• Assess the woman's:
• Current risk for pregnancy.
• Need for future contraception.
• Risk for sexually transmitted infection.
• Risk for having had non-consensual sexual intercourse.
• Vulnerability.

• Provide verbal and printed information on:
• The options that are available: the levonorgestrel pill, the ulipristal acetate pill, and the copper intrauterine device.
• Their pros and cons of the different emergency contraception methods, including their failure rates and complications/adverse effects.
• Their mechanisms of action.

In depth

• Options include the levonorgestrel pill, the ulipristal acetate pill, or a copper intrauterine device (IUD).
• The choice of emergency contraception should be made by the woman.
• Levonorgestrel is licensed for use up to 72 hours (3 days). Inform the woman that the effectiveness of levonorgestrel effectiveness diminishes rapidly with delay in using it, and that pharmacists will not provide levonorgestrel without a prescription if the time since unprotected sexual intercourse is more than 72 hours.
• Ulipristal acetate is licenced for use up to 120 hours (5 days) after unprotected sexual intercourse. Effectiveness is maintained over time. Safety and efficacy of ulipristal acetate has only been established in women 18 years and older and it is only available on prescription.
• An IUD containing at least 380 mm² of copper is the most effective method. It can be inserted up to 5 days after unprotected intercourse or, if the timing of ovulation can be estimated, up to 5 days after ovulation. Ideally, an emergency IUD should be fitted at first presentation, but insertion can be offered later. In this case, levonorgestrel emergency contraception should be given in the interim.

In depth

• Reassure her that the consultation will remain confidential.
• Counsel her on the emotional and physical implications of sexual activity, including the risks and consequences of pregnancy and the risks of sexually transmitted infections.
• Assess her competency to make an independent consent to treatment, and document in her case notes that she meets (or does not meet) the Fraser criteria.

• Offer to arrange ongoing contraception if appropriate — see the CKS topic on Contraception. If the woman does not want long-term contraception, consider advance provision of levonorgestrel emergency contraception.
• For women at higher risk for sexually transmitted infection, offer advice, one to one discussion about preventing sexually transmitted infection, and testing (for Chlamydia trachomatis at a minimum if an intrauterine device is to be inserted).
• Refer or manage adolescents or women who have been abused, or who are at risk for sexual abuse, or who are particularly vulnerable.

• A few women vomit after taking levonorgestrel or ulipristal acetate. If this happens within 2 hours of taking levonorgestrel or 3 hours of taking ulipristal acetate, the woman should repeat the dose as soon as possible.
• A new prescription will be required for ulipristal acetate and some pharmacies may require a prescription to provide a repeat dose of levonorgestrel.
• Some women have light bleeding or spotting after taking levonorgestrel or ulipristal acetate.
• No contraceptive method is perfect. If pregnancy is suspected (e.g. the next menstruation is abnormally late or light), the woman should have a pregnancy test.

• A copper intrauterine device is the preferred option in women taking liver enzyme–inducing drugs who require emergency contraception.
• However, if oral levonorgestrel emergency contraception is prescribed to a woman taking a liver enzyme–inducing drug:
• Double the dose of levonorgestrel to 3 mg (i.e. 2 tablets of levonorgestrel 1500 micrograms).
• Explain to the woman that this recommendation is based on expert clinical judgement of the balance of risks and benefits rather than evidence, and is outside the terms of the product licence.
• Ulipristal acetate is not recommended for women taking an liver enzyme-inducing drug.