Emergency Contraception

Publication Date: January 21, 2023
Last Updated: March 14, 2023

Summary of Recommendations

We recommend that clinicians counsel individuals considering EC on the following:
The copper IUD is more effective than ECPs (1, A)
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UPA ECPs are more effective than LNG ECPs (1, A)
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LNG and UPA ECPs prevent pregnancy through preovulatory effects

(1, A)
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The LNG 52 mg IUD is noninferior to the copper IUD for EC within 5 days of unprotected intercourse (1, B)
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We recommend that clinicians counsel individuals that UPA ECPs, if available, are more effective than LNG ECPs in overweight and obese persons and those with bodyweight 70 kg or greater. (1, C)
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We recommend advising patients currently or recently taking cytochrome P450–3A4 and P450–3A5 inducers or glucuronidation enzyme inducers that ECPs may be less effective and that IUD placement for EC should be considered. (1, C)
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We recommend routine hormonal contraception be initiated as soon as desired following LNG ECP use, with abstinence or a nonhormonal contraceptive method used as back-up for 7 days or until the next menstrual period/withdrawal bleed, whichever occurs first. (1, A)
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Following UPA ECPs, we recommend generally delaying initiation of routine hormonal contraception for five days and abstinence or a nonhormonal contraceptive method used as back-up for an additional seven days or until the next menstrual period/withdrawal bleed. However, the specific timing of routine hormonal contraceptive initiation should be individualized through shared decision-making. (1, B)
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We recommend against withholding or delaying ECPs for pregnancy testing. (1, B)
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We recommend offering urine pregnancy testing for post-EC pregnancy assessment as needed. (1, C)
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We recommend offering or referring persons requesting EC for sexually transmitted infection screening, postexposure prophylaxis, pre-exposure prophylaxis, and treatment as indicated. (1, C)
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We recommend screening persons who use EC for intimate partner violence and human trafficking as indicated. (1, C)
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We recommend offering or referring persons who use EC for ongoing contraception as desired. (1, C)
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We recommend clinicians provide EC counseling and advanced prescription of ECPs to individuals relying on the lactational amenorrhea method. (1, B)
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We recommend that clinicians counsel individuals that breastfeeding does not need to be disrupted because of LNG ECP use. (1, A)
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We recommend offering regular pericoital use of LNG ECPs for individuals who desire this method either alone or as a supplement to nonhormonal coitus-dependent methods, such as periodic abstinence, barrier methods, or withdrawal. (1, B)
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Table - World Health Organization indications for emergency contraception use

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Condoms Breakage, slippage, or incorrect use
Combined hormonal contraceptive pills Three or more consecutively missed pills or three days late during the first week of the cycle
Progesterone-only contraceptive pills Three or more hours late from usual pill use time or more than 27 h after the previous pill
Desogestrel-only contraceptive pills Twelve or more hours from usual pill use time o rmore than 36 h after the previous pill
Norethisterone enanthate injection Two or more weeks late for injection
Depot-medroxyprogesterone acetate injection Four or more weeks late for injection
Combined injectable contraceptive Seven or more days late for injection
Cervical cap or diaphragm Dislodgement, breakage, tearing, or early removal
Withdrawal Failed withdrawal
Spermicide Failure to melt prior to intercourse
Fertility awareness methods Miscalculation of abstinence period, or failure to abstain or use a barrier on the fertile days
Intrauterine device or implant Device expulsion
  • Sexual intercourse when no contraceptive has been used
  • Sexual assault when the person was not protected by an effective contraceptive method
  • Sexual intercourse where there is concern for contraceptive failure or misuse, including:

Recommendation Grading

Abbreviations

  • EC: Emergency Contraception
  • ECP: Emergency Contraceptive Pills
  • ECPs: Emergency Contraceptive Pills
  • IUD: Intrauterine Device
  • LNG: Levonorgestrel
  • UPA: Oral Ulipristal Acetate

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Emergency Contraception

Authoring Organization

Publication Month/Year

January 21, 2023

Last Updated Month/Year

December 20, 2023

Document Type

Consensus

Country of Publication

US

Document Objectives

Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.

Target Patient Population

Individuals who are or who may become pregnant

Target Provider Population

OBGYNs, primary care providers and other allied care providers caring for individuals who are or who may become pregnant

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D003267 - Contraception, D003270 - Contraceptive Agents, D044363 - Contraception, Postcoital, D003281 - Contraceptives, Postcoital

Keywords

intrauterine devices, emergencies, contraception, emergency contraception, Intrauterine device, Levonorgestrel, Postcoital contraception, Ulipristal acetate

Source Citation

Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception. 2023 Jan 21:109958. doi: 10.1016/j.contraception.2023.109958. Epub ahead of print. PMID: 36693445.

Supplemental Methodology Resources

Data Supplement