See FSRH Decision-making Algorithms for Emergency Contraception to help with deciding the best method of emergency contraception.

A copper intrauterine device (IUD) is the most effective method of emergency contraception (EC) and should always be offered / considered. See Contraception guidance and 7.3.4 Contraceptive devices

Ulipristal acetate

• Tablets 30mg (£14.05 per dose)

Indications

• Emergency contraception within 120 hours of unprotected intercourse

Dose

• One 30mg tablet is effective if taken within 120 hours of unprotected intercourse, the earlier it is taken the more likely ovulation is prevented

Notes

1. Ulipristal acetate should be used with caution in patients with uncontrolled severe asthma
2. Oral contraceptive use is not thought to be harmful to the foetus if the woman is subsequently found to be pregnant. There is no evidence of harm to foetus from ulipristal acetate. Breast feeding should be avoided for at least 7 days
3. Most women will menstruate at their expected time or within 7 days of expected time. For a small number of women menstruation will be delayed beyond 20 days. This may cause concern to women who may think they are pregnant
4. A routine method of hormonal contraception (e.g. CHC) is not advised to be started at the same time with ulipristal because the efficacy of ulipristal and the hormonal contraception may be reduced. Therefore, if a woman wishes to start or continue using hormonal contraception, she should be advised not to do so for at least 5 days and to use a reliable barrier method for 7 days after starting Combined Hormonal Contraceptive (CHC), 9 days for Qlaira (non-formulary) CHC or 2 days after Progesterone only pill. (FSRH guidance March 2017)
5. If a woman has a BMI > 30kg/m² the efficacy of ulipristal acetate may be reduced. See Contraception guidance for further information.
6. Please refer to section 6.4.1 Female sex hormones and their modulators for use of ulipristal acetate in the treatment of uterine fibroids

Levonorgestrel

• Tablets 1.5mg (£4.18 per dose)

Indications

• Emergency contraception within 96 hours of unprotected intercourse

Dose

• One 1.5mg tablet effective if taken within 72 hours of unprotected intercourse, may also be used between 72 and 96 hours (unlicensed use) the earlier it is taken the more likely ovulation is prevented

Notes

1. Practitioners supplying levonorgestrel under Patient Group Directive are constrained to supply within 72 hours of unprotected sexual intercourse. Therefore, GPs and contraceptive services may be approached by patients requesting emergency contraception outside the 72 hour period
2. If a woman is over 70kg in weight or has a BMI > 26kg/m², consider ulipristal acetate single dose or Levonorgestrel double dose (unlicensed use). See Contraception guidance for further information.