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

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.

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

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.

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.

•  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.

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.