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Emergency Contraceptive Pills: Medical and Service Delivery Guidance
Emergency Contraceptive Pills: Medical and Service Delivery Guidance
Cecilia Berger (Karolinska Institutet, Sweden); Diana Blithe (National Institutes of Health,
United States of America); Cristián Jesam Gaete (Instituto Chileno de Medicina Reproductiva,
Chile); Raymond Li (University of Hong Kong, China); and Wilson Liambila (Population Council,
Kenya) revised and provided very valuable input to the first draft of the updated document.
Mary Lyn Gaffield and Mario Festin (World Health Organization) reviewed the final draft.
Members of ICEC’s Technical Advisory Group reviewed the final draft. They include Diana Blithe
(National Institutes of Health, United States of America); Vivian Brache (Profamilia, Dominican
Republic); Sharon Camp (retired, Guttmacher Institute, United States of America); Francine Coeytaux
(PlanC, United States of America); Daniel Davis (retired, Food and Drug Administration, United States
of America); Ian Fraser (University of Sydney, Australia); Jeff Spieler (retired, US Agency for
International Development); and James Trussell (Princeton University, United States of America).
Luis Bahamondes, Nathalie Kapp, Elizabeth Westley, and Melissa Garcia provided valuable input
to specific sections of the final draft.
Cristina Puig Borràs updated the previous version of the guide, which was written by Elizabeth
Raymond. Cristina Puig Borràs coordinated the review process. Melissa Garcia provided
additional support.
This guidance has been endorsed by the International Federation of Gynecology and Obstetrics (FIGO),
whose representatives participated in reviewing the document.
The International Consortium for Emergency Contraception (ICEC) unites organizations and individuals
committed to a common mission: to expand access to emergency contraception, with an emphasis on
developing countries. For more information about ICEC, visit our website at
www.emergencycontraception.org.
This guidance document may be freely reviewed, abstracted, and translated in part or whole, provided
that publication credit is given to ICEC.
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
Foreword
The mission of the International Consortium for Emergency Contraception (ICEC) is to
expand access to emergency contraception (EC), with an emphasis on developing
countries. The Consortium was founded in 1996 by seven international organizations:
the Concept Foundation; International Planned Parenthood Federation (IPPF); the Pacific
Institute for Women's Health; PATH; Pathfinder International; the Population Council; and
the World Health Organization’s (WHO) Special Programme of Research, Development
and Research Training in Human Reproduction. It now brings together several dozen
agencies and thousands of individuals in support of its mission. Despite more than 20
years of efforts to expand access to EC, this contraceptive method remains out of reach
for many women. The Consortium first produced guidelines in 2000, based on guidelines
initially created by Pathfinder, PATH, and IPPF. The guidelines were revised in 2004 and
2012. Given recent changes in accessibility and new research findings in the field of
emergency contraception, a new update was necessary.
The Consortium has produced this medical and service delivery guidance about oral
emergency contraceptive pills to assist family planning programs and providers in
ensuring that the women they serve can use these regimens effectively and safely. This
document reflects the latest available evidence and has been reviewed by internationally
recognized reproductive health experts. Local programs are welcome to adapt it as
needed to comply with national or other requirements.
The guidance does not discuss in depth the use of the copper-bearing intrauterine device
(Cu-IUD) for emergency contraception. This device is the most effective emergency
contraceptive option and should be offered to women when appropriate. Further
information about this option is available on the ICEC website
(www.emergencycontraception.org) and the Emergency Contraception website
managed by Princeton University and the Association of Reproductive Health
Professionals (www.not-2-late.com). In addition, the United Kingdom Faculty of Sexual &
Reproductive Healthcare and the European Consortium for Emergency Contraception
have published guidelines that offer recommendations on EC pills and the Cu-IUD.
We hope this updated guidance will help you in your work, whether you are a pharmacist
or pharmacy worker, health provider, program manager, policy maker, or advocate. We
welcome your participation in our community of practice, which is open to all those
committed to the Consortium's mission of expanding access to emergency
contraception; please feel free to contact us via our website at
www.emergencycontraception.org.
4
EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
EMERGENCY CONTRACEPTIVE PILLS: MEDICAL AND SERVICE DELIVERY GUIDANCE
ECP regimens: The two primary ECP regimens, packaged and labeled specifically for
emergency contraception (EC), are:
Regardless of the regimen used, ECPs should be taken as soon as possible, and no later
than five days after sexual intercourse, to maximize use before ovulation occurs.
