What are the options for emergency contraception?

Emergency Contraception Options

The copper intrauterine device (Cu-IUD) is the most effective emergency contraception option, followed by ulipristal acetate (UPA), with levonorgestrel and combined hormonal methods being less effective alternatives, especially after 72 hours post-intercourse. 1

Available Emergency Contraception Methods

Copper IUD

• Most effective emergency contraception option that can be inserted within 5 days of unprotected intercourse 1
• Can be inserted beyond 5 days when ovulation timing can be estimated, as long as insertion occurs no more than 5 days after ovulation 1
• Provides ongoing contraception after insertion, making it cost-effective for women seeking long-term protection 2, 3

Oral Emergency Contraceptive Pills (ECPs)

1. Ulipristal acetate (UPA)

   • Single 30 mg dose effective up to 5 days (120 hours) after unprotected intercourse 1, 4
   • Maintains consistent effectiveness throughout the full 120-hour window 2, 5
   • More effective than levonorgestrel when taken 3-5 days after unprotected intercourse 1, 2
   • May be more effective than levonorgestrel for women with higher BMI 1, 2

2. Levonorgestrel

   • Available as a single 1.5 mg dose or split dose (0.75 mg followed by another 0.75 mg 12 hours later) 1
   • Most effective when taken within 72 hours of unprotected intercourse 1, 6
   • Effectiveness decreases significantly after 72 hours 2, 5

3. Combined estrogen and progestin regimen (Yuzpe method)

   • Two-dose regimen: 100 μg ethinyl estradiol plus 0.50 mg levonorgestrel, repeated 12 hours later 1
   • Less effective than UPA or levonorgestrel 1, 7
   • Associated with more side effects, particularly nausea and vomiting 1, 8
   • Can be used when dedicated EC products are unavailable 7

Effectiveness Comparison

• Cu-IUD: Highest efficacy rate among all emergency contraception methods 1, 3
• UPA: More effective than levonorgestrel, especially after 72 hours post-intercourse 1, 2, 6
• Levonorgestrel: More effective than Yuzpe regimen but less effective than UPA after 72 hours 1, 3
• Combined regimen (Yuzpe): Least effective option but reduces pregnancy risk by approximately 75% 8, 7

Timing Considerations

• All ECPs should be taken as soon as possible after unprotected intercourse for maximum effectiveness 1
• Cu-IUD can be inserted up to 5 days after unprotected intercourse, or later if ovulation timing is known 1
• UPA maintains effectiveness throughout the 120-hour window 2, 4, 5
• Levonorgestrel and combined regimen effectiveness decreases significantly after 72 hours 1, 2, 7

Post-Emergency Contraception Considerations

• After UPA use, hormonal contraception should not be started for at least 5 days, and a reliable barrier method should be used until the next menstrual period 4
• After using any ECP, a reliable barrier method should be used until the next menstrual period 4
• ECPs may affect the timing of the next menstrual period (typically delayed by 2-3 days with UPA) 4
• Emergency contraception should not replace regular contraceptive methods 4

Special Considerations

• Advance provision of ECPs may increase the likelihood of timely use when needed 1, 2
• UPA requires a prescription in the United States, while levonorgestrel is available over-the-counter 6, 5
• Repeated use of UPA within the same menstrual cycle is not recommended 4
• No emergency contraception method protects against sexually transmitted infections 4

Algorithm for Emergency Contraception Selection

1. If within 5 days of unprotected intercourse and Cu-IUD is appropriate (no risk of STIs, provider available), choose Cu-IUD as the most effective option 1, 2
2. If Cu-IUD is not appropriate or available:
   • If within 5 days (120 hours) and especially if >72 hours or higher BMI: UPA (30 mg) 1, 2, 5
   • If within 72 hours and UPA unavailable: Levonorgestrel (1.5 mg) 1, 6, 7
   • If no dedicated ECPs available and within 72 hours: Combined hormonal method (Yuzpe regimen) 8, 7