What is the appropriate follow-up for patients who have used emergency contraception, particularly regarding ongoing contraceptive needs?

Appropriate follow-up for patients who have used emergency contraception (EC) involves ensuring effective ongoing contraception and pregnancy exclusion.

After using levonorgestrel EC, women should quick start progestogen-only contraception (pill, implant, or injectable) immediately, but use additional contraception (e.g., condoms) or avoid intercourse until the method becomes effective, and take a pregnancy test 21 days later to exclude EC failure.

For ulipristal acetate EC, immediate initiation of hormonal contraception is not recommended due to potential interaction reducing EC effectiveness; contraception should be delayed, and pregnancy testing performed 21 days after the last unprotected intercourse.

If a copper intrauterine device (Cu-IUD) is chosen for EC, it should be inserted within 5 days of unprotected intercourse or the earliest likely ovulation date; no additional contraception is needed, and pregnancy testing is not required unless insertion criteria are not met.

Women should be offered suitable ongoing contraception at the time of EC provision or referred promptly to contraceptive services to prevent unintended pregnancy.

Advise women to avoid unprotected intercourse or use barrier methods for 7 days after starting hormonal contraception post-EC.

Pregnancy testing is advised no sooner than 3 weeks after the last episode of unprotected sex if there is any uncertainty about pregnancy status.

Young women and those recently pregnant should receive tailored contraceptive advice and support to choose effective methods, including same-day provision where possible.