Emergency Contraception (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

 

If EC given because of UPSI:

  • advise condom use for remainder of cycle. Pregnancy test in 3 weeks advisable.
  • discuss ongoing contraception and provide method for future use
  • after LNG-EC use: consider ‘quick-starting’ (starting method at time of giving LNG-EC) ongoing hormonal contraception plus condoms for 7 days.
  • after UPA-EC use: start ongoing hormonal contraception after 5 days plus condoms for 7 days or at next period.

If EC given because hormonal contraception failure:

  • effectiveness of UPA-EC may be reduced. Avoid pill/patch/vaginal ring for 5 days after UPA-EC use before restarting method. Additional condom should be used for the 5 days plus a further 1 week after restarting the method. Pregnancy test in 3 weeks advisable.
  • after LNG-EC, continue with the hormonal method with additional condom use for 1 week. Pregnancy test in 3 weeks advisable.
  • effectiveness of UPA-EC may be reduced if progestogen taken in the previous 7 days. Avoid pill/patch/vaginal ring, etc.

If current or recent (past 4 weeks) enzyme-inducing drug use: 

  • copper-IUD most effective EC. If declined, give double dose (3mg) of LNG-EC*. Don’t use UPA-EC (SPC advice).

If breast feeding:  

  • avoid breast-feeding for 1 week after UPA-EC use. Can use LNG-EC.

If BMI greater than 26 Kg/M2 or weight greater than 70Kg

  • may be reduced efficacy of LNG-EC.  Re-consider Copper IUD or Give UPA-EC or double dose LNG-EC
  • if BMI is greater than 30kg/m2 or weight greater than 85kg there may be reduced efficacy of UPA-EC. Reconsider Copper IUD.

* off-label

All EC methods

  • full consultation, including side-effects, action to be taken if vomiting within 2 to 3 hours (hormonal EC only)
  • provide written information
  • accurate documentation
  • consider STI testing
  • follow-up as appropriate.

The Faculty of Sexual & Reproductive Healthcare Guideline to Emergency Contraception

Referral to HSH for Emergency IUD (Raigmore Hospital)

Emergency IUD can be inserted up to 5 days after estimated date of ovulation and patient may not be seen immediately.

HSH Clinics in Zone 14, Raigmore Hospital are open Monday to Friday, excluding public holidays. There is no on call provision.

To Refer:

  • Daytime (Monday to Friday 9 to 5): Phone Health Adviser line – 01463 706070
  • Out of Hours: Phone Health Adviser line 01463 706070 and leave message or email nhsh.hsh-healthadvisor@nhs.scot
  • Important information required:
    • Patient’s name, date of birth and contact phone number
    • LMP, date of first and last UPSI this cycle, usual cycle length

Immediate need for Emergency IUD OOH

  • If patient is at time limit for Cu IUD insertion (i.e. will be past 5 days after postulated date of ovulation by the time HSH clinic is open) please speak to Gynaecology Reg on call to discuss if they can accommodate this procedure OOH (may not always be possible)

Caithness, Lochaber, Skye and Lochalsh

  • Patients from these areas requesting an Emergency IUD may be required to travel to Raigmore Hospital if an Emergency IUD cannot be provided locally by GP.
  • HSH provide monthly IUD clinics in Wick/Thurso and Fort William. Contact HSH as above to discuss with a clinician.
  • Caithness Gynaecology team may be able to provide Emergency IUD.

Abbreviations

Abbreviation Meaning
EC Emergency contraception
IUD Intrauterine device
HSH Highland Sexual Health
LMP Last menstrual period
LNG-EC Levonorgestrel-only containing emergency contraception
PT Pregnancy test
STI Sexually transmitted infection
SPC Summary of product characters
UPA-EC Ulipristal acetate emergency contraception
UPSI Unprotected sexual intercourse

 

Editorial Information

Last reviewed: 28/08/2023

Next review date: 31/08/2026

Author(s): Sexual Health Department .

Approved By: TAM subgroup of ADTC

Reviewer name(s): Dr B Howe, Consultant, Highland Sexual Health.

Document Id: TAM373