Method When to start or restart

Hormonal methods

(combined oral contraceptives, progestin-only pills, progestin-only injectables, monthly injectables, implants, combined patch, combined vaginal ring)

After taking progestin-only or combined ECPs:

  • Can start or restart any method immediately after she takes the ECPs. No need to wait for her next monthly bleeding.
    • The continuing user of oral contraceptive pills who needed ECPs due to error can resume use as before. She does not need to start a new pack.

    • Patch users should begin a new patch.

    • Ring users should follow the instructions for late replacement or removal.

  • All women need to abstain from sex or use a backup method* for the first 7 days of using their method.
  • If she does not start immediately, but instead returns for a method, she can start any method at any time if it is reasonably certain she is not pregnant.

After taking ulipristal acetate (UPA) ECPs:

  • She can start or restart any method containing progestin on the 6th day after taking UPA-ECPs. No need to wait for her next monthly bleeding. (If she starts a method containing progestin earlier, both the progestin and the UPA could be less effective.)
    • If she wants to use oral contraceptive pills, vaginal ring, or patch, give her a supply and tell her to start on the 6th day after taking UPA-ECPs. If she wants to use injectables or implants, give her an appointment to return for the method on the 6th day after taking UPA-ECPs or as soon as possible after that.

    • All women need to use a backup method from the time they take UPA-ECPs until they have been using a hormonal method for
      7 days (or 2 days for progestin-only pills).

  • If she does not start on the 6th day, but instead returns later for a method, she may start any method at any time if it is reasonably certain she is not pregnant.

Levonorgestrel intrauterine device

After taking progestin-only or combined ECPs:

  • She can have the LNG-IUD inserted immediately.
  • She should use a backup method for the first 7 days after LNG-IUD insertion.

  • If she does not have the LNG IUD inserted immediately, but instead returns later, she can have it inserted any time if it can be determined she is not pregnant.

After taking UPA-ECPs:

  • She can have the LNG-IUD inserted on the 6th day after taking UPA-ECPs.

    • If she wants to use the LNG-IUD, give her an appointment to return to have it inserted on the 6th day after taking UPA-ECPs or as soon as possible after that.

  • She will need to use a backup method from the time she takes UPA-ECPs until 7 days after the LNG-IUD is inserted.

  • If she does not have the LNG-IUD inserted on the 6th day, but instead returns later, she can have it inserted at any time if it can be determined she is not pregnant.

Copper-bearing intrauterine device

After taking progestin-only, combined, or UPA-ECPs:

  • If she decides to use an IUD after taking ECPs, she can have it inserted on the same day she takes the ECPs. No need for a backup method.
  • If she does not have it inserted immediately, but instead returns for the method, she can have the copper-bearing IUD inserted any time if it can be determined that she is not pregnant.

Note: The copper-bearing IUD can be used for emergency contraception. A woman who wants to use the IUD for regular contraception can have it inserted for emergency contraception within the first 5 days after unprotected sex and then continue using it (see Copper-Bearing IUD).

Female sterilization

After taking progestin-only, combined, or UPA-ECPs:

  • The sterilization procedure can be done within 7 days after the start of her next monthly bleeding or any other time if it is reasonably certain she is not pregnant. Give her a backup method to use until she can have the procedure.
Male and female condoms, spermicides, diaphragms, cervical caps, withdrawal

After taking progestin-only, combined, or UPA-ECPs:

  • Immediately.

Fertility awareness methods

After taking progestin-only, combined, or UPA-ECPs:

  • Standard Days Method: With the start of her next monthly bleeding.
  • Symptoms-based methods: Once normal secretions have returned.

  • Give her a backup method to use until she can begin the method of her choice.

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.