Contraception and Emergency Contraception Clinical Reference

Posted on Oct 7, 2026 in Medicine

Contraception and UKMEC Guidelines

COCP – increases the risk of breast and cervical cancers, decreases the risk of ovarian and endometrial cancer.
After giving birth, women need contraception after day 21.
Progestogen-Only Pill (POP)
- The FSRH advises postpartum women (breastfeeding and non-breastfeeding) can start the POP anytime after postpartum.
- After day 21, additional contraception should be used for the first 2 days.
- A small amount of progestogen enters breast milk, but this is not harmful to the infant.
Combined Oral Contraceptive Pill (COCP)
- Absolutely contraindicated – UKMEC 4 – if breastfeeding < 6 weeks postpartum.
- UKMEC 2 – if breastfeeding 6 weeks – 6 months postpartum*.
- The COCP may reduce breast milk production in lactating mothers.
- Should not be used in the first 21 days due to the increased venous thromboembolism risk postpartum.
- After day 21, additional contraception should be used for the first 7 days.

UKMEC Category	Meaning
UKMEC 1	No restriction for use of the contraceptive method
UKMEC 2	Advantages generally outweigh disadvantages
UKMEC 3	Disadvantages generally outweigh advantages
UKMEC 4	Represents an unacceptable health risk

Condition	UKMEC
Age >35 + smoking <15 cigarettes/day	3
BMI >35 kg/m²	3
Family history of thromboembolic disease in 1st-degree relative <45 years	3
Controlled hypertension	3
Immobility (e.g., wheelchair use)	3
Carrier of known gene mutation associated with breast cancer (e.g., BRCA1/BRCA2)	3
Current gallbladder disease	3

Condition	UKMEC
Age >35 + smoking >15 cigarettes/day	4
Migraine with aura	4
History of thromboembolic disease or thrombogenic mutation	4
History of stroke or ischaemic heart disease	4
Breastfeeding <6 weeks postpartum	4
Uncontrolled hypertension	4
Current breast cancer	4
Major surgery with prolonged immobilisation	4
Positive antiphospholipid antibodies (e.g., in SLE)	4

Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on the severity.
NOTE – Breastfeeding 6 weeks – 6 months postpartum was changed from UKMEC 3 to 2.
Depo-Provera – Lasts for up to 12 weeks; can take several months for normal menstrual cycle to return and hence delay fertility; must be discontinued after the age of 50 years due to long-term effects on bone mineral density.

Method	Key points
Levonorgestrel	Emergency hormonal contraception
Ulipristal (EllaOne)	Emergency hormonal contraception; progesterone receptor modulator
Copper IUD	Most effective method of emergency contraception

Feature	Key information
Mechanism	Not fully understood; acts mainly by preventing ovulation
Dose	1.5 mg orally, single dose
Timing	Take as soon as possible; efficacy decreases with time
Time limit	Within 72 hours of UPSI
After 72 hours	May be offered with awareness of reduced effectiveness and unlicensed use
Effectiveness	~84% if used within 72 hours
BMI/weight	Double dose if BMI >26 kg/m² or weight >70 kg
Enzyme-inducing drugs	Double dose; copper IUD preferred
Adverse effects	Menstrual disturbance; vomiting occurs in ~1%
Vomiting	If vomiting occurs within 3 hours, repeat the dose
Repeated use	Can be used more than once in the same menstrual cycle if clinically indicated
Starting hormonal contraception	Can be started immediately after levonorgestrel
Breastfeeding	No restriction

Feature	Key information
Class	Selective progesterone receptor modulator
Mechanism	Primarily inhibits ovulation
Dose	30 mg orally, single dose
Timing	As soon as possible, up to 120 hours (5 days) after intercourse
With levonorgestrel	Concomitant use not recommended
Hormonal contraception	Start/restart 5 days after ulipristal
Barrier contraception	Use during the 5-day delay
Repeated use	Can be used more than once in the same cycle
Severe asthma	Use with caution
Breastfeeding	Breastfeeding should be delayed for 1 week after taking ulipristal

Feature	Key information
Effectiveness	~99% — most effective emergency contraception
Who should be offered it?	Should be offered to all women who meet the criteria
Timing	Insert within 5 days of UPSI
Alternative timing	If presenting >5 days after UPSI, may be fitted up to 5 days after likely ovulation
Mechanism	May inhibit fertilisation and/or implantation
STI risk	Prophylactic antibiotics may be considered if high risk of STI
Long-term contraception	Can be left in situ to provide ongoing contraception
Removal	If removal is requested, should generally be kept until at least the next period
If IUD unsuitable/unacceptable	Consider oral emergency contraception

Feature	Levonorgestrel	Ulipristal	Copper IUD
Maximum time after UPSI	72 h	120 h (5 days)	5 days / up to 5 days after likely ovulation
Dose	1.5 mg	30 mg	—
Most effective?	No	No	Yes (~99%)
Hormonal contraception	Start immediately	Wait 5 days	Can provide ongoing contraception
Breastfeeding	No restriction	Delay 1 week	No hormonal restriction
Can repeat in same cycle?	Yes	Yes	—
Enzyme-inducing drugs	Double dose; IUD preferred	—	Preferred option

Method	Women < 50 years	Women >= 50 years
Non-hormonal (e.g., IUD, condoms, natural family planning)	Stop contraception after 2 years of amenorrhoea	Stop contraception after 1 year of amenorrhoea
COCP	Can be continued to 50 years	Switch to non-hormonal or progestogen-only method
Depo-Provera	Can be continued to 50 years	Switch to either a non-hormonal method and stop after 2 years of amenorrhoea OR switch to a progestogen-only method and follow advice below
Implant, POP, IUS	Can be continued beyond 50 years	Continue. If amenorrhoeic, check FSH and stop after 1 year if FSH >= 30u/L or stop at 55 years. If not amenorrhoeic, consider investigating abnormal bleeding pattern.