A 32-year-old woman requires emergency contraception 60 hours after unprotected intercourse. She has a BMI of 32 kg/m² and is not breastfeeding. The most effective method at this time interval is:

• A Copper intrauterine device (Cu-IUD) ✓
• B Levonorgestrel 1.5 mg orally
• C Ulipristal acetate (ella) 30 mg orally
• D Combined OCP high-dose (Yuzpe regimen)

Explanation

The copper IUD is the most effective emergency contraception regardless of time of presentation (up to 120 hours = 5 days post-coitus) with a failure rate <0.1%. At 60 hours, ulipristal acetate remains effective (up to 120 hours) and is more effective than levonorgestrel, especially in women with BMI ≥26 kg/m² where levonorgestrel efficacy is significantly reduced. However, the copper IUD surpasses all oral methods in effectiveness. The Yuzpe regimen is least effective and rarely used. In a high-BMI woman at 60 hours, Cu-IUD is the optimal single answer.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.