A 35-year-old woman who is 5 days postcoital requests emergency contraception. She had unprotected intercourse 5 days ago. What is the most effective emergency contraception option available at this time point?

• A Levonorgestrel 1.5 mg orally — still within the effective 72-hour window if adjusted for body weight
• B Ulipristal acetate 30 mg orally — licensed for use up to 120 hours (5 days) post-coitus
• C Copper intrauterine device (Cu-IUD), effective up to 5 days after unprotected intercourse ✓
• D Mifepristone 200 mg orally within 120 hours is the most effective oral emergency contraceptive

Explanation

The copper IUD is the most effective emergency contraceptive available, with a failure rate <0.1%, and is effective when inserted up to 5 days (120 hours) after unprotected intercourse OR up to 5 days after the estimated date of ovulation, whichever is later. At exactly 5 days post-coitus, ulipristal acetate (UPA) at 30 mg is also licensed up to 120 hours and is superior to levonorgestrel in this time window. However, the Cu-IUD remains MORE effective than oral UPA, particularly in obese women, and provides ongoing contraception. Levonorgestrel loses significant efficacy beyond 72 hours and is not recommended at 5 days. Mifepristone as emergency contraceptive is used in some countries (China) but at 25 mg, not 200 mg.

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

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Written and medically reviewed by the StethoPrep medical team.