What are the red flags for emergency contraception in urgent care?

Under 16, or concerns about coercion / exploitation → Safeguarding — Fraser guidelines, local safeguarding lead; Sexual assault → SARC referral, forensic and STI/HIV PEP considerations; Already pregnant (positive test) → EC not indicated — pregnancy options; Abdominal pain / bleeding with possible pregnancy → Exclude ectopic

Which decision rule is used for emergency contraception?

Choosing EC (FSRH): Within 120 h and eligible → copper IUD is most effective (offer to all); Within 120 h → ulipristal 30 mg (unless progestogen in last 7 days, enzyme inducers, severe asthma on oral steroids); Within 72 h → levonorgestrel 1.5 mg (3 mg if BMI > 26, weight > 70 kg, or enzyme inducers)

What should I prescribe for emergency contraception?

Ulipristal acetate (within 120 h): 30 mg single dose (More effective than levonorgestrel; avoid if progestogen taken in the last 7 days, enzyme inducers, severe asthma on oral steroids; breastfeeding — express and discard for 1 week); Levonorgestrel (within 72 h): 1.5 mg single dose (Use 3 mg if BMI > 26 or weight > 70 kg, or on enzyme inducers (FSRH))

Emergency Contraception: IUD, Ulipristal & Levonorgestrel | Urgent Care Clinic

Q: What safety-netting advice should I give for emergency contraception?

Return or seek help if: Next period more than 7 days late, unusually light or short — do a pregnancy test; Lower abdominal pain (ectopic); Do a pregnancy test 3 weeks after the unprotected sex anyway.

1Rule out first — red flags

If you find…	…then
Under 16, or concerns about coercion / exploitation	Safeguarding — Fraser guidelines, local safeguarding lead
Sexual assault	SARC referral, forensic and STI/HIV PEP considerations
Already pregnant (positive test)	EC not indicated — pregnancy options
Abdominal pain / bleeding with possible pregnancy	Exclude ectopic

2What to ask

Time since first and any other unprotected sex this cycle
LMP, cycle length (where in the cycle)
Contraception normally used / missed pills
Weight/BMI
Medicines: enzyme inducers (e.g. carbamazepine, rifampicin, St John’s wort); progestogen use in last 7 days
Breastfeeding; severe asthma on oral steroids (UPA)
STI risk; consent and safeguarding

3What to examine

Usually none needed
Pregnancy test if indicated

4How to do it — the senior at your shoulder

Work out the timing

Ask about every episode of unprotected sex since the last period. EC timing runs from the first episode in this cycle, but treatment can still be given for recent episodes.

Choosing the pill

Ulipristal works later in the cycle (closer to ovulation) and up to 120 h. Levonorgestrel works up to 72 h and is the option if hormonal contraception was used in the last 7 days or with enzyme inducers (at 3 mg).

5Decide — investigate only if it changes the plan

Choosing EC (FSRH)

Within 120 h and eligible → copper IUD is most effective (offer to all)
Within 120 h → ulipristal 30 mg (unless progestogen in last 7 days, enzyme inducers, severe asthma on oral steroids)
Within 72 h → levonorgestrel 1.5 mg (3 mg if BMI > 26, weight > 70 kg, or enzyme inducers)

Safeguarding check for every under-16; offer STI testing.

Investigation	Only if…
Pregnancy test	If UPSI > 21 days ago or period late; repeat 3 weeks after EC

6Treat & send home

Management & advice

Copper IUD is the most effective EC — offer to all eligible (within 120 h of first UPSI, or within 5 days of earliest likely ovulation)
If IUD not wanted/available: oral EC now, and refer for IUD if still possible
Vomiting within 3 h of a pill → repeat dose
After levonorgestrel: start hormonal contraception immediately (condoms 7 days, 2 days for POP)
After ulipristal: wait 5 days before starting hormonal contraception (condoms meanwhile)
STI testing advice; pregnancy test in 3 weeks

Refer / follow-up

Copper IUD → sexual health / contraception service (same or next day)
Under 16 / safeguarding → per local policy
Sexual assault → SARC

℞

Discharge prescription (TTO)Typical adult doses. Check allergies, renal function, pregnancy/breastfeeding and interactions. Tap BNF ↗ to confirm.

Drug	Dose	Duration / notes
Ulipristal acetate (within 120 h) BNF ↗	30 mg single dose	More effective than levonorgestrel; avoid if progestogen taken in the last 7 days, enzyme inducers, severe asthma on oral steroids; breastfeeding — express and discard for 1 week
Levonorgestrel (within 72 h) BNF ↗	1.5 mg single dose	Use 3 mg if BMI > 26 or weight > 70 kg, or on enzyme inducers (FSRH)

7Safety-net

Say it like this

The copper coil is the most effective emergency contraception and also gives you ongoing contraception, so I can refer you today. If you’d prefer a tablet, take it now. If you’re sick within 3 hours, you’ll need another dose. Do a pregnancy test in 3 weeks, or sooner if your period is late or unusual, and come back if you get tummy pain.

Come back / call 111 — or 999 if severe — if:

Next period more than 7 days late, unusually light or short — do a pregnancy test
Lower abdominal pain (ectopic)
Do a pregnancy test 3 weeks after the unprotected sex anyway

8Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Emergency contraceptionnhs.uk/conditions/contraception/emergency-contraception

9Where juniors slip up

Not offering the copper IUD
Standard-dose levonorgestrel for BMI > 26 / weight > 70 kg
Starting hormonal contraception straight after ulipristal
Missing safeguarding in under-16s

▶Practise the decision

Revision practice. Work through a real or imagined case to rehearse the reasoning. It builds a model note to learn from. It doesn’t replace your judgement, your seniors or local guidance.

✎Blank clinic note template

Emergency contraception — clinic note

URGENT CARE — EMERGENCY CONTRACEPTION PRESENTING COMPLAINT: HISTORY Time since first and any other unprotected sex this cycle: LMP, cycle length (where in the cycle): Contraception normally used / missed pills: Weight/BMI: Medicines: enzyme inducers (e.g. carbamazepine, rifampicin, St John’s wort); progestogen use in last 7 days: Breastfeeding; severe asthma on oral steroids (UPA): STI risk; consent and safeguarding: RED FLAGS (record present / absent) [ ] Under 16, or concerns about coercion / exploitation [ ] Sexual assault [ ] Already pregnant (positive test) [ ] Abdominal pain / bleeding with possible pregnancy PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Usually none needed: Pregnancy test if indicated: DECISION RULE — Choosing EC (FSRH): result ______ INVESTIGATIONS: none required / Pregnancy test — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Emergency contraception Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Next period more than 7 days late, unusually light or short — do a pregnancy test - Lower abdominal pain (ectopic) - Do a pregnancy test 3 weeks after the unprotected sex anyway Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical doses drawn from the guidance above. Always confirm in the current BNF/BNFc and your local antimicrobial policy.

More infections & medical

Cough & chest infectionBronchitis vs pneumonia, and the NICE rules on antibiotics.Lower UTIDiagnose on symptoms, choose by eGFR and pregnancy, spot pyelonephritis.Diarrhoea & vomitingRehydrate, rule out the surgical belly and the C. diff, and keep them off work.HeadacheScreen SNOOP, then treat tension and migraine well — and avoid opioids.