Scope of this summary
People at risk of pregnancy after recent unprotected intercourse, contraceptive failure or sexual assault. Emergency contraception prevents pregnancy after intercourse; it does not end an established pregnancy, prevent sexually transmitted infection or substitute for assault-informed medical care.
The Bottom Line
- Offer emergency contraception as soon as possible and within five days of unprotected intercourse; efficacy and method suitability differ across the five-day window.
- A copper intrauterine device placed within the recommended timing is highly effective emergency contraception and can continue as ongoing contraception when insertion is acceptable and medically eligible.
- Ulipristal acetate generally retains greater effectiveness than levonorgestrel later in the five-day window, while body weight and access may affect oral-method counseling without justifying refusal of care.
- After ulipristal, delay starting or resuming a progestin-containing method for five days because simultaneous progestin may reduce ulipristal effectiveness; use barrier protection during the transition.
- After levonorgestrel emergency contraception, a regular method can start immediately with the method-specific backup period described in U.S. SPR.
Practical clinical workflow
1
Establish the timing of every recent unprotected exposure, usual cycle pattern, current contraception, pregnancy possibility, medications, desired ongoing method and need for confidential or assault-informed care.
2
Explain copper-IUD and oral options with timing, expected efficacy, weight evidence, contraindications, access, cost and whether the patient wants ongoing intrauterine contraception.
3
Provide the selected method without requiring an unnecessary examination or pregnancy test when oral emergency contraception is appropriate; do not withhold pills solely because pregnancy cannot yet be excluded.
4
Give written instructions for starting ongoing contraception, required backup, expected bleeding change, vomiting after a dose and how to obtain another dose or urgent review.
5
Arrange a pregnancy test if no withdrawal bleed occurs within three weeks, and offer sexually transmitted infection testing, condoms and advance provision of emergency contraception where appropriate.
Safety boundaries and escalation
- Severe or one-sided abdominal pain, syncope, shoulder-tip pain or heavy bleeding after a missed period requires urgent assessment for ectopic pregnancy or another emergency.
- Enzyme-inducing medicines can reduce oral emergency-contraception exposure; check current product labeling and prioritize an effective noninteracting option when eligible.
- An intrauterine device is not inserted for emergency contraception in a patient with current purulent cervicitis or known untreated chlamydial or gonococcal infection; same-day screening can otherwise occur without automatic delay.
- Sexual assault requires consent-led forensic, infection-prophylaxis, safety and support options in addition to pregnancy prevention; emergency contraception alone is not complete care.
Localization
This summary follows CDC U.S. SPR and U.S. MEC. Prescription status, pharmacy stocking, age-neutral access, insurance coverage and same-day IUD availability vary across US settings; local assault and safeguarding pathways apply.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Centers for Disease Control and PreventionU.S. Selected Practice Recommendations for Contraceptive Use, 2024MMWR 2024;73(No. RR-3); DOI 10.15585/mmwr.rr7303a1 路 published 2024-08-08 路 accessed 2026-08-20view source
- Centers for Disease Control and PreventionU.S. Medical Eligibility Criteria for Contraceptive Use, 2024MMWR 2024;73(No. RR-4); DOI 10.15585/mmwr.rr7304a1 路 published 2024-08-08 路 accessed 2026-08-20view source
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