Question
Emergency contraception and ARVs
3 November 2024. Related: All topics, Drug interactions, Pregnancy, Sexual health.
What emergency contraception can I use if I am on ARVs?
Answer
Hello and many thanks for the question
There are three options for emergency contraception: two hormonal ones and the copper IUD.
Contemporary ARVs don’t have interactions with emergency hormonal contraception or as it is often referred to “the morning after” pill.
However, Efavirenz based regimens (like Atripla, Trenvir, Atroiza, etc. here you can see a list of generic ARVs and their names) interact with oral hormonal contraception so there need to be adjustments to the dose for it to be effective.
Oral hormonal emergency contraception
Currently according to FSRH (The Faculty of Sexual and Reproductive Health) clinical guidance and the BNF (British National Formulary) those who are on Efavirenz should be using double the dose of levonorgestrel (LNG) 1.5 mg (commonly found under the brand names Levonelle, Upostelle and Emerres) for emergency contraception.
Ulipristal acetate (UPA), the other oral hormonal emergency contraception drug (commonly found under the brand name EllaOne) should not be used by those on efavirenz regimens as the dose cannot be adjusted.
For any oral hormonal emergency contraception there are also weight considerations so it’s best to speak to a healthcare professional before deciding to take any of these tablets.
The copper IUD
The third option for emergency contraception is the copper coil or IUD.
On the bright side: It is more effective, doesn’t have any interactions with medication, and doesn’t need any dose adjustments according to weight.
The disadvantages are: the IUD has to be placed and removed by a healthcare professional and if you decide to keep it (for long acting contraception) might make your periods heavier and more painful.
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