Emergency Contraception Options 5 Days After Unprotected Sex
For emergency contraception 5 days (120 hours) after unprotected sex, a copper intrauterine device (Cu-IUD) is the most effective option, while ulipristal acetate (UPA) is the only effective oral option at this timepoint. 1
Available Emergency Contraception Options
Copper IUD
- Can be inserted within 5 days of unprotected intercourse as an emergency contraceptive 1
- Most effective emergency contraception method available 1
- Can be inserted beyond 5 days if ovulation timing can be estimated (as long as insertion is not >5 days after ovulation) 1
- Provides ongoing contraception after insertion 1
Oral Emergency Contraceptive Pills (ECPs)
Ulipristal Acetate (UPA)
- Single 30 mg dose effective up to 5 days (120 hours) after unprotected sex 1, 2
- Maintains consistent effectiveness throughout the full 120-hour window 2, 3
- More effective than levonorgestrel when taken 3-5 days after unprotected sex 1, 4
- Particularly effective at delaying ovulation even when taken close to expected ovulation time 4, 5
- Can inhibit follicular rupture with follicles up to 18mm in size 5
- May be more effective for women with higher BMI compared to levonorgestrel 1
Levonorgestrel
- Single 1.5 mg dose or split dose (0.75 mg followed by 0.75 mg 12 hours later) 1
- FDA-approved for use up to 72 hours after unprotected sex 1
- Effectiveness decreases significantly after 72 hours 1
- Less effective than UPA when taken 3-5 days after unprotected sex 1, 6
- Can only inhibit follicular rupture with follicles up to 14mm in size 5
- May be less effective in women with obesity (BMI >30) 1, 2
Combined Estrogen-Progestin Regimen
- Two doses (100 μg ethinyl estradiol plus 0.50 mg levonorgestrel each) taken 12 hours apart 1
- Less effective than both UPA and levonorgestrel 1
- Higher incidence of side effects (nausea and vomiting) 1
- Not recommended as first-line emergency contraception 1
Effectiveness Comparison at 5 Days Post-Intercourse
- Cu-IUD: Highly effective as emergency contraception at 5 days 1
- UPA: Maintains effectiveness through 120 hours with observed pregnancy rates as low as 1.3% when taken between 96-120 hours after unprotected sex 3
- Levonorgestrel: Significantly reduced effectiveness after 72 hours, with pregnancy rates increasing at 4-5 days 1
- Combined regimen: Less effective than other options and higher side effect profile 1
Clinical Recommendations for 5-Day Timepoint
First choice: Copper IUD if appropriate for the patient and provider available 1, 7
- Provides the highest efficacy
- Offers ongoing contraception
- Not suitable for women at risk of sexually transmitted infections 7
Not recommended at 5 days: Levonorgestrel or combined regimen 1
- Significantly reduced effectiveness at this timepoint
- Meta-analysis shows pregnancy rates increase after 4 days with levonorgestrel 1
Important Considerations
- After UPA use, any regular contraceptive method can be started immediately, but barrier contraception or abstinence is needed for 14 days or until next menses 1
- UPA is more effective than levonorgestrel in preventing pregnancy when taken between 72-120 hours after unprotected sex (0 pregnancies vs. 3 pregnancies in comparative trials) 6
- Common side effects of UPA include headache, nausea, and abdominal pain 3
- UPA may delay onset of menstruation by approximately 2-3 days 3
- Advance provision of emergency contraception may increase likelihood of timely use 1
Pitfalls to Avoid
- Waiting too long to seek emergency contraception (efficacy decreases with time) 1
- Using levonorgestrel at the 5-day mark when UPA would be more effective 1, 6
- Not considering a copper IUD, which is the most effective emergency contraception option 1, 7
- Not providing instructions for ongoing contraception after emergency contraception use 1
- Not considering BMI impact on effectiveness, particularly with levonorgestrel 1, 2