Emergency contraception: an overview

SUMMARY

Emergency contraception can be used to prevent pregnancy when contraception has failed or was not used, or after a sexual assault.

Methods of emergency contraception available in Australia include 2 kinds of oral pills (levonorgestrel and ulipristal acetate) and the copper intrauterine device. Oral emergency contraception can be obtained from pharmacies without a prescription, while the copper intrauterine device must be inserted by a trained healthcare provider.

For greatest effectiveness after unprotected sexual intercourse, oral levonorgestrel should be taken within 72 hours (3 days), ulipristal acetate should be taken within 120 hours (5 days) or the copper intrauterine device should be inserted within 120 hours.

 

Introduction

Emergency contraception (EC) plays a crucial role in reproductive health care, offering individuals an option to prevent unintended pregnancy in situations where contraception was not used or may have failed (for example, following missed contraceptive pills or condom breakage). Emergency contraception may also be used following a sexual assault where the person is at risk of pregnancy. Emergency contraception is not necessary when unprotected sexual intercourse occurs within 21 days postpartum or 5 days post-abortion.

This article outlines the available methods of EC in Australia, their efficacies and precautions, and considerations for specific patient groups. It also includes guidance on starting ongoing contraception after EC and counselling related to sexually transmissible infections and potential sexual assault.

 

Emergency contraception methods

There are 3 methods of EC: levonorgestrel and ulipristal acetate, which are both taken orally, and the copper intrauterine device (IUD).

In Australia, oral ECs are Schedule 3 Pharmacist Only Medicines available without a prescription from community pharmacies. Some general practices, sexual health clinics and emergency departments may stock oral ECs. The copper IUD is a non-hormonal medical device requiring a private prescription and insertion and removal by a trained healthcare provider in primary or secondary care settings. No method of EC is currently available on the Pharmaceutical Benefits Scheme.

Emergency contraception is most effective when used as soon as possible after intercourse, although the different methods have varying time frames in which they are effective, and their physiological mechanisms of action differ significantly (Table 1). The choice of EC will depend on individual circumstances, including time since intercourse, accessibility, cost and patient preference, as well as impact on initiation of ongoing contraception.

Table 1 Comparison of emergency contraception methods^1-3

Details	Levonorgestrel	Ulipristal acetate	Copper intrauterine device (IUD)
Dose	1.5 mg orally as a single dose 3 mg orally may be considered in some situations (see 'Weight or BMI considerations' and 'Drug interactions' further on in this table)	30 mg orally as a single dose	Multiple sizes and types available
Schedule (in Australia)	Schedule 3 Pharmacist Only Medicine	Schedule 3 Pharmacist Only Medicine	Not applicable (classified as medical device)
Approximate cost (AUD)	$15 to $30	$30 to $50	$100 to $120 plus consultation and insertion costs
Window of efficacy following unprotected sex	72 to 96 hours (3 to 4 days)	120 hours (5 days)	120 hours (5 days)
Mechanism of action	Preventing or delaying ovulation	Preventing or delaying ovulation	Impairs sperm motility, preventing fertilisation and implantation of a fertilised ovum
Overall pregnancy rate	0.6 to 2.6%	1 to 2%	Less than 0.1%
Contraindications and precautions	No absolute contraindications Absorption may be reduced in individuals with malabsorptive conditions (e.g. active Crohn disease)	No absolute contraindications Not recommended for individuals with severe asthma requiring long-term oral glucocorticoids Absorption may be reduced in individuals with malabsorptive conditions (e.g. active Crohn disease)	Same contraindications as for routine copper IUD use (e.g. untreated symptomatic pelvic inflammatory disease)
Weight or BMI considerations	Less effective as BMI increases; consider double-dose (3 mg) levonorgestrel in individuals with body weight over 70 kg or BMI above 26 kg/m2 if ulipristal acetate is unavailable or contraindicated [NB1]	Preferred to levonorgestrel in individuals with body weight over 70 kg or BMI above 26 kg/m2	Efficacy not known to be affected by body weight or BMI Preferred to levonorgestrel and ulipristal acetate in individuals with body weight over 85 kg or BMI above 30 kg/m2
Drug interactions	Substrate of CYP3A4 enzyme; efficacy may be reduced by CYP3A4-inducing drugs – consider using copper IUD instead or double-dose (3 mg) levonorgestrel [NB1]	Substrate of CYP3A4 enzyme; efficacy may be reduced by CYP3A4-inducing drugs – consider using copper IUD instead or double-dose (3 mg) levonorgestrel [NB1] Efficacy of ulipristal acetate may be reduced if a progestogen-containing drug was used in the 7 days prior	Not affected by drug interactions
Use in breastfeeding	Safe to use	Safe to use; breastmilk can be expressed and discarded for 24 hours after dose of ulipristal acetate to reduce infant exposure	Safe to use
Other comments	Well tolerated Vomiting affects 1 to 5%; if vomiting occurs within 3 hours of oral emergency contraception dose, a repeat dose may be required. Can be used again within the same menstrual cycle	Well tolerated Vomiting affects 1%; if vomiting occurs within 3 hours of oral emergency contraception dose, a repeat dose may be required. Can be used again within the same menstrual cycle	Requires insertion and removal by trained health professional Can remain in situ for 5 to 10 years for ongoing contraception
BMI = body mass index; CYP = cytochrome P450 NB1: Evidence supporting the use of double-dose (3 mg) levonorgestrel for people with higher body weight or BMI, or to mitigate drug interactions, is limited.

