Contraception, Emergency

Emergency contraception after pregnancy is excluded

Referral

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Z30.0/Z30.4

Emergency contraception is indicated to prevent pregnancy after unprotected intercourse in women not using contraception or where contraception is likely to be ineffective:

• Forgotten tablets (See Missed pills (Contraception, hormonal))
• Slipped or broken condom
• Injectable contraception given late (>2 weeks for NET-EN, >4 weeks for DMPA)
• Sexual assault

A woman who needs emergency contraception often should be counselled to consider a longer-acting and more effective family planning method.

Emergency Contraception after Pregnancy is Excluded

Do a pregnancy test in all women and female adolescents. Children must be tested and given emergency contraception from Breast Tanner Stage III.

• Copper IUCD inserted as soon as possible after unprotected intercourse and no later than 5 days

LoE:IIIb²⁶

OR

• Levonorgestrel 1.5 mg, oral, as a single dose as soon as possible after unprotected intercourse, and not later than 5 days
  • If the client vomits within 2 hours, repeat the dose

LoE:Ia²⁷

Advise women that their period should be on time. It is rarely delayed but it should not be more than 7 days late. If this occurs, they should come back for a pregnancy test.

If using enzyme inducing drugs or woman weighs > 80 kg / BMI ≥ 30

• It is recommended to have a copper IUCD inserted
• If this is not possible, double the dose of levonorgestrel administered:
  • Levonorgestrel, 1.5 mg, oral, 2 tablets taken as a single dose.
• If the dedicated product is not available, use COCs containing 30 μg ethinylestradiol + 150 μg levonorgestrel (e.g. Nordette/Oralcon):
  • Ethinylestradiol/levonorgestrel, oral, 30 mcg/150 mcg, 6 tablets taken as a single dose, followed by 6 tablets 12 hours later

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CAUTION
Emergency contraceptive tablets must be taken as soon as possible, preferably within 72 hours of unprotected intercourse, and not later than 5 days
Enzyme inhibitors (ketoconazole, fluconazole) significantly increase the bioavailability of levonorgestrel and may increase nausea and vomiting. Women taking these medicines should preferably have copper IUCD inserted

LoE:IIIb²⁸

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REFERRAL

Women in need of emergency contraception must be referred for HIV counselling and testing and PEP (See Post exposure prophylaxis, rape and sexual assault).

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_ April 2025

Chapter 7: Family Planning_7.4 Contraception, Emergency