What is the recommended timing for placing an Intrauterine Device (IUD) for emergency contraception in a female, relative to unprotected sex or ovulation?

Timing for IUD Placement as Emergency Contraception

A copper IUD can be inserted within 5 days of unprotected intercourse, OR when the day of ovulation can be estimated, the copper IUD can be inserted beyond 5 days after intercourse as long as insertion does not occur more than 5 days after ovulation. 1

Standard Timing Window

• The copper IUD must be placed within 5 days (120 hours) of the first act of unprotected sexual intercourse as the standard emergency contraception protocol 1
• This 5-day window from intercourse is the most straightforward and commonly used timing guideline for emergency IUD placement 1

Extended Timing Based on Ovulation

• When ovulation timing can be reliably estimated, the copper IUD may be inserted beyond 5 days after intercourse, provided insertion occurs within 5 days of ovulation 1
• This ovulation-based timing recognizes that the critical window is preventing implantation, which occurs approximately 5-7 days after fertilization 1
• The ovulation-based approach allows for more flexibility in clinical practice when the date of ovulation can be determined through cycle history, ovulation predictor kits, or other methods 1

Levonorgestrel IUD Considerations

• The levonorgestrel 52 mg IUD can be used as emergency contraception up to 7 days after unprotected intercourse, though this remains subject to expert debate and is not as well-established as copper IUD use 1
• If the LNG-IUD is placed within the first 7 days since menstruation started, no additional contraceptive protection is needed 1
• If the LNG-IUD is placed more than 7 days after menstrual bleeding starts, the patient should abstain from intercourse or use barrier methods for the next 7 days 1

Clinical Effectiveness

• The copper IUD is the most effective emergency contraception method available, with less than 1% failure rate 2, 3
• The copper IUD is highly effective as emergency contraception and provides the additional benefit of ongoing long-term contraception after insertion 1, 4, 5, 6

Important Clinical Caveats

• No additional contraceptive protection is needed after copper IUD placement for emergency contraception 2
• The eligibility criteria for interval copper IUD insertion also apply for emergency contraception insertion 1
• IUDs should not be inserted in women with high risk for sexually transmitted infections at the time of placement (Category 3), though low STI risk is Category 1 1
• Pregnancy must be ruled out before insertion, as IUD use during pregnancy carries risk of serious pelvic infection and septic spontaneous abortion (Category 4) 1