Article Text

Download PDFPDF
Quick starting hormonal contraception after using oral emergency contraception: a systematic review
  1. Lauren EE Murphy1,2,
  2. Zhong E Chen3,
  3. Valerie Warner3,
  4. Sharon T Cameron1
  1. 1 Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK
  2. 2 Brighton and Sussex Medical School, University of Sussex, Brighton, UK
  3. 3 Chalmers Centre, Edinburgh, UK
  1. Correspondence to Lauren EE Murphy, 2A Chalmers Street, Edinburgh EH3 9ES, UK; l.murphy1{at}


Introduction Unprotected intercourse after oral emergency contraception (EC) significantly increases pregnancy risk. This underlies the importance of promptly starting effective, ongoing contraception – known as ‘quick starting’. However, theoretical concern exists that quick starting might interact with EC or hormonal contraception (HC) potentially causing adverse side effects.

Method A systematic review was conducted, evaluating quick starting HC after oral EC [levonorgestrel 1.5 mg (LNG) or ulipristal acetate 30 mg (UPA)]. PubMed, EMBASE, The Cochrane Library, ICTRP, and relevant reference lists were searched in February 2016. A lack of comparable studies prevented meta-analysis.

Results Three randomised controlled trials were identified. Two biomedical studies suggested HC action was unaffected by quick starting after UPA; one study examined ovarian quiescence (OR 1.27; 95% CI 0.51–3.18) while taking combined oral contraception (COC). Another assessed cervical mucus impenetrability (OR 0.76; 95% CI 0.27–2.13) while taking progestogen-only pills (POP). Quick starting POP reduced the ability of UPA to delay ovulation (OR 0.04; 95% CI 0.01–0.37). Side effects (OR 1.22; 95% CI 0.48–3.12) and unscheduled bleeding (OR 0.53; 95% CI 0.16–1.81) were unaffected by quick starting COC after UPA. Another study reported higher self-reported contraceptive use at 8 weeks among women quick starting POP after LNG, compared with women given LNG alone (OR 6.73; 95% CI 2.14–21.20).

  • emergency contraception
  • quick start
  • levonorgestrel
  • ulipristal acetate
  • systematic review

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors This study was undertaken as an undergraduate research project by LM, supervised by ZEC. LM produced and registered the protocol. LM and VW conducted the systematic literature search and assessed the included study quality. ZEC and SC reviewed and edited the drafts and final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • Highlights from this issue
    British Medical Journal Publishing Group