Providing emergency contraceptive pills

ECPs may be needed in many different situations. Therefore, if possible, give all women who want ECPs a supply in advance. A woman can keep them in case she needs them. Women are more likely to use ECPs if they already have them when needed. Also, having them on hand enables women to take them as soon as possible after unprotected sex.

When to use

Any time within 5 days after unprotected sex. The sooner after unprotected sex that ECPs are taken, the more effective they are.
ECPs Appropriate in Many Situations

ECPs can be used any time a woman is worried that she might become pregnant.

For example, after:

Sex was forced (rape) or coerced

Any unprotected sex

Contraceptive mistakes, such as:

– Condom was used incorrectly, slipped, or broke

– Couple incorrectly used a fertility awareness method (for example, failed to abstain or to use another method during the fertile days)

– Man failed to withdraw, as intended, before he ejaculated

– Woman has missed 3 or more combined oral contraceptive pills or has started a new pack 3 or more days late

– IUD has come out of place

– Woman is more than 2 weeks late for her repeat progestin-only injection or more than 7 days late for her repeat monthly injection

Dosing Information

For specific products and number of pills to provide, see Pill Formulations and Dosing.

Pill type	Total dosage to provide
Levonorgestrelonly dedicated product	1.5 mg of levonorgestrel in a single dose. Alternatively, clients can be given 0.75 mg levonorgestrel at once, followed by the same dose 12 hours later. One dose is easier for the client to take and works just as well as 2 doses.
Estrogenprogestin dedicated product	0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel. Follow with same dose 12 hours later.
Progestin-only pills with levonorgestrel or norgestrel	Levonorgestrel pills: 1.5 mg levonorgestrel in a single dose. Norgestrel pills: 3 mg norgestrel in a single dose.
Combined (estrogenprogestin) oral contraceptives containing levonorgestrel, norgestrel, or norethindrone	Estrogen and levonorgestrel pills: 0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel. Follow with same dose 12 hours later. Estrogen and norgestrel pills: 0.1 mg ethinyl estradiol + 1 mg norgestrel. Follow with same dose 12 hours later. Estrogen and norethindrone pills: 0.1 mg ethinyl estradiol + 2 mg norethindrone. Follow with same dose 12 hours later.

Giving emergency contraceptive pills

1. Give pills

She can take them at once.
If she is using a 2-dose regimen, tell her to take the next dose in 12 hours.

2. Describe the most common side effects

Nausea, abdominal pain, possibly others.
Slight bleeding or change in timing of monthly bleeding.
Side effects are not signs of illness.

3. Explain what to do about side effects

Nausea:

– Routine use of anti-nausea medications is not recommended.

– Women who have had nausea with previous ECP use or with the first dose of a 2-dose regimen can take anti-nausea medication such as 50 mg meclizine (Agyrax, Antivert, Bonine, Postafene) one-half to one hour before taking ECPs.

Vomiting:

– If the woman vomits within 2 hours after taking ECPs, she should take another dose.

(She can use anti-nausea medication with this repeat dose, as above.) If vomiting continues, she can take the repeat dose by placing the pills high in her vagina. If vomiting occurs more than 2 hours after taking ECPs, she does not need to take any extra pills.

4. Give more ECPs and help her start an ongoing method

If possible, give her more ECPs to take home in case she needs them in the future.
See Planning Ongoing Contraception

"Come back any time": reasons to return

No routine return visit is required. Assure every client that she is welcome to come back any time, however, and also if:

she thinks she might be pregnant, especially if she has no monthly bleedingor her next monthly bleeding is delayed by more than one week.

Planning ongoing contraception

Method	When to start
Combined oral contraceptives, progestin-only pills, combined patch, combined vaginal ring	Can begin the day after she takes the ECPs. No need to wait for her next monthly bleeding. Oral contraceptives and vaginal ring: – New users should begin a new pill pack or ring. – A continuing user who needed ECPs due to error can resume use as before. Patch: – All users should begin a new patch. All women need to use a backup method for the first 7 days of using their method. Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.
Progestin-only injectables	She can start progestin-only injectables on the same day as the ECPs, or if preferred, within 7 days after the start of her monthly bleeding. She will need a backup method for the first 7 days after the injection. She should return if she has signs or symptoms of pregnancy other than not having monthly bleeding (see p. 371 for common signs and symptoms of pregnancy).
Monthly injectables	She can start monthly injectables on the same day as the ECPs. There is no need to wait for her next monthly bleeding to have the injection. She will need a backup method for the first 7 days after the injection.
Implants	After her monthly bleeding has returned. Give her a backup method or oral contraceptives to use until then, starting the day after she finishes taking the ECPs.
Intrauterine device (copper-bearing or hormonal IUDs)	A copper-bearing IUD can be used for emergency contraception. This is a good option for a woman who wants an IUD as her longterm method (see Copper-Bearing IUD, p. 131). If she decides to use an IUD after taking ECPs, the IUD can be inserted on the same day she takes the ECPs. No need for a backup method.
Male and female condoms, spermicides, diaphragms, cervical caps, withdrawal	Immediately.
Fertility awareness methods	Standard Days Method: With the start of her next monthly bleeding. Symptoms-based methods: Once normal secretions have returned. Give her a backup method or oral contraceptives to use until she can begin the method of her choice.

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