In a reproductive‑age woman with unprotected intercourse 7 days ago who suspects possible pregnancy and wishes to terminate early, what is the appropriate management?

Emergency Contraception is the Appropriate Management

Your patient needs emergency contraception (EC) immediately, as she is still within the 5-day window after unprotected intercourse where EC is effective. At 7 days post-intercourse, she is not yet pregnant in the clinical sense (implantation occurs 6-12 days after fertilization), so this is pregnancy prevention, not termination 1.

Immediate Action Required

First-Line Options (in order of effectiveness):

1. Copper IUD (Most Effective)

• Can be inserted up to 5 days after unprotected intercourse 1
• Highly effective as emergency contraception (>99% effective) 1
• Provides ongoing contraception
• She is on day 7, which is BEYOND the standard 5-day window, so this option may no longer be available unless ovulation timing can be estimated 1

2. Ulipristal Acetate (Ella) - 30mg single dose

• Approved for use up to 120 hours (5 days) after intercourse 1, 2
• More effective than levonorgestrel at 3-5 days post-intercourse 1
• More effective in obese women compared to levonorgestrel 1
• Requires prescription 2
• At day 7, this is also beyond the approved window

3. Levonorgestrel (Plan B) - 1.5mg single dose

• Approved for up to 72 hours but can be used up to 5 days 1
• Less effective than ulipristal after 72 hours 1
• Available over-the-counter
• At day 7, effectiveness is significantly reduced or absent

Critical Timing Issue

Your patient is at day 7 post-intercourse, which is beyond the evidence-based window for emergency contraception effectiveness. The guidelines consistently state EC should be used within 5 days 1. At this point:

• Emergency contraception is unlikely to be effective
• Implantation may have already occurred (typically 6-12 days post-fertilization)
• She needs pregnancy testing in 2-3 weeks to determine if pregnancy has occurred 3

Next Steps

If Pregnancy Test is Negative (in 2-3 weeks):

• Counsel on consistent contraception use
• Provide advance prescription for EC for future use 1

If Pregnancy Test is Positive and She Desires Termination:

Medication abortion with mifepristone + misoprostol is appropriate up to 70 days (10 weeks) gestation 4, 5:

• Mifepristone 200mg orally, followed 24-48 hours later by
• Misoprostol 800mcg buccally or vaginally
• Safe and effective for ambulatory settings 4
• No pelvic exam required before provision 3

Common Pitfalls to Avoid

1. Don't delay: Even though she's at day 7, document the timeline and explain the reduced/absent effectiveness of EC at this point
2. Don't confuse emergency contraception with medication abortion: EC prevents pregnancy; medication abortion terminates an established pregnancy
3. Don't require unnecessary testing: No pelvic exam needed for EC provision 3
4. Don't miss the counseling opportunity: Provide advance EC prescription for future use 1

What to Tell the Patient

"You're 7 days past intercourse, which is beyond the time window where emergency contraception works effectively. Emergency contraception works best within 5 days. We need to wait 2-3 weeks to do a pregnancy test. If you are pregnant and still wish to terminate, medication abortion is a safe and effective option available up to 10 weeks of pregnancy."