Emergency contraception

Emergency contraception can be used by people who have had sex where there's a risk of pregnancy (for example, if they've had penis-in-vagina sex but haven't used contraception, or they think the contraception might have failed). There are two types of emergency contraception available in Aotearoa New Zealand:

• The copper IUD (sometimes known as the 'copper coil')
• The emergency contraceptive pill.

If you need emergency contraception, see your doctor or local sexual health clinic. Find a local clinic here. Some pharmacies provide the emergency contraceptive pill over the counter without you having to see a nurse or doctor.

The copper IUD is a small, T-shaped device. It is placed in the uterus (womb). It contains copper and does not contain hormones. The copper IUD is the most effective form of emergency contraception. It is more than 99% effective at preventing pregnancy and is not known to be affected by body weight or BMI. 

It can be used as emergency contraception up to 5 days after unprotected sex. In some situations, it may still be an option up to 5 days after the earliest likely date of ovulation, so it is worth contacting a clinic as soon as possible. 

Once it is fitted, the copper IUD starts working straight away. You can choose to keep it in as ongoing contraception or you can have it removed earlier (usually the earliest time you can remove it after having it inserted for EC is after your first period post insertion).

The IUD prevents the egg from being fertilised by sperm by;

• Preventing the sperm from surviving inside a woman’s body as copper is toxic to sperm.
• Stopping a fertilised egg implanting in the uterus.
• It can stay in place and prevent pregnancy for 5 years.

The copper IUD does not end an established pregnancy. 

The IUD is fitted in the uterus by a trained nurse, midwife or doctor. 

An appointment will typically include:

• A few questions about your medical and family history, to work out what method would suit you best
• Before the IUD is fitted, you will need to have a vaginal examination. The doctor, midwife or nurse will pass a small instrument called a speculum into your womb (uterus) to check its size and position.

Fitting the IUD (shouldn’t take longer than 5-10 minutes):

• You will be given privacy to remove your underwear and lower clothing. You will usually be covered with a sheet
• You will lie on an examination bed with your knees bent. The nurse, midwife or doctor will gently place a speculum into the vagina. A speculum is the same instrument used for cervical screening. It helps them see the cervix, which is the opening to the uterus
• They may also do a vaginal examination to check the size and position of your uterus. This helps them insert the IUD safely
• The copper IUD is placed into the uterus using a small plastic insertion device. The arms of the IUD fold down while it is being inserted, then open once it is in the right place
• The insertion itself usually only takes a few minutes, but the full appointment will take longer
• Some people feel cramping or strong period-like pain during the insertion. Others feel only mild discomfort. Everyone’s experience is different
• Your nurse, midwife or doctor can talk with you about ways to make the appointment more comfortable. This may include pain relief tablets, local anaesthetic, breathing techniques, taking things slowly, or stopping if you need a break
• Once the IUD is in place, the clinician will trim the small threads so they sit high in the vagina. These threads are used later to check or remove the IUD. They should not hang outside the body

You may have cramping and light bleeding afterwards. Some people feel well enough to carry on with their day, while others prefer to rest.

To reduce the risk of infection, nothing is to go inside the vagina for 2 days following the procedure (no tampons/menstrual cups/fingers/penis/no baths or swimming - but you can still shower!)

The copper IUD can sometimes make periods heavier, longer or more crampy, especially at first. This often improves with time, but it is worth talking to a nurse or doctor if bleeding or pain is difficult to manage.

Seek medical attention if post insertion you are experiencing:

• Severe or worsening pain
• Heavy or unusual bleeding
• Fever or feeling very unwell
• Bad-smelling discharge
• A late period or pregnancy symptoms
• Pain during sex
• Concerns that the IUD has moved or come out.

The emergency contraceptive pill (ECP) The emergency contraceptive pill, or ECP, is sometimes called the “morning-after pill”. It can help prevent pregnancy after sex if no contraception was used, contraception failed, or something went wrong, like a condom breaking. 

In Aotearoa New Zealand the ECP we currently have available contains the hormone Levonorgestrel. This pill can help prevent pregnancy by delaying or stopping ovulation (aka the release of an egg cell from the ovary).

It only works if the ECP is taken before ovulation (Ovulation usually occurs in the middle of your cycle). If ovulation has already happened, the ECP will not prevent pregnancy. 

The ECP works best when it is taken as soon as possible after sex. It is most effective in the first 24 hours but can be taken up to 3 days (72 hours) after unprotected sex. The earlier it is taken, the more likely it is to delay ovulation in time.

The ECP does not end a pregnancy. It does not work once a pregnancy has already started, and there is no evidence that it harms a pregnancy if someone takes it and later finds out they are pregnant. 

If unprotected sex happened more than 3 days ago, or if you are unsure if ovulation may have already occurred, it’s important to talk to a nurse, doctor, or sexual health clinic, as other emergency contraception options may still be available.

Body weight can affect how well the levonorgestrel ECP works.

If you weigh over 70kg, or have a BMI over 26, the standard one-tablet dose may be less effective. This does not mean you have done anything wrong, and it does not mean you should not ask for emergency contraception. It just means it is worth talking with a pharmacist, nurse, doctor, or sexual health clinic about the best option for you.

For people over 70kg, a healthcare provider may recommend:

• Taking two levonorgestrel ECP tablets together instead of one, or
• Talking about other emergency contraception options, such as a copper IUD.

The copper IUD is the most effective form of emergency contraception. It can be inserted up to 5 days after unprotected sex, or up to 5 days after the earliest likely date of ovulation, depending on the situation. It is also not known to be affected by body weight or BMI.

Take the ECP as soon as possible. It helps to take it with food as some people feel sick after taking the ECP. If you vomit within three hours of taking the pills, you should return to your health care provider or clinic as you may need to take it again.

If you are already using a regular method of contraception such as the oral contraceptive pill, continue to take this as you would regularly.

After taking the ECP, some people may experience bleeding or spotting and some may experience an early or later start to the next menstrual period.

It is important to take a pregnancy test three to four weeks after taking the ECP to make sure that you are not pregnant, even if you have a period. 

The ECP may not prevent pregnancy if:

• Ovulation has already happened
• It is taken too late
• You vomit soon after taking it
• You have had more unprotected sex after taking it
• You take certain medicines that affect how it works
• Your body weight means the standard dose may be less effective.

Please speak with your healthcare provider or pharmacist to decide what the best option is for you.

The copper IUD is recommended for those who:

• Weigh over 70kg
• Aren't able to have the emergency contraceptive pill within 3 days of having unprotected sex
• Want the most effective emergency contraception.

The emergency contraceptive pill:

• Needs to be taken within 72 hours (3 days after unprotected sex), though the earlier the better
• Is 98% effective at preventing pregnancy in those under 70kg if taken within 72 hours after unprotected sex
• For those who weigh under 70kg: the ECP is 98% effective at preventing pregnancy
• For those who weigh over 70kg or have a BMI of more than 26 or more: getting a copper IUD is the best option. The ECP can be less effective and there is a risk that it won't work. In this situation, taking two ECPs might provide more protection against pregnancy, but there is limited evidence at this time

Your healthcare professional will be able to have a conversation with you about the options.

The ECP does not give you any ongoing protection against pregnancy - it is important to use condoms or another form of contraception for ongoing protection against pregnancy. However, the copper IUD will provide an ongoing method of contraception.

Neither the emergency contraceptive pill nor the copper IUD protects against sexually transmitted infections (STIs). If you have had unprotected sex, you should get tested by your doctor, nurse or sexual health clinic to ensure you have not contracted an STI.