Emergency contraception (intrauterine device)

Intrauterine device (IUD) inhibits fertilisation by direct toxicity. It is said to have both pre and post fertilisation effects.

• in case fertilisation occurs, an anti inflammatory reaction within the endometrium will prevent implantation.
• in addition copper has a toxic effect on sperm and inhibits penetration (1)

An IUD (or advice on how to obtain one) should be offered to women who inquire about emergency contraception (EC) even if they present within 72 hours of unprotected sexual intercourse (1).

• ideally, an emergency IUD should be fitted at first presentation, but insertion can be delayed, at the woman's convenience; in which case, hormonal EC should always be given in the interim
  • in a situation where facilities are unavailable, local referral mechanisms should facilitate timely access to a specialist who can provide emergency IUD (1)

It is possible to insert a copper intrauterine contraceptive device (IUCD) within 5 days of unprotected sexual intercourse as a method of emergency contraception; however, of note, is that it is also possible to insert a copper IUCD within five days of the earliest time of ovulation (i.e. day 19 of a 28-day menstrual cycle) as a form of emergency contraception (1)

• the lowest failure rates are observed in IUD’s with banded copper on the arms and containing at least 380 mm2 of copper, hence these should be the first choice specially in women who intend to continue the IUD as long-term contraception (1)
• it is recommended that swabs are taken (including for chlamydia) before insertion
• prophylactic antibiotics should be prescribed if there is a risk of a sexually transmitted disease e.g. in the case of rape

Women should be informed to return 3 to 6 weeks after the insertion of the IUD to exclude infection, perforation or expulsion. Educated them about

• the small increase in the risk of pelvic infection for the immediate 20 days following IUD insertion
• to seek immediate medical advice if they develop symptoms of pelvic infection, pain, persistent menstrual abnormalities, missed period or non-palpable threads

There is no recorded evidence suggesting that concomitant drug use affects emergency IUD use (1). Therefore emergency IUD is the better option for patients on enzyme inducing drugs (2).

Contraindications for emergency IUD use is the same as routine IUD insertion (1).

Reference:

• (1) Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. FFPRHC Guidance (April 2006). Emergency contraception. J Fam Plann Reprod Health Care. 2006;32(2):121-8
• (2) Sharma A. Emergency contraception. BJMP 2009: 2(3) 64-65