How ECPs work: The primary mechanism is disruption of ovulation. Other mechanisms
have been postulated but are not well supported by data. No evidence supports the
theory that ECPs interfere with the implantation of a fertilized egg. ECPs do not cause
abortion of an existing pregnancy.
ECP effectiveness: The LNG regimen reduces pregnancy risk by at least half and
possibly by as much as 80% to 90% for one act of unprotected intercourse. The UPA and
mifepristone regimens are more effective than the LNG regimen. The Yuzpe regimen is
the least effective.
Side effects: ECPs are safe, and there is no situation in which the risks of using any EC
regimen outweigh the benefits. Side effects are minor and self-limiting and may include
altered bleeding patterns, nausea, headache, abdominal pain, breast tenderness,
dizziness, or fatigue.
Effects on pregnancy: ECPs are not harmful if inadvertently taken in pregnancy. If the
woman became pregnant despite using ECPs, these will do no harm to her, her
pregnancy, or the fetus.
Clinical screening: No examinations or laboratory tests are needed before using ECPs.
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
Special issues:
Adolescents: ECPs are safe for all women regardless of age and can be used by
girls in beginning stages of puberty, before menarche.
Breastfeeding: LNG ECPs can be used with no restrictions. If UPA ECPs are used,
it is recommended to stop breastfeeding for one week.
Use of ECPs before sex: ECPs could be an appropriate method for women with
low coital frequency, but this warrants further study. If a woman has the
opportunity to plan to use a contraceptive method before sex, a method other
than ECPs, such as condoms or another barrier method, is recommended.
Use after more than one episode of unprotected sexual intercourse: Women
should use only one ECP treatment at a time regardless of the number of prior
episodes of unprotected intercourse. If all episodes of unprotected intercourse
were within the last 120 hours, using UPA ECPs is recommended. If all episodes
took place within the last 72 hours, a woman can either use LNG or UPA ECPs.
Repeated use: ECPs can be used as often as needed but do not need to be taken
more than once every 24 hours if multiple episodes of unprotected intercourse
occur within this timeframe. Using EC more than once in the same menstrual
cycle is perfectly safe. Because UPA and LNG interact with one another, the same
regimen that had already been used (whether LNG or UPA) should be repeated if
EC is needed again within a five-day period.
Use of ECPs during the “non-fertile period”: Determining with certainty whether
intercourse had occurred on a fertile or non-fertile cycle day is often not possible.
Thus, women should not refrain from using ECPs due to an assumption that a
particular episode of unprotected intercourse may have occurred on a potential
non-fertile day.
Drug interactions: Inducers of hepatic CYP450 enzymes may reduce the
effectiveness of LNG and UPA ECPs. These include the HIV medicines efavirenz
and ritonavir, certain medicines for tuberculosis and epilepsy, and herbal
medicines containing St. John’s wort. A woman using these drugs and in need of
EC should be offered the Cu-IUD or, alternatively, a double dose of LNG (3 mg). In
addition, the effectiveness of UPA ECPs could be reduced if progestogen was
taken seven days prior or is taken within five days after UPA intake. Use of UPA
ECPs is not recommended in women with severe asthma treated by oral
glucocorticoid or in women with severe hepatic impairment.
Ectopic pregnancy: No ECP regimen increases the risk that a pregnancy will be
ectopic.
Obesity: ECPs may be less effective among women with a body mass index
(BMI) ≥30 kg/m2 than among women with a BMI <25 kg/m2. The Cu-IUD or the
UPA regimen is recommended for obese-BMI women. Alternatively, a double
dose of LNG can be considered. Women should never be denied access to ECPs
due to higher weights or BMI.
Service delivery systems: All women, girls, and men should be informed about ECPs
before the need arises. To ensure timely access, obtaining a package of ECPs or a
prescription in advance of need should be considered.
6
Providing ECPs: With a variety of EC methods increasingly available, women should be
Starting or resuming regular contraceptives after ECPs use: Women must be informed
that they are at an increased risk of pregnancy after using ECPs if further episodes of
unprotected intercourse take place in the same cycle and that ECPs will not provide
contraception for subsequent unprotected intercourse. After using ECPs, a woman
should use another contraceptive method before she resumes sexual activity.
If she used LNG ECPs or the Yuzpe method, a barrier method or abstinence is
advised for one week. Combined or progestogen-only hormonal contraceptive
methods (pills, patches, injection, implants, ring) can be safely started or
resumed on the same day of LNG ECP intake.
