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Emergency Contraception

Checked: 23-03-2023 by Vicky Ryan Next Review: 23-06-2023

Emergency contraception overview

All women needing emergency contraception (EC) should be offered the emergency copper intrauterine device (emIUD) as a first line choice if there are no contraindications (see below). It is the most effective method of emergency contraception – pregnancy rate in users <0.1%. It can be inserted up to 120hrs after sex or up to 5 days after the woman’s earliest expected ovulation.

Oral emergency contraception can be obtained from:

GP
Pharmacy - patients can find out their nearest pharmacy that provides oral emergency contraception by texting ‘Pharmacy emergency contraception [and their post code]’ to 80011
NHS Walk in centre
Unity Sexual Health Clinic also offer an emergency contraception service For emergency IUD (emIUD) see below. For urgent clinical advice re. emergency contraception call: 0117 342 26913 Please note that Unity and the WISH clinic in Weston do not offer a walk in service

The BNSSG formulary - contraception page has advice on emergency contraception including links to an emergency contraception algorithm.

Emergency copper intrauterine device

Use the Faculty of Sexual and Reproductive Health (FSRH) Emergency Contraception guideline to establish whether a woman requires emergency contraception. The decision flowchart can be found on page 13

Encourage emIUD especially if:

Unprotected sexual intercourse (UPSI) has taken place in the 5 days leading up to predicted ovulation (the high risk window)
Also note that the oral EC does not work after ovulation
patient is motivated to keep IUD for long term contraception

Exclusions- as per routine coil fit e.g. active uterine infection

Who to refer

Refer to Unity:
- If patient requires an emIUD fit and this is not possible in primary care
- If specialist input is required to make EC assessment or to complete IUD fit.

Red flags

Under 16
Vulnerabilities
Complex medical conditions preventing oral EC/reliable ongoing contraception

Referral process for emIUD

Complete the Emergency IUD referral form. (available in EMIS)
Email the referral form to UnityReferrals@uhbw.nhs.uk
EmIUD referrals will be assessed Mon-Fri 9-5 and 9-12 Sat. The patient will receive a call back from a clinician (on a withheld number) within 1 working day.
Women will receive information to read prior to appointment- see below

What to do before referral:

All women who you refer for EmIUD should ALSO be given oral EC, in case the fitting is unsuccessful or patient does not attend.
Use the FSRH Emergency Contraception flow diagram on page 14, to guide decision-making about which pill. Top tips:
- !! You must weigh and calculate BMI before prescribing oral EC !!
  - Patients >70kg or BMI >26 may need require a specific oral EC or dose adjustments. See BNF
- Patients using enzyme-inducing medications require a double dose of LNG

Patient information resources

See our website’s Unity EC pages for full range of resources including a patient information video
- Unity pre-IUD fit leaflet
- Unity post-IUD fit leaflet

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.