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PocketGuide for Family Planning Service Providers
Emergency Contraception Emergency Contraception

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Counseling Outline

COCs | POPs | IUDs
METHOD COCs
TIMING IN RELATION TO UNPROTECTED INTERCOURSE Should be taken within 72 hours of unprotected intercourse.
REMARKS Effective (2% become pregnant). Side effects:
  • Nausea ( 1 day)
  • Vomiting (see last page of this chapter for management)
  • Breast tenderness

If pregnancy not prevented, counsel client regarding options.
CLIENT INSTRUCTIONS Take four tablets of a low-dose COC (30–35 µg EE) orally within 72 hours of unprotected intercourse. Take four more tablets in 12 hours. (Total = 8 tablets)1

OR

Take two tablets of a high-dose COC (50 µg EE) orally within 72 hours of unprotected intercourse. Take two more tablets in 12 hours. (Total = 4 tablets)

If no menses within 3 weeks, consult clinic or service provider to check for possible pregnancy.

 

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METHOD Progestin-Only Pills (POPs)
TIMING IN RELATION TO UNPROTECTED INTERCOURSE Should be taken within 48 hours of unprotected intercourse.
REMARKS Effective (< 3% become pregnant). Same side effects as with COCs but less severe. If pregnancy not prevented, counsel client regarding options. These regimens have not yet been as widely studied as those using COCs.
CLIENT INSTRUCTIONS Take 1 Postinor® tablet (750 µg of levonorgestrel each) or 20 Ovrette® tablets (75 µg norgestrel each) orally within 48 hours of unprotected intercourse. Take 1 or 20 more tablets in 12 hours. (Total = 2 Postinor or 40 Ovrette tablets) If no menses within 3 weeks, consult clinic or service provider to check for possible pregnancy.

 

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METHOD IUDs
TIMING IN RELATION TO UNPROTECTED INTERCOURSE Should be inserted within 5 days of unprotected intercourse.
REMARKS Very effective (< 1% become pregnant). Few side effects. Failure increases with longer interval between unprotected intercourse and insertion. Insertion requires a minor procedure that must be performed by a trained service provider. Provides long-term contraception as well. Should not be inserted in women at risk for STDs (e.g., HBV, HIV/AIDS). May not be advisable for nulliparous clients.
CLIENT INSTRUCTIONS If no menses within 3 weeks, consult clinic or service provider to check for possible pregnancy. If pregnancy not prevented, counsel client regarding options.

 

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1 If COCs not available, high-dose estrogen can be substituted. The recommended dose of each medication (2.5 mg EE, 10 mg conjugated estrogens or 5 mg esterone) must be taken twice daily (e.g., 5 mg EE) for 5 consecutive days.

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