If UPA ECPs were used, a barrier method or abstinence is advised for two
weeks. Combined or progestogen-only hormonal contraceptive methods (pills,
patches, injection, implants, ring), except the LNG Intrauterine System (LNG-IUS),
can be safely started five full days after using UPA ECPs.
If the user becomes pregnant: A woman who used ECPs may subsequently learn that
she is pregnant (because she may have already been pregnant; because the ECPs may
have failed; or because subsequent unprotected intercourse may have taken place after
using ECPs). In any case, she should be aware that ECPs have no known adverse effects
on a pregnancy.
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
1. INTRODUCTION
Despite the availability of highly effective methods of contraception, many pregnancies
are mistimed or unintended. These pregnancies may carry a high risk of morbidity and
mortality, particularly in settings where safe abortion is not accessible or where quality
obstetric services are not available for those women continuing a pregnancy to term.
Many of these unintended pregnancies can be avoided using emergency contraception.
2. INDICATIONS
Emergency contraceptive pills are drugs taken orally to prevent pregnancy after
unprotected or inadequately protected sex. ECPs are sometimes referred to as "the
morning after pill" or "postcoital oral contraceptives."
Examples of common situations in which ECPs may be needed by a woman who is using
a routine contraceptive method are listed below:2
8
Because of the difficulties in determining the risk of pregnancy in any particular situation
and the serious consequences of a mistimed or unintended pregnancy, a woman who
does not want to be pregnant should consider using EC after any episode of sexual
intercourse during which contraceptive protection was not reasonably assured. ECPs are
particularly indicated in cases of non-consensual sex (rape) when the woman was not
protected by an effective contraceptive method.
3. ECP REGIMENS
There are four main oral emergency contraceptive regimens. This guidance focuses
primarily on two of the four regimens: the one containing the progestin hormone
levonorgestrel and the one containing the selective progesterone receptor modulator
ulipristal acetate:
Pill products based on the LNG regimen have been marketed for almost 20 years and are
currently available in most countries in the world. The newest generation of ECPs, the
UPA formula, was first registered in the European Union in 2009 and in the United States
of America in 2010. UPA ECPs are now available in many countries.
Both regimens are marketed as dedicated products, specifically packaged and labeled
for EC. The UPA ECPs are licensed for use up to 120 hours after unprotected
intercourse.3,4,5 The LNG ECP products are licensed for use up to 72 hours after
unprotected intercourse. Off-label use of LNG beyond 72 hours was and is still common
(especially before the appearance of UPA ECPs or in settings where UPA is not
available), given that it appears to still be moderately effective up to 96 hours after
unprotected intercourse.6
Two other ECP regimens have also been well studied, one containing the progesterone
receptor modulator mifepristone and the other using a combination of estrogen and
progestin hormones:
Mifepristone ECPs are available as dedicated ECP products in a few countries, including
Armenia, China, Moldova, Russia, Ukraine, and Vietnam. This regimen is likely effective
up to five days after unprotected intercourse. The Yuzpe combined hormonal regimen is
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
not currently marketed anywhere, but it can be made up from many brands of widely
available oral contraceptive pills. This regimen may be useful in settings where none of
the dedicated products are available. Some data suggest that the combined hormonal
regimen is effective up to three days after sex and possibly up to five days.7,8 Listings of
ECP products and regimens by country are available at
www.emergencycontraception.org and www.not-2-late.com.
4. MODE OF ACTION
The primary documented mechanism of action for both the LNG and UPA regimens is
interference with the process of ovulation.9,10,11,12 If taken before the pre-ovulatory
luteinizing hormone surge has started, LNG can inhibit the surge, impeding follicular
development and maturation and/or the release of the egg itself. UPA has been shown
to prevent ovulation both before and after the surge has started, delaying follicular
rupture for at least five days.13,14,15 Ovulation is not prevented if either LNG or UPA is
administered on the day of the luteinizing hormone peak.16
The LNG regimen has been shown not to prevent implantation of a fertilized egg into the
uterus in several studies.17,18,19 Earlier UPA research suggested minor endometrial
changes in certain aspects of endometrial function and receptivity.20,21 One study of mid-
cycle administration of UPA suggests an effect on endometrial gene expression.22 Two
functional studies of human embryo implantation (with in-vitro implantation models)
found that UPA at the dosage used for EC does not affect the human embryo
implantation process.23,24 In addition, a significantly higher percentage of pregnancies
were prevented when LNG and UPA were given pre-ovulatory compared with post-
ovulatory administration.25,26,27 Despite any possible effect on endometrial receptivity or
maturation, UPA has not been demonstrated to be effective as EC when administered
after ovulation. This is also the case with LNG.
