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  7. Indications for emergency contraception following potential failure of hormonal and intrauterine methods of contraception
Update your RDS mobile app to v4.7.2 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience  arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Indications for emergency contraception following potential failure of hormonal and intrauterine methods of contraception

Method Situation leading to possible contraceptive failure Indication for EC
Hormonal methods
of contraception		 Failure to use additional contraceptive precautions when starting the method UPSI or barrier failure during time that additional precautions required, as indicated within CEU guidance.

Combined
hormonal
transdermal
patch

or

combined
hormonal
vaginal ring

Patch detachment/ring
removal for more than 48 hours

 

Extension of patch-free or ring-free interval by more than 48 hours

EC is indicated if:

  • patch detachment or ring removal occurs in week 1, and
  • there has been UPSI or
    barrier failure during the hormone-free interval (HFI) or week 1.

If the HFI is extended, a Cu-IUD can be offered up to 13 days after the start of the HFI assuming previous perfect use.

If CHC has been used in the 7 days prior to EC, the effectiveness of UPA-EC could theoretically be reduced. Consider use of LNG-EC.
Combined oral
contraceptive pill
(monophasic pill
containing
ethinylestradiol)		 Missed pills (if two or more active pills are missed)

EC is indicated if:

  • the pills are missed in week 1, and
  • there has been UPSI or barrier failure during the pill-free interval or week 1.

If the pill-free interval is extended (this includes
missing pills in week 1), a Cu-IUD can be offered up to 13 days after the start of the HFI assuming previous perfect use.

If COC has been taken in the 7 days prior to EC, the effectiveness of UPA-EC could theoretically be reduced. Consider use of LNG-EC.

Combined
hormonal
contraception,

progestogen-
only pill,

and

progestogen-
only implant

 Failure to use additional contraceptive precautions whilst using liver enzyme inducing drugs or in the 28 days after use

EC is indicated if there is UPSI or barrier failure
during, or in the 28 days following, use of liver
enzyme-inducing drugs.

Offer a Cu-IUD (unaffected by liver enzyme-
inducing drugs) or a double dose (3 mg) of LNG-EC.

UPA-EC is not recommended with liver enzyme-inducing drugs.
Progestogen-
only pill		 Late or missed pill (more than 27 hours since last traditional POP or more than 36 hours since last desogestrel-only pill)

EC is indicated if:

  • a pill is late or missed, and
  • there has been UPSI or barrier failure before efficacy has been re-established (i.e. 48 hours after restarting).

Timing of ovulation after missed pills cannot be
accurately predicted. A Cu-IUD is therefore only recommended up to 5 days after the first UPSI
following a missed POP.

If POP has been taken in the 7 days prior to EC, the effectiveness of UPA-EC could theoretically be reduced. Consider use of LNG-EC.
Progestogen-
only injectable		   EC is indicated if there has been UPSI or barrier
failure:
  •  more than than 14 weeks after the last injection
  • within the first 7 days after late injection

Timing of ovulation after expiry of the progestogen only injectable is extremely variable.
A Cu-IUD is only recommended up to 5 days after the first UPSI that takes place more than 14 weeks after the last DMPA injection.

The effectiveness of UPA-EC could theoretically be reduced by residual circulating progestogen.
Consider use of LNG-EC.
Progestogen-
only implant		 Expired implant Low risk of pregnancy in 4th year PO-Implant.
Effectiveness of UPA-EC unknown. See FSRH CEU EC Guideline.
Intrauterine
contraception
(Cu-IUD and
LNGIUS)		 Removal without immediate replacement;
partial or complete expulsion;
threads missing and IUC location unknown

If UPSI has occurred in the 7 days (the duration of sperm viability in the upper genital tract) prior to removal, perforation, partial or complete expulsion.

Depending on the timing of UPSI and time since IUD known to be correctly placed, it may be appropriate to fit another Cu-IUD for EC.

If missing LNG-IUS threads and unable to confirm placement with a scan, consider LNG EC due to reduction in effectiveness of UPA-EC due to progestogens.

Editorial Information

Last reviewed: 31/01/2023

Next review date: 31/01/2025

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group.

Version: 8.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health