Synopsis
Select copper IUD, ulipristal or levonorgestrel emergency contraception by intercourse and ovulation timing, interactions, weight and the ongoing-method plan.
- Offer a copper IUD to every eligible EC user because it is the most effective method, works after ovulation and can remain for continuing contraception.
- Insert copper IUD within 120 hours of the first unprotected intercourse in the cycle or, when ovulation can be estimated, within five days after the earliest likely ovulation date.
- Use ulipristal acetate 30mg within 120 hours or levonorgestrel 1.5mg within 72 hours. Oral EC delays ovulation and is ineffective after ovulation has occurred.
Key red flags
Pelvic pain, collapse, shoulder-tip pain or bleeding with a late period requires urgent ectopic-pregnancy assessment rather than routine EC alone.
A copper IUD is the most effective EC and can be inserted within 120 hours after first unprotected sex in the cycle or within five days of earliest estimated ovulation.
Levonorgestrel 1.5mg is recommended as soon as possible within 72 hours; ulipristal 30mg can be used up to 120 hours and is generally the more effective oral option later in the window.
During enzyme induction and for 28 days after stopping, offer copper IUD; if declined or unsuitable use LNG 3mg once with uncertainty counselling and do not use UPA.
After UPA wait five days before any progestogen-containing contraception; after LNG, ongoing hormonal contraception can start immediately.
Breakage, expulsion, delayed injection, missed pills or extended hormone-free interval require method-specific risk assessment.
Current use or the 28 days after stopping changes oral EC choice and dose.
Late period, pregnancy symptoms, pain or bleeding requires testing and ectopic assessment; EC will not end a pregnancy.
Investigation priorities
Identify the first and latest unprotected sex, cycle day and possible ovulation window.
Management branches
Unprotected sex or method failure falls within an emergency-contraception window.
- Exclude urgent pregnancy symptoms, date every exposure, estimate earliest ovulation and identify current hormones and enzyme induction.
- Offer copper IUD as most effective within 120 hours of first exposure or five days after earliest estimated ovulation.