If taken after implantation has occurred, the LNG and UPA regimens have no effect on an
existing pregnancy and do not increase rates of miscarriage.29,30,31,32,33,34
5. EFFECTIVENESS
Twelve studies of the LNG regimen that included more than 13,500 women concluded
that this regimen reduced a woman’s risk of pregnancy after a single episode of
intercourse by between 52% and 100%.35,36,37,38,39,40,41,42,43,44,45,46 A rigorous analysis of data
from two randomized trials demonstrated that the LNG regimen reduces the absolute
risk of pregnancy after unprotected intercourse by at least 49% (95% confidence interval
17–69%).47
Some data suggest that the efficacy of the LNG regimen decreases with time since
coitus.48,49 However, a combined analysis of data from four large trials did not find a
significant decline in efficacy of this regimen over the first four days after sex. In this
analysis, the regimen appeared to have minimal or no efficacy if taken on day five.50
10
Since data are conflicting, the prudent recommendation is always to take the LNG dose
Several studies have found that both the efficacy and the side effects of the LNG
regimen are equivalent whether the hormone is taken as a single 1.5 mg dose or as two
doses of 0.75 mg each, either 12 or 24 hours apart.51,52,53,54 However, since taking one
single dose is simpler for the user than taking two doses 12 hours apart, it is currently
recommended that, when using the two-tablet LNG ECP product, both tablets be taken at
the same time.55
Two randomized trials have found that UPA is at least as effective as the LNG regimen
when used within 72 hours after sex.56,57 An analysis that combined data from these
trials suggested that the UPA regimen is more effective through five days after sex.58 No
decline in efficacy of the UPA was apparent within five days after sex. However, since
effectiveness may depend on delaying ovulation, it is prudent to take the dose of UPA as
soon as possible after intercourse.
With any ECP regimen, the risk of pregnancy is substantially higher if the woman has
subsequent unprotected intercourse in the same menstrual cycle than if she does not.
A number of factors may impact the efficacy of LNG and UPA ECPs. These include the
woman’s weight, BMI, and concomitant use of certain drugs (see Section 10).
The mifepristone regimen is more effective than the LNG regimen,59,60 but it has never
been directly compared to the UPA regimen. A systematic review indicated that doses of
25–50 mg mifepristone may be significantly more effective for EC than a dose of 10
mg.61,62
The combined hormonal regimen is the least effective of the four ECP regimens.63,64
Although ECPs are effective in reducing pregnancy risk after unprotected intercourse,
increasing the availability of this method to populations has not been shown to reduce
rates of unintended pregnancy or abortion.65,66,67 The reason for this apparent
discrepancy is likely, at least in part, because even with ready access to ECPs, women do
not use them after every episode of unprotected intercourse.68 Tackling the public health
problem of unintended pregnancy requires a multi-dimensional approach of which
provision of EC is only one aspect.
6. SIDE EFFECTS
ECPs are extraordinarily safe. No deaths or serious complications have been causally
linked to any ECP regimen. According to the World Health Organization (WHO) Medical
Eligibility Criteria for Contraceptive Use (MEC), fifth edition, there are no situations in
which the risks of using LNG or UPA ECPs or the combined hormonal regimen outweigh
the benefits.69,70
Side effects are medically minor and self-limiting but may be troublesome to some
users. The combined hormonal regimen has the highest incidence of side effects.
Because they are less likely to cause nausea and vomiting, WHO recommends the use of
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
dedicated LNG or UPA ECPs over the use of the combined hormonal regimen.71,72 Side
effects are described below.
