The copper intrauterine device can be inserted for emergency contraception within 5 days after the first unprotected sexual intercourse in a cycle, or within 5 days of the earliest estimated date of ovulation, whichever is later.

There are two methods currently available in the UK:

Emergency hormonal contraception

There are now two methods of emergency hormonal contraception ('emergency pill', 'morning-after pill'); levonorgestrel and ulipristal, a progesterone receptor modulator.

Levonorgestrel

• mode of action not fully understood - acts both to stop ovulation and inhibit implantation
• should be taken as soon as possible - efficacy decreases with time
• must be taken within 72 hours of unprotected sexual intercourse (UPSI)
  • may be offered after this period as long as the client is aware of reduced effectiveness and unlicensed indication
• single dose of levonorgestrel 1.5mg (a progesterone)
  • the dose should be doubled for those with a BMI >26 or weight over 70kg
  • dose should also be doubled if taking enzyme-inducing drugs (although a copper IUD as emergency contraception is preferable in this situation)
• 84% effective if used within 72 hours of UPSI
• levonorgestrel is safe and well-tolerated. Disturbance of the current menstrual cycle is seen in a significant minority of women. Vomiting occurs in around 1%
• if vomiting occurs within 3 hours then the dose should be repeated
• can be used more than once in a menstrual cycle if clinically indicated
• hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception

Ulipristal

• a selective progesterone receptor modulator currently marketed as EllaOne. The primary mode of action is thought to be inhibition of ovulation
• 30mg oral dose taken as soon as possible, no later than 120 hours after intercourse
• concomitant use with levonorgestrel is not recommended
• Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period