Oral emergency contraception

Oral ECs work primarily by delaying ovulation for at least 5 days, until sperm from the unprotected sexual intercourse for which EC was taken are no longer viable.¹ They do not prevent fertilisation or implantation, so their effectiveness is greatly diminished if ovulation has already occurred. In practice, however, oral ECs can be offered at any time in the menstrual cycle. Oral ECs do not affect an already established pregnancy.

Oral ECs do not provide ongoing contraceptive protection for the remainder of the individual's menstrual cycle; however, they can be taken again, if required, even within the same cycle. There is no limit to recurrent use, although repeated use of oral EC is less effective at preventing pregnancy than using a regular, more efficacious method of contraception (see Australian Prescriber article on Update on long- and short-acting contraceptive methods).

Levonorgestrel

Levonorgestrel is an oral progestin-only drug and should ideally be taken as soon as possible after intercourse. Levonorgestrel is approved by the Australian Therapeutic Goods Administration for use within 72 hours (3 days) of intercourse. Efficacy decreases rapidly with delayed administration, and it is ineffective if taken after 96 hours.⁴

Ulipristal acetate

Ulipristal acetate is a selective progesterone receptor modulator that is taken orally. It remains effective for up to 120 hours (5 days) after intercourse. Unlike levonorgestrel, ulipristal acetate delays ovulation even after the start of the luteinising hormone surge.¹ It is therefore more effective than levonorgestrel, particularly when taken between 72 and 120 hours after unprotected intercourse, or 24 to 36 hours preceding ovulation.¹

Copper intrauterine device

Insertion of a copper IUD within 5 days of unprotected intercourse (or within 5 days of earliest estimated date of ovulation) is more than 99% effective at preventing pregnancy.¹ The copper IUD works by interfering with sperm motility and creating a hostile environment for fertilisation and implantation, making it the most effective form of EC available. It has the added benefit of providing highly effective long-acting reversible contraception on an ongoing basis (between 5 and 10 years depending on the type of copper IUD inserted). However, as with all IUD insertions, there is an increased risk of pelvic infection for 3 weeks after insertion and the copper IUD can cause heavier periods.

