is no absolute medical contraindication to the use of such contraception. There is also no age limit for its use. The medical eligibility criteria for the general use of a copper IUD also apply to the use of such a device for emergency contraception.
In what situations can emergency contraception be used?
Emergency contraception can be used after sex in a number of situations, including the following:
Lack of contraception;
in cases of sexual assault or rape, when the woman is not protected by an effective method of contraception;
contraceptive failure or misuse, including but not limited to, failure to use a contraceptive method:
Tearing, slipping or incorrect use of the condom;
Forgetting the associated oral contraceptive for 3 or more consecutive days;
taking a progestin-only contraceptive (minipill) more than 3 hours later than usual, or more than 27 hours after the previous pill;
taking a desogestrel pill (0.75 mg) more than 12 hours later than usual, or more than 36 hours after the previous pill;
injection of norethisterone enantate (progestin-only EN-NET) more than 2 weeks late;
injection of medroxyprogesterone acetate delay (DMPA-progestin only) more than 4 weeks late;
injection of a combined injectable contraceptive (CIC) more than 7 days late;
Displacement, rupture, tearing or premature removal of a diaphragm or cervical cap;
failure of the withdrawal method (e.g., ejaculation in the vagina or on the external genitalia);
Undissolved spermicidal tablet or film before intercourse;
miscalculation of the abstinence period or inability to abstain or use a barrier method during the fertile period of the cycle when the couple is using a fertility awareness method; or
expulsion of the intrauterine device (IUD) or contraceptive hormone implant.
Women can be provided with emergency contraceptive pills in advance to ensure that they will have these pills available when needed and that they will be able to take them as soon as possible after unprotected sex.
Selected Practical Recommendations for Contraceptive Use
Transition to regular contraception
After using an emergency contraceptive pill, a woman or girl can resume or begin a regular contraceptive method. If a copper-bearing IUD has been inserted as emergency contraception, no additional contraceptive protection is needed.
After taking levonorgestrel (LNG)-based ECPs or combined oral contraceptive pills (COC), a woman or girl can resume her previous method of contraception or start any other contraceptive method immediately, including IUD use.
After taking ulipristal acetate-based ECPs (AUPs), a woman or girl may resume or start any method of birth control using a progestin (combined hormonal contraception or progestin-only contraception) on the sixth day after taking the ECP. An IUD can be inserted immediately if it can be determined that she is not pregnant. A copper-bearing IUD can be inserted immediately.
Emergency Contraception Methods
Four methods of emergency contraception are available:
ulipristal acetate pills;
levonorgestrel pills;
combined oral contraceptive pills;
copper intrauterine devices.
Emergency contraceptive pills (ECPs) and combined oral contraceptive pills (COCs)
For emergency contraception, WHO recommends one of the following drugs:
ECPs based on AUP, taken as a single dose of 30 mg;
LNG-based ECPs, taken as a single dose of 1.5 mg, or LNG taken in 2 doses of 0.75 mg each, 12 hours apart;
Combined Oral Contraceptive (COC), taken in divided doses: one of 100 μg ethinyl estradiol plus 0.50 mg LNG, followed by a second of 100 μg ethinyl estradiol plus 0.50 mg LNG 12 hours later (Yuzpe method).
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