What are the options for emergency contraception?

Emergency Contraception Options

The copper intrauterine device (Cu-IUD) is the most effective emergency contraceptive method, followed by ulipristal acetate, with levonorgestrel being the third most effective option. 1 All these methods should be taken as soon as possible after unprotected intercourse to maximize effectiveness.

Available Emergency Contraception Methods

1. Copper IUD

• Effectiveness: Highest efficacy (>99%) among all emergency contraception methods 1
• Timing: Can be inserted within 5 days of unprotected intercourse
• Extended use: Can be inserted beyond 5 days if ovulation can be estimated (up to 5 days after ovulation) 1
• Additional benefit: Provides ongoing contraception for up to 10 years
• Best for: Women who desire long-term contraception or those at highest risk of pregnancy

2. Emergency Contraceptive Pills (ECPs)

A. Ulipristal Acetate (UPA)

• Dosage: Single 30mg dose 1, 2
• Timing: Effective up to 5 days (120 hours) after unprotected intercourse 2
• Effectiveness: More effective than levonorgestrel between 3-5 days after intercourse 1
• Prescription status: Requires prescription
• Special considerations:
  • More effective than levonorgestrel for overweight/obese women 1
  • After use, wait 5 days before starting hormonal contraception 2
  • Use barrier method until next menstrual period 2

B. Levonorgestrel

• Dosage options:
  • Single 1.5mg dose (preferred)
  • Split dose: 0.75mg followed by 0.75mg 12 hours later 1, 3
• Timing: Most effective within 72 hours, but can be used up to 5 days 1
• Prescription status: Available over-the-counter
• Effectiveness: Prevents approximately 50% of expected pregnancies when used within 72 hours 4

C. Combined Estrogen-Progestin (Yuzpe method)

• Dosage: Two doses of 100μg ethinyl estradiol plus 0.50mg levonorgestrel taken 12 hours apart 1
• Effectiveness: Less effective than other ECP options and has more side effects (nausea/vomiting) 1
• Use case: Only when other options are unavailable

Timing and Effectiveness Considerations

1. Take as soon as possible after unprotected intercourse for maximum effectiveness 1
2. Effectiveness hierarchy:
   • Cu-IUD (>99% effective) 1
   • Ulipristal acetate (prevents ~65% of pregnancies) 4
   • Levonorgestrel (prevents ~50% of pregnancies) 4
   • Combined estrogen-progestin (least effective) 1

Special Situations

Vomiting After Taking ECPs

• If vomiting occurs within 3 hours of taking ulipristal acetate, consider repeating the dose 2
• For any ECP, consider emergency contraception if vomiting occurs shortly after taking the pill 1

After Using Emergency Contraception

• After ulipristal acetate:
  • Wait 5 days before starting/resuming hormonal contraception 2
  • Use barrier method until next menstrual period 2
• After levonorgestrel or combined ECPs:
  • Can start regular contraception immediately
  • Use barrier method for 7 days 1

Advance Provision

• Providing ECPs in advance increases likelihood of use when needed 1
• Does not increase risk-taking behavior or decrease regular contraceptive use 1

Important Caveats and Considerations

1. Not for regular use: Emergency contraception should not replace regular contraceptive methods 2
2. No STI protection: None of these methods protect against sexually transmitted infections 2
3. Effect on menstrual cycle: May cause earlier or later menses (by approximately 2.5 days) 2
4. Pregnancy testing: Recommend pregnancy test if no withdrawal bleeding within 3 weeks 2
5. Ectopic pregnancy awareness: While not increasing risk, women should seek medical attention if they experience severe lower abdominal pain 3-5 weeks after using ECPs 2

Emergency contraception is an important option for preventing unintended pregnancy after unprotected intercourse or contraceptive failure, but should be used as soon as possible for maximum effectiveness.