starting hormonal contraceptive pill after emergency contraception

Last edited 09/2018 and last reviewed 03/2021

• if starting hormonal contraception immediately after progestogen-only emergency contraception, condoms or avoidance of sex should be advised for 7 days (2 days for POP, 9 days for Qlaira) (1,2)
  
  • after taking LNG-EC (levonorgestrel (for emergency contraception)), women should be advised to start suitable hormonal contraception immediately. Women should be made aware that they must use condoms reliably or abstain from sex until contraception becomes effective
    • recommended that suitable hormonal contraception (CHC, POP, IMP or DMPA) should be quick started immediately LNG-EC with a pregnancy test 21 days later to exclude pregnancy resulting from EC failure
      
      
• if starting hormonal contraception immediately after ulipristal acetate EC (3)
  • women should be advised to wait 5 days after taking UPA-EC (ulipristal acetate (for emergency contraception) before starting suitable hormonal contraception. Women should be made aware that they must use condoms reliably or abstain from sex during the 5 days waiting and then until their contraceptive method is effective
    
    
    • has been demonstrated that starting a desogestrel POP immediately after UPA-EC reduces the ability of the UPA-EC to delay ovulation
      
      
    • FSRH recommend that after UPA-EC, commencement of CHC, POP, IMP and DMPA be delayed for 5 days (at least 120 hours) after UPA-EC has been given - ensures that the UPA-EC is as effective as possible in preventing pregnancy resulting from the episode(s) of UPSI for which it was taken
      
      
    • pregnancy can be excluded by a urine pregnancy test taken 21 days after the last episode of UPSI
      
      
    • Time to contraceptive effectiveness when starting 120 hours after ulipristal acetate emergency contraception (UPA-EC)

• Contraceptive method	Time to efficacy - Requirement for additional contraception after starting method
  Combined oral contraceptive pill*	7 days
  Combined vaginal ring/transdermal patch	7 days
  Progestogen-only pill (traditional/desogestrel)	2 days
  Progestogen-only implant or injectable	7 days

  • *Except Qlaira which requires 9 days of additional contraceptive precautions
    
    
  • previous guidance noted that if contraception started immediately after UPA-EC that (2,4):
    • additional precautions are advised for 14 days after taking UPA (9 days if using or starting the progestogen-only pill, 16 days for the estradiol valerate/dienogest pill) - however now the guidance is for CHC, POP, IMP and DMPA be delayed for 5 days (at least 120 hours) after UPA-EC has been given (3)

Reference:

• FSRH (November 2017). Switching or Starting Methods of Contraception
• Faculty of Sexual & Reproductive Healthcare Clinical Guidance. Quick Starting Contraception. September 2010.
• FSRH (December 2017). FSRH Guideline - Emergency Contraception
• FSRH (August 2012). FSRH Guideline - Combined Hormonal Contraception