What are the recommended emergency contraception options available in the UK for women who have had unprotected intercourse?

The recommended emergency contraception (EC) options available in the United Kingdom for women who have had unprotected intercourse include the copper intrauterine device (Cu-IUD) and oral emergency contraception (EC) pills ¹.

• Copper Intrauterine Device (Cu-IUD): The Cu-IUD is considered the most effective method of EC and should be offered to all women, provided the criteria for insertion are met and the method is acceptable ¹. It can be inserted up to 120 hours (5 days) after unprotected sexual intercourse (UPSI) ¹. It can also be considered if it is currently within 5 days after the earliest likely date of ovulation, even if more than 120 hours have passed since UPSI ¹. The Cu-IUD is the preferred option if a woman is taking liver enzyme-inducing drugs ¹.
• Oral Emergency Contraception (EC): If the Cu-IUD is contraindicated or not acceptable, oral EC should be considered ¹. The choice of oral EC depends on several factors, including the time since UPSI, current medications, and the woman's body mass index (BMI) or weight ¹.
  • Ulipristal Acetate: This oral EC can be used up to 120 hours (5 days) after UPSI ¹. It is generally offered if the last UPSI occurred between 96 and 120 hours ago ¹. It is also preferred if UPSI is likely to have taken place during the 5 days before the earliest likely date of ovulation, or if the woman is unsure ¹. For women with a BMI over 26 kg/m² or body weight over 70 kg, ulipristal acetate is an option when UPSI is unlikely to have occurred during the 5 days before ovulation ¹. Regular contraception should be started 5 days after taking ulipristal acetate ¹. Ulipristal acetate is not recommended if taking liver enzyme-inducing drugs ¹.
  • Levonorgestrel: This oral EC is effective if taken as soon as possible and within 72 hours of UPSI ¹. If ulipristal acetate is not suitable (e.g., if UPSI is likely to have taken place during the 5 days before ovulation), levonorgestrel can be offered ¹. For women with a BMI less than 26 kg/m² or body weight less than 70 kg, levonorgestrel is an option when UPSI is unlikely to have occurred during the 5 days before ovulation ¹. A double dose (3 mg) of levonorgestrel, taken as a single dose, is recommended as an off-label option if the woman is taking liver enzyme-inducing drugs ¹. Immediate quick start of suitable hormonal contraception can be initiated with levonorgestrel ¹.

It is important to note that oral EC is unlikely to be effective if ovulation has already occurred ¹. All methods of EC, including the Cu-IUD, should be offered to adolescents ¹. Health professionals should also ensure young women are advised that oral EC needs to be used as soon as possible and that other methods are more effective and reliable for primary contraception ².