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 at any time it can be determined that she is not pregnant (see Ruling Out Pregnancy).
  • She should use a backup method* for the first 7 days after LNG-IUD insertion.

After taking UPA-ECPs:

  • She can have the LNG-IUD inserted on the 6th day after taking UPA-ECPs if it can be determined that she is not pregnant.

    • 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 a copper-bearing 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.