Remote Primary Health Care Manuals

Emergency contraceptive pills (ECP)

85% effective —  UPA-ECP more effective than LNG-ECP, especially days 3–5

What — 2 types of oral pill

Type — hormone

  • 30mg UPA-ECP (ulipristal acetate emergency contraceptive pill)
  • OR 1.5mg of LNG-ECP (levonorgestrel emergency contraceptive pill)

How they work

  • Prevent/delay ovulation if this has not yet occurred 
  • Doesn't affect established pregnancy

Prescription — available over the counter, UPA more expensive than LNG

Timing 

  • UPA-ECP  — effective up to 5 days (120 hours) after unprotected sex
  • LNG-ECP  — effective up to 3 days (72 hours) but may be effective for up to 4 days after unprotected sex

Fertility return — quick, next usual ovulation

Packet

  • UPA-ECP — 1 x 30mg tablet
  • LNG-ECP — 1 x 1.5mg tablet 

Quick Start after ECP

  • UPA-ECP — no, Must wait 5 days before starting hormonal contraceptive
  • LNG-ECP — yes, Can quick start hormonal contraceptive immediately 

Who benefits

  • Any woman who has had unprotected sex in the previous 5 days
  • Safe to use in women where pregnancy is risky, high CV risk

Special issues

  • Do not use for long-term contraception
  • There are no absolute risks for using ECP, very safe to use
  • If vomits within 3 hours of taking ECP — give antiemetic and repeat ECP dose
  • If ECP tablets not available locally — medical consult
  • Always consider STI check — woman, young person

Table 7.5 Important differences between UPA and LNG

Emergency contraceptive pill

 UPA-ECP LNG-ECP 
Breastfeeding Discard milk for 7 days after taking  OK
Taking enzyme-inducing medications (including anti-epileptic medications) Do not use

Give double dose
(eg 2 x 1.5mg tablets)

Severe asthma treated with glucocorticoids OK
Overweight or obese

Effectiveness may be reduced if BMI more than 26 kg/m2
OR weight more than 70kg

 Effectiveness may be reduced if BMI more than 30 kg/m2
OR weight more than 85kg

Side effects

  • May get altered vaginal bleeding for some days after use
  • Uncommon (1%) — headache, nausea, vomiting

Follow-up

  • Must do repeat urine pregnancy test in 4 weeks — high priority recall
  • Ensure ongoing contraception and offer condoms