How do I manage a patient who presents for emergency contraception but has a history of previous adverse reactions to hormonal methods?

If a patient presenting for emergency contraception has a history of previous adverse reactions to hormonal methods, the copper intrauterine device (Cu-IUD) should be offered as the first-line emergency contraception option because it is non-hormonal and unaffected by hormonal sensitivities or liver enzyme-inducing drugs.

Explain to the patient the mode of action, efficacy, advantages, disadvantages, and possible risks and adverse effects of the Cu-IUD, including the importance of checking for threads regularly and the option to remove the device at any time without delay to fertility.

If the Cu-IUD is declined or contraindicated, oral emergency contraception with levonorgestrel can be considered cautiously, but ulipristal acetate is generally not recommended if there are concerns about hormonal adverse reactions or interactions.

Ensure a full history is taken, including the timing of unprotected sexual intercourse, previous use of hormonal emergency contraception, and any contraindications or restrictions based on the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).

Provide information on the risks and benefits of all options and support the patient in making an informed choice, considering non-hormonal methods preferentially in the context of previous adverse hormonal reactions.