Levonorgestrel 1500 micrograms is available both on prescription and as a P medicine. POM levonorgestrel may be supplied without a prescription in pharmacies under the terms of a local PGD. The PGD will state whether a supply can be made to girls under 16 years of age when appropriate. If not, the girl must be referred to a GP or a sexual health service.

One tablet should be taken as soon as possible after UPSI or possible contraceptive failure and up to 72 hours after, where there are no contraindications to supply. Use between 72 and 120 hours after unprotected intercourse is an off-licence use.

It is possible that higher weight or BMI could reduce the effectiveness of oral emergency contraception, particularly levonorgestrel.

The FSRH no longer recommends levonorgestrel as first-line oral emergency contraception for a woman who has had UPSI that has taken place during the five days prior to the estimated day of ovulation. UPA is the first-line choice in this situation. The FSRH also states that women should be told that UPA is the most effective method of oral emergency hormonal contraception.

Ovulation

As a pharmacy professional offering EC services you need to consider ovulation and how to estimate ovulation date as this determines the most suitable type of oral emergency contraception.

The FSRH states that the evidence suggests that EC is ineffective if administered more than five days after the estimated ovulation date. However, since a woman’s ovulation date is hard to predict, the FSRH recommends that emergency contraception is offered after unprotected sexual intercourse (UPSI) on any day of a woman’s natural menstrual cycle. Choice of EC method may depend on whether it is considered likely that UPSI may have taken place during the woman’s fertile period.

For EC purposes, the FSRH states that ovulation occurs about 14 days prior to the onset
of menstruation, i.e. day 14 for a 28-day cycle or day 21 of a 35-day cycle.