If vomiting occurs within two hours after taking a dose of the LNG regimen or the
combined hormonal regimen, another dose should be taken as soon as possible. If
vomiting occurs within three hours after taking a dose of UPA ECPs, the dose should be
repeated as soon as possible.82
7. EFFECTS ON PREGNANCY
Studies of women who became pregnant despite using the LNG regimen or who used it
inadvertently after becoming pregnant indicate that this regimen does not harm either a
pregnant woman or her fetus. It does not increase rates of miscarriage, ectopic
pregnancy, low birth weight, congenital
• malformations, or pregnancy complications.84,85
Postmarketing pharmacovigilance data collection for UPA ECPs also confirm the safety
of this regimen.86 LNG and UPA ECPs are not indicated for women with a known or
suspected pregnancy; however, there is no known harm to the woman, the course of her
pregnancy, or the fetus if ECPs are accidentally used.87
12
ECPs are not indicated for a woman who has a confirmed pregnancy because they will
9. CLINICAL SCREENING
Because ECPs are safe for all women and women can determine for themselves whether
they have had unprotected or inadequately protected sex, no provider screening is
needed before the use of ECPs. Clinical assessments (e.g., pregnancy tests, blood
pressure measurements, laboratory tests, pelvic examination) are not necessary. ECPs
are appropriate for over-the-counter, non-prescription provision.
EC should be incorporated into routine family planning guidance for adolescents, males
and females, and families of adolescents with disabilities, regardless of current
intentions of sexual behavior.91
WHO strongly recommends offering EC to girls who have been raped involving peno-
vaginal penetration and who present within five days of the incident. This includes girls
who have attained menarche as well as those who are in the beginning stages of puberty
(as they may be ovulating even prior to the onset of menstruation). UPA and LNG are
recommended as first-line treatment. If these are not available, the combined hormonal
regimen may be offered.92
10.2 Breastfeeding
A woman who is less than six months postpartum, is exclusively breastfeeding, and has
not had a menstrual period since delivery is unlikely to be ovulating and therefore is
unlikely to need ECPs. However, a woman who does not meet all three criteria may be at
risk for pregnancy.93
WHO’s MEC states that the LNG regimen of ECPs is not contraindicated during lactation
and that the UPA regimen can generally be used by breastfeeding women, but as a
precautionary measure, she should not breastfeed for one week and instead express and
discard her breast milk.94
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
of pericoital oral contraception with 1.5 mg of LNG, in which women were instructed to
take one dose up to 24 hours before or after intercourse over the 6.5-month
study. Findings suggest that such a method was moderately effective and was well
accepted and tolerated by healthy women who reported having intercourse up to six
times a month.96
However, using LNG this way, as a pericoital contraceptive, warrants further research.
With further study, it may be an appropriate method for women with low coital frequency
who are comfortable using a less effective contraceptive method and who are at low risk
of sexually transmitted infections (STIs).
If a woman has the opportunity to plan to use a contraceptive method before sex, a
method other than ECPs is recommended.
ECPs pose no risk of harmful overdose, and evidence suggests that these regimens do
not become less effective when used repeatedly.98 A recent study tested women using
1.5 mg of LNG up to six times a month and found no adverse effects and a pregnancy
rate comparable to that of condoms.99 Several older studies had previously suggested
that the use of LNG ECPs as a regular, ongoing contraceptive method is safe.100 These
data provide reassurance that women may safely use the LNG regimen as many times or
as often as needed. Some experts recommend that no more than one dose is needed in
a 24-hour period.101,102,103
The repeated use of UPA ECPs (either every five or seven days, up to an eight-week
period) has also been studied recently, and safety data indicate that it can be safely used
more than once in the same cycle.104 The efficacy of the UPA regime, however, may be
reduced by recent or subsequent use of LNG.105,106 Therefore, if a woman who has
recently (in the past five days) used the LNG regimen has a subsequent need for EC, she
14
should use the LNG regimen again. If a woman who has recently used the UPA regimen
LNG regimen:
Inducers of hepatic CYP450 enzymes may reduce the effectiveness of LNG
ECPs. These include the HIV medicines efavirenz and ritonavir, certain medicines
for tuberculosis and epilepsy, and herbal medicines containing St. John’s wort.108
A woman using these drugs and in need of EC should be offered the Cu-IUD or,
alternatively, a double dose of LNG (3 mg).109
UPA regimen:
Inducers of hepatic CYP450 enzymes may also reduce the effectiveness of UPA
ECPs. Women using these drugs should be offered the Cu-IUD. A double dose of
UPA is not recommended.110
UPA effectiveness could be reduced if progestogen was taken seven days prior
to taking UPA or within five days after UPA intake.111
Use in women with severe asthma treated by oral glucocorticoid is not
recommended.112
In the absence of specific studies, the Summary of Product Characteristics of the
UPA ECP recommends not to use UPA in women with severe hepatic
impairment.113
Drugs that increase gastric pH (such as esomeprazole) may interfere with UPA,
but the clinical significance of this interaction for UPA ECPs is unknown.114
Both LNG115 and UPA116 ECPs contain lactose monohydrate (UPA products in larger
amounts than LNG). Women with rare hereditary problems of galactose intolerance, the
Lapp lactase deficiency, or glucose-galactose malabsorption should not use either LNG
or UPA regimens.
