Emergency IUD and emergency contraception at HAP.GENT
Dr Didier Hebberecht — HAP.GENT
A condom breaking or sex without contraception: it can happen. Missing a pill can also create a risk of pregnancy. This depends on the type of pill, how many pills you missed and when. Ask a doctor or pharmacist for advice as soon as possible. In addition to the emergency contraceptive pill, an intrauterine device (IUD) can be used for emergency contraception. Belgian recommendations identify both the copper IUD and the hormonal IUD containing 52 mg of levonorgestrel as highly effective options. Below, we explain the time limits for fitting an IUD and how to choose the option that suits your situation. [4, 8, 9]
What is an emergency IUD?
An emergency IUD is not a separate type of device. It is an IUD fitted after unprotected sex to prevent pregnancy. Both a copper IUD and a hormonal IUD containing 52 mg of levonorgestrel may be suitable. The Belgian decision flowchart lists a copper or levonorgestrel IUD as the first choice when fitting is possible and wanted. Using a hormonal IUD for emergency contraception is off-label, meaning it is outside its officially approved indication. [4, 8–10]
A copper IUD works mainly by preventing fertilisation: copper affects sperm function and movement. An effect on implantation may also contribute to its action as emergency contraception. The copper IUD contains no hormones. It is not an abortion treatment and is not fitted during an existing pregnancy. [1, 2, 4]
How quickly do you need to act?
Both a copper IUD and a hormonal IUD containing 52 mg of levonorgestrel can be fitted for emergency contraception within five days of unprotected sex. Have you had unprotected sex more than once? Do not simply count from the most recent occasion: for the usual five-day window, the first episode of unprotected sex in the relevant cycle matters. Tell us when all episodes took place so that we can assess whether an IUD can still be fitted. Do not wait until the last day: time is needed to assess your situation and arrange the fitting. [3, 8, 9]
Was the first episode more than five days ago? Contact us anyway. For the copper IUD only, a longer window may apply: if the timing of ovulation can be estimated with sufficient confidence, fitting may still be possible up to five days after the estimated date of ovulation. We assess whether this is appropriate in your situation; a cycle-tracking app alone does not provide enough certainty. This extended window does not apply to the hormonal IUD. [3]
How effective is an emergency IUD?
When fitted within five days, the copper IUD is more than 99% effective as emergency contraception. The emergency contraceptive pill works by delaying ovulation and is no longer reliable once ovulation has occurred. A copper IUD may still be an option at that stage. [1, 4]
An additional benefit is that you can leave the IUD in place for contraception over the following years. How long it can be used depends on the model. You therefore do not need to decide on another contraceptive method straight away. If you only want to use it temporarily, discuss when it can safely be removed. [2, 3]
Emergency IUD or emergency contraceptive pill?
The best choice depends on when you had sex, your cycle, your usual contraception, any medicines you take and your preferences. An IUD is particularly useful if you also want long-term contraception afterwards. [9, 10]
At a higher body weight or BMI, oral emergency contraception may be less reliable, particularly the emergency pill containing levonorgestrel. An IUD is an important option in this situation. Evidence on the effect of weight is limited; we take this into account when choosing a method. [4]
Some medicines and herbal remedies also reduce the effectiveness of the emergency pill. Examples include carbamazepine, rifampicin and St John’s wort. Tell us if you are taking these now or have taken them in the past four weeks. Belgian recommendations advise an IUD or, alternatively, a double dose of levonorgestrel under the guidance of a doctor or pharmacist. Ulipristal is not recommended in this situation. [9]
The levonorgestrel emergency pill is used within 72 hours; ulipristal can be taken up to 120 hours after unprotected sex. The sooner you seek advice, the better. Always tell us if you have already taken an emergency pill. A copper IUD may still be an option afterwards. [4]
If you cannot get an IUD fitted promptly, ask for advice about an emergency pill straight away. Do not let the available time pass while waiting for an appointment.
Can a hormonal IUD also be used?
Yes. According to Belgian recommendations, the hormonal IUD containing 52 mg of levonorgestrel is one of the most effective forms of emergency contraception. A randomised trial supports its use within five days of unprotected sex. This does not automatically apply to hormonal IUDs containing a lower dose. This use remains off-label. [4, 8, 9]
Have you already taken ulipristal? Tell us before choosing an IUD. Progestogens, such as levonorgestrel, can reduce the effectiveness of ulipristal. Immediate fitting of a hormonal IUD after ulipristal therefore requires an individual assessment. The copper IUD does not have this interaction and can still be fitted within the permitted time window. [3, 4]
How is the IUD fitted?
During the consultation, we discuss when you had unprotected sex, the first day of your last period and your medical history. We also ask about symptoms that could suggest an infection and any possible risk of a sexually transmitted infection (STI).
A pregnancy test may be needed, but a negative test shortly after unprotected sex does not rule out a very early pregnancy. The timing of your cycle and sexual contacts therefore remains important. [5]
The IUD is inserted into the womb through the vagina and cervix. Fitting usually takes a few minutes and may cause cramping or pain. Beforehand, we discuss how to minimise this as much as possible. An IUD can also be suitable if you have not had children. [2]
What can you expect afterwards?
You may have period-like cramps and some bleeding during the first few days. With a copper IUD, your periods may become heavier, longer or more painful. This matters when choosing a method, especially if you already have these symptoms. Serious complications, such as perforation of the womb, are rare. Occasionally, an IUD moves out of position or is expelled. [2, 6]
Take a pregnancy test three weeks after the last episode of unprotected sex. Contact us sooner if you miss a period or develop pregnancy symptoms. [7]
Seek prompt medical assessment if you develop worsening or severe lower abdominal pain, fever, unusual or unpleasant-smelling discharge, very heavy bleeding or a positive pregnancy test. Severe abdominal pain with dizziness or fainting requires urgent medical attention. [6]
An IUD does not protect against STIs. Depending on your situation, we discuss whether STI testing is appropriate. [2]
Emergency contraception at HAP.GENT
Think you may need emergency contraception? Call HAP.GENT the same day and clearly state that you need emergency contraception. Tell us when you had unprotected sex. Do not wait for a routine check-up appointment or your next period.
Together, we assess which option is suitable and how to arrange it in time. If you cannot reach the practice, ask a pharmacist for advice straight away. Outside opening hours, you can reach the out-of-hours GP service on 1733 for medical help that cannot wait. Explain that you need emergency contraception and when you had unprotected sex. [11]
Sources
WHO — Emergency contraception.
WHO — Intrauterine devices, 22 January 2026.
CDC — Emergency contraception, U.S. Selected Practice Recommendations 2024.
BCFI — Emergency contraception (Dutch).
CDC — How to be reasonably certain that a patient is not pregnant.
NHS — Side effects of an IUD or copper coil.
Devon Sexual Health — Emergency contraception.
BCFI — Emergency contraception decision flowchart, 2021 (Dutch).
FPS Public Health — Need an out-of-hours doctor? Call 1733 (Dutch).