 

Patient groups, limitations and precautions

Accessibility and cost

The Australian health system is not currently set up to facilitate the prompt IUD insertion required for EC. Many pharmacies do not routinely stock copper IUDs, and a health professional trained in IUD insertion may be difficult to access in the necessary time frame. The out-of-pocket costs associated with copper IUD insertion are the purchase of the IUD itself (about $100 to $120 AUD) and potentially the cost of the insertion procedure and associated consultation. There are also indirect costs such as time off work.

Despite neither of the oral ECs requiring a prescription, access to ulipristal acetate may be more limited. A recent study found that only 70% of Australian community pharmacies stocked ulipristal acetate compared with 98% that stocked levonorgestrel.⁵ In addition, where available, ulipristal acetate can cost up to $15 more than levonorgestrel for a single dose.

Public hospitals and family planning and sexual health clinics typically provide subsidised ECs when needed.

Purchasing an oral EC in advance (advance provision) to ensure the individual has it readily available and can take it as soon as possible after unprotected intercourse is an approach that has been endorsed by the Pharmaceutical Society of Australia to help overcome access barriers.^1,6

Clinical considerations

Medical contraindications

There are no absolute medical contraindications to the use of oral EC, although ulipristal acetate is not recommended for individuals with severe asthma requiring long-term oral glucocorticoids because of its anti-glucocorticoid effect.¹ The absorption and effectiveness of levonorgestrel and ulipristal acetate may be reduced in individuals with malabsorption issues, such as active Crohn disease or short bowel syndrome, so a copper IUD should be considered in these circumstances.¹

A copper IUD is contraindicated in individuals with untreated symptomatic pelvic inflammatory disease. However, it is not contraindicated if asymptomatic Chlamydia trachomatis or Neisseria gonorrhoeae is diagnosed and treated before or at the time of copper IUD insertion.¹

Higher body mass index

Levonorgestrel EC becomes less effective as body mass index (BMI) increases, likely due to altered drug absorption and metabolism.¹ For individuals weighing more than 70 kg or with a BMI above 26 kg/m², ulipristal acetate is the preferred oral EC as it has shown greater efficacy than levonorgestrel in this population.¹ If ulipristal acetate is contraindicated or unavailable, a double dose (3 mg) of levonorgestrel may be considered.

For individuals weighing over 85 kg or with a BMI over 30 kg/m², it is unclear whether ulipristal acetate or double-dose levonorgestrel is more effective.¹ For this group, a copper IUD is preferred where acceptable and accessible because its efficacy is not known to be affected by weight or body mass index (Table 1).¹

Drug interactions

Some drugs can interfere with the effectiveness of oral ECs. Cytochrome P450 (CYP) 3A4-inducing drugs, such as certain anticonvulsants (e.g. carbamazepine, phenytoin), rifampicin (used for tuberculosis), and antiretrovirals for human immunodeficiency virus, may reduce the efficacy of levonorgestrel and ulipristal acetate (Table 1).¹ Herbal supplements like St John's Wort can have a similar effect.¹ Individuals taking CYP3A4-inducing drugs may require a double dose (3 mg) of oral levonorgestrel or should consider using the copper IUD to ensure adequate protection. The effectiveness of double-dose levonorgestrel and how it compares with ulipristal acetate is unknown. Double dosing of ulipristal acetate is not currently recommended.¹

The efficacy of ulipristal acetate may also be reduced if a progestogen-containing drug (including regular contraceptives or levonorgestrel EC) was used in the 7 days prior to ulipristal acetate due to competition for progesterone receptors.¹

Use in breastfeeding

Different EC methods have varying recommendations regarding their use in breastfeeding individuals (Table 1). The copper IUD does not impact lactation. Levonorgestrel is generally considered safe for use during breastfeeding, with no known significant effects on milk production or infant health. Where ulipristal acetate is the preferred EC for a breastfeeding individual, breastfeeding can continue uninterrupted as the risk to the infant is low. To minimise infant exposure to the low concentrations of ulipristal acetate excreted in breastmilk, the individual may express and discard breastmilk for 24 hours after taking ulipristal acetate.²

Vomiting after emergency contraception

Vomiting is a common adverse effect impacting approximately 1% of people after taking levonorgestrel or ulipristal acetate.³ Vomiting within 3 hours of taking an oral EC may result in incomplete absorption, necessitating a repeat dose. Those with a history of vomiting following prior use of EC may require an antiemetic to prevent vomiting. Vomiting is less common with current oral ECs than historic higher dose hormonal EC approaches.