pregnancies occurring after use of the LNG regimen and 0.6% of pregnancies occurring
after use of the mifepristone regimen were ectopic. These figures are similar to the risk
that pregnancies not exposed to ECPs will be ectopic. Thus, the review concluded that
neither regimen increases the risk that a pregnancy will be ectopic.117
10.9 Obesity
Research conducted in the past few years seems to suggest that the effectiveness of
LNG and UPA ECPs could be reduced in women with overweight and/or high BMI.118,119
According to WHO’s MEC, ECPs may be less effective among women with BMI ≥ 30
kg/m2 than among women with BMI < 25 kg/m2.120
Recent pharmacokinetic studies found that clinical obesity reduces the bioavailability of
LNG but not UPA.121,122,123 Given that the negative effect of obesity is greater on LNG’s
effectiveness than it is on UPA’s, the Cu-IUD or the UPA regimen should be
recommended as the first-line treatment for obese-BMI women. A double dose of LNG
can also be considered if the Cu-IUD or UPA is not an option.124 Women should never be
denied access to EC due to higher weight or BMI.125
A woman who does not want to be pregnant should consider using ECPs any
time she has sex that was not adequately protected by effective contraception.
She should try to obtain and use EC as quickly as possible.
ECPs will not provide protection for subsequent episodes of unprotected
intercourse. A woman is at increased risk of pregnancy after using ECPs and
should, therefore, abstain from intercourse or use effective contraception during
the rest of her cycle.
ECPs are not intended for ongoing, routine contraception but are safe if used
repeatedly. More effective methods are recommended for women with frequent
need.
In addition, every woman and girl should know where and how she can obtain ECPs in
her community. To ensure that she will have ECPs available whenever she needs them,
she may consider obtaining a package of ECPs or a prescription in advance.
Providers and programs may disseminate these messages in numerous ways, including:
16
together will not compromise efficacy or increase side effects, and it is more
convenient and will avoid the possibility that a second tablet will be lost or
forgotten.
If possible, provide the desired ECPs and recommend that the woman swallow
them immediately. Alternatively, provide a prescription and instructions about
where in the community the woman can obtain the product.
Clearly inform the women that the ECPs will not protect her from pregnancy if
she has subsequent unprotected sex within the same cycle and that she should
abstain from sex, use condoms, or initiate an ongoing contraceptive method right
away if she used LNG ECP (see Section 13).
Caution the user that EC does not protect against HIV and other STIs.
Tell the client that if she does not have a menstrual period within three weeks
after taking ECPs, she should consider the possibility that she may be pregnant
and seek appropriate evaluation and care.
ECPs should not be withheld from clients who decline these additional services.
12.3 Follow-up
No scheduled follow-up is required after ECP use unless the client identifies a problem or
question. However, she should be encouraged to seek follow-up care if she:
18
Combined or progestin-only hormonal contraceptives (pills, patches, injection, implants,
If the LNG or the combined hormonal regimen was used, a barrier method or
abstinence is advised for one week. All combined or progestogen-only hormonal
contraceptive methods (pills, patches, injection, implants, ring) can be safely
started or resumed on the same day of LNG ECP intake. The LNG Intrauterine
System (LNG-IUS) can also be inserted as long as pregnancy can be ruled
out.131,132
If the UPA regimen was used, a barrier method or abstinence is advised for two
weeks. Combined or progestogen-only hormonal contraceptive methods (pills,
patches, injection, implants, ring), except the LNG-IUS, can be safely started five
full days after using UPA EPCs (that is, the sixth day after the day of UPA ECPs
intake).133
Cu-IUD:
The Cu-IUD, when inserted within five days after unprotected intercourse, will provide
highly effective EC. Therefore, oral ECPs are not needed if this type of IUD is inserted in
this time interval. If a woman wants the Cu-IUD more than five days after using ECPs, it
may be inserted after the start of the next menstrual period.
Sterilization:
Perform the procedure after the start of the menstrual period following ECP
administration. Use a barrier method until the sterilization is completed.
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EMERGENCY CONTRACEPTIVE PILLS: Medical and Service Delivery Guidance
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