Use of IUDs for emergency contraception: current perspectives

Figures & data

Table 1 Indications for emergency contraception when regular contraception fails

Method	Indication
Combined oral	When efficacy is compromised: ○ Two or more pills missed (or compromised by diarrhea and vomiting) in the first week of the pack and UPSI has occurred in week 1 or during the preceding pill-free interval. ○ As above, with an error in last week of penultimate pack. ○ UPSI during use of an enzyme-inducing drug or in the 28 days following cessation. When quick starting: ○ After day 5 of cycle – UPSI in first 7 days. ○ After EHC: ■ UPSI in first 7 days after levonorgestrel. ■ UPSI in first 14 days after ulipristal acetate.
Combined ring or patch	When efficacy is compromised: ○ UPSI during extended ring- or patch-free interval. ○ UPSI during extended ring or patch use. ○ UPSI during use of an enzyme-inducing drug or in the 28 days following cessation. When quick starting: ○ After day 5 of cycle – UPSI in first 7 days. ○ After EHC: ■ UPSI in first 7 days after levonorgestrel. ■ UPSI in first 14 days after ulipristal acetate.
Progestogen-only oral	When efficacy is compromised: ○ Extended pill interval (more than 27 or 36 hours, depending on formulation) or pill-taking is compromised by diarrhea and/or vomiting and additional precautions have not been used until two further pills have been taken correctly. ○ UPSI during use of an enzyme-inducing drug or in the 28 days following cessation. When quick starting: ○ After day 5 of cycle – UPSI in first 2 days. ○ After EHC: ■ UPSI in first 2 days after levonorgestrel. ■ UPSI in first 9 days after ulipristal acetate.
Progestogen-only injectable, eg, depot medroxyprogesterone acetate	UPSI in first 7 days of use when started after day 5 of cycle or quick-started after EHC. UPSI more than 14 weeks since last injection.
Progestogen-only implant	UPSI in first 7 days of use when not fitted in first 5 days of cycle or quick-started after EHC. UPSI beyond duration of licensed period, ie, 3 years.
Levonorgestrel intrauterine system	UPSI in first 7 days of use when not fitted in first 7 days of cycle. UPSI after 5 years of use, ie, out of license (except when fitted in a woman aged 45 years or over). Removal within 7 days of UPSI.

Abbreviations: EHC, emergency hormonal contraception; UPSI, unprotected sexual intercourse.

Figure 1 Window of opportunity for action of the three emergency contraception options.

Abbreviations: IUD, intrauterine device; LH, luteinizing hormone; LNG, levonorgestrel; UPA, ulipristal acetate.

Figure 2 Calculation of safe limits for intrauterine device (IUD) insertion with three different cycle lengths.

Note: Numbers indicate day of cycle.

Figure 3 Comparison of pros and cons of hormonal methods and the Cu IUD.

Abbreviations: BMI, body mass index; IUD, intrauterine device; STI, sexually transmitted infection; UPA, ulipristal acetate.