 

Initiation of contraception following oral emergency contraception

A single dose of oral EC does not provide ongoing protection against pregnancy. Additional doses of the same oral EC may be supplied following further unprotected intercourse within the same menstrual cycle, if required. However, the efficacy of ulipristal acetate may be reduced if levonorgestrel EC or other hormonal contraception was used in the 7 days before or the 5 days after taking ulipristal acetate.

Comprehensive counselling of the patient when supplying oral EC, whatever the setting, may include assessment of ongoing contraceptive needs and provision of efficacy-based advice regarding contraceptive options. Where EC supply is occurring in a pharmacy, referral to a general practitioner (GP) or a sexual health or family planning clinic to access effective contraception may be needed if prescribing the preferred contraceptive is not within the pharmacist's legal scope of practice.

For individuals supplied levonorgestrel EC, ongoing contraception can be started immediately. However, additional non-hormonal contraception (e.g. condoms) should be used for 7 days (9 days if using the Qlaira combined oral contraceptive pill and 2 days if using the levonorgestrel-only pill) to ensure protection against pregnancy.

Starting hormonal contraception immediately after taking ulipristal acetate may reduce the effectiveness of both the emergency and ongoing contraception competing for progesterone receptors. Guidelines therefore advise delaying the initiation of hormonal contraception for 5 days to allow ulipristal acetate to be cleared.¹ During these 5 days, and until the newly commenced contraceptive method becomes effective (Table 2), individuals should abstain from sex or use condoms.

Table 2 Time to contraceptive effectiveness when starting 120 hours (5 days) after taking ulipristal acetate for emergency contraception

Contraceptive method	Time to contraceptive effectiveness when starting 120 hours (5 days) after taking ulipristal acetate for emergency contraception
Combined oral contraceptive pill	7 days (9 days if using Qlaira combined oral contraceptive pill)
Vaginal ring	7 days
Progestogen-only pill	2 days for levonorgestrel- or norethisterone-containing progestogen-only pills 7 days for drospirenone-containing progestogen-only pill
Progestogen-only implant or injection	7 days
Adapted from reference 1

 

When to do a follow-up pregnancy test

Patients should be advised to undertake a follow‑up urinary pregnancy test at 3 weeks after unprotected intercourse if:

• menstruation is delayed more than 1 week
• the patient experiences pregnancy symptoms (e.g. nausea, fatigue, breast tenderness)
• there are concerns about EC failure; for example, vomiting occurs within 3 hours of taking EC, or there are known drug interactions.¹

 

Counselling on sexually transmissible infections

Emergency contraception does not protect against sexually transmissible infections (STIs). It is essential for healthcare providers to assess STI risk based on patient history and inform patients that EC does not protect against STIs. Pharmacists should routinely provide advice about STI screening, ongoing sexual health support and referral to a GP or sexual health clinic when needed. GPs and other sexual healthcare providers should offer screening for common STIs, such as chlamydia, gonorrhoea and syphilis (noting the increasing incidence of syphilis in Australia⁷), as per Australian guidelines.⁸ Barrier methods, such as condoms, should be recommended to prevent future STI transmission, where relevant.

 

Discussion around potential sexual assault

Emergency contraception may be sought by individuals following sexual assault. Cases of suspected sexual assault involving minors should be referred in accordance with mandatory reporting requirements. All individuals experiencing or who have experienced sexual violence should be offered referral services, including access to crisis intervention, forensic examination and legal support. More information is available at the Australian Sexual Assault Services Directory, which lists services by state. Where relevant, individuals should be advised of the availability of services such as 1800RESPECT, a 24-hour national sexual assault, family and domestic violence hotline.

