Indications for emergency contraception

Emergency contraception after unprotected sexual intercourse should be offered when:

• no contraception has been used
  
  
• failed coitus interruptus (e.g., ejaculation in vagina or on external genitalia) (1)
  
  
• barrier methods fail
  • dislodgment, incorrect use or breakage of a condom
  • a diaphragm or cervical cap is incorrectly inserted, damaged dislodged or removed within 6 hours of intercourse
    
    
• regular oral contraceptive pills have been missed or taken incorrectly
  • in combined oral contraceptive pills (21 active tablets) -
    • if three or more 30-35 micrograms of ethinyl estradiol (EE) pills, or two or more 20 micrograms of EE pills have been missed in the first week of pill taking (days 1 to 7) and
    • unprotected sexual intercourse occurred in week 1 or during the pill-free week
  • in progestogen-only pills
    • if one or more progestogen-only pills (POPs) have been missed or taken more than 3 hours late and
    • unprotected intercourse has occurred in the 2 days following this (2)
      
      
• medroxyprogesterone acetate injection is late
  • if overdue for more than 14 weeks from the previous injection for medroxyprogesterone acetate or more than 10 weeks for norethisterone enantate and unprotected intercourse has occurred
    
    
• expulsion of IUD
  • complete or partial expulsion is identified or mid cycle removal of an IUD/IUS is deemed necessary and unprotected sexual intercourse has occurred in the last 7 days
    
    
• contraceptive patch lifts
  • for 48 hours or more o if there is a delay of >48 hours in changing patches at the end of week 1 or 2
  • if there is a delay of more than 48 hours in applying a new patch after the patch-free week (3)
    
    
• woman is taking liver enzyme-inducing drugs e.g. - St John's Wort
  • emergency contraception is indicated in case of unprotected sexual intercourse or barrier method failure or in the first 28 days following the use of liver enzyme inducing drugs
  • an additional barrier method is recommended if oral contraceptives, progestogen implants or contraceptive patch and liver enzyme-inducers are taken concurrently
    
    
• following rape or sexual assault (1)

Note:

• emergency contraception is not indicated in case of unprotected sex or failure of barrier method occurring less than 21 days postpartum (4)

Reference:

• 1. World Health Organization (WHO) 2005. Emergency contraception
• 2. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. FFPRHC Guidance (April 2006). Emergency contraception. J Fam Plann Reprod Health Care. 2006;32(2):121-8
• 3. Family Planning Association (FPA) 2009. Your guide to the contraceptive patch.
• 4. Faculty of Sexual and Reproductive Healthcare (FSRH) 2009. UK medical eligibility criteria for contraceptive use.