 

Additional considerations when consulting minors

Oral ECs can be legally supplied to individuals of any age in all Australian states and territories.

When providing EC to minors, health professionals must assess the capacity to consent for treatment and address confidentiality concerns while adhering to mandatory reporting requirements. It is important to offer education on contraception and sexual health to empower young individuals with knowledge and choices. Additionally, ensuring a supportive and non-judgemental environment is essential for minors to feel comfortable disclosing issues related to sexual abuse or coercion, or concerns about consent.

 

Best practice emergency contraception provision

Individuals may feel uncomfortable or stigmatised when approaching a health professional for EC. Consideration needs to be given to providing a private space, such as a consulting room, to counsel individuals about both EC and ongoing contraceptive needs and options. The consultation should occur in a respectful and non-judgemental conversational manner. Guidelines advise against using a written checklist or form as these can be perceived as a barrier to care;⁶ however, some individuals may feel more comfortable providing specific information on a form to support the consultation. Pharmacists should also document the supply (or refusal) of oral EC and details of the consultation, including counselling points, advice and any referrals provided.⁶

 

Conclusion

Options for EC include oral levonorgestrel, oral ulipristal acetate and the copper IUD. The choice of method for any individual will depend on factors such as time since unprotected intercourse, accessibility, cost and patient preference. Medical conditions and potential drug interactions should also be considered. Patients should be offered contraceptive counselling and STI testing and connected to support where sexual assault is suspected or reported.

This article was finalised on 20 April 2026.

Conflicts of interest: Danielle Mazza has received research funding from Bayer, Organon, and Merck Sharp & Dohme (MSD), and has been on advisory boards for Bayer, Organon, MSD and Gedeon Richter. Danielle is the director of SPHERE, the Centre of Research Excellence in Women's Sexual and Reproductive Health in Primary Care, which is funded by the National Health and Medical Research Council. Danielle is a member of the Therapeutic Goods Administration Women's Health Product Working Group and was previously a member of the Royal Australian College of General Practitioners' Expert Committees on Quality Care and Research.

Joanne Gross is the President of the Tasmanian branch of the Pharmaceutical Society of Australia (PSA) and has represented PSA at the Pharmaceutical Benefits Advisory Committee oral contraceptives stakeholder meeting, the Tasmanian Pharmacist Scope of Practice Working Group, and the University of Tasmania School of Pharmacy Clinical Advisory Committee. Joanne is also a member of the Tasmanian Medicines Access and Advisory Committee.

This article is peer reviewed.

 

References

1. College of Sexual and Reproductive Healthcare. Emergency Contraception. 2017. Last updated July 2023. [cited 2026 Apr 5]
2. Sexual and Reproductive Health Australia. Ulipristal acetate emergency contraception and breastfeeding, Family Planning Alliance Australia: Statement from the Clinical Reference Group of the Medical Advisory Committee January 2020. Family Planning Alliance Australia; 2020. [cited 2026 Mar 30]
3. Australian Medicines Handbook Pty Ltd. Australian Medicines Handbook 2026 (online). Adelaide; 2026. [cited 2026 Apr 5]
4. World Health Organization. Selected practice recommendations for contraceptive use. World Health Organization; 2016. [cited 2026 Apr 5]
5. Stevenson TB, Thapaliya K, Moore V, Mazza D, Grzeskowiak LE. Accessibility of oral emergency contraceptives in Australian community pharmacies. Contraception 2024;137:110480.
6. Samson L. Emergency Contraception. In: Australian Pharmaceutical Formulary and Handbook. 26th ed.; 2024.
7. Australian Centre for Disease Control. National Syphilis Surveillance Report Q2 2025. Department of Health, Disability and Ageing; 2025. [cited 2026 Apr 5]
8. ASHM. Australian STI Management Guidelines. ASHM; 2025. [cited 2026 Apr 5]