A 35-year-old woman requests post-coital emergency contraception 60 hours after unprotected intercourse. Which method has the highest efficacy at this time point?
- A Copper intrauterine device (Cu-IUD) ✓
- B Levonorgestrel 1.5 mg single dose
- C Combined estrogen-progestogen Yuzpe regimen
- D Ulipristal acetate 30 mg single dose
Explanation
The copper IUD is the most effective emergency contraception, with a failure rate <0.1% when inserted within 5 days (120 hours) of unprotected intercourse, regardless of when in the 5-day window it is inserted — making it superior to all oral EC methods at 60 hours. Levonorgestrel has optimal efficacy within 72 hours but declines sharply after 48–72 hours. Ulipristal acetate (a selective progesterone receptor modulator) maintains consistent efficacy up to 120 hours and is superior to levonorgestrel between 72–120 hours. At 60 hours, Cu-IUD is still the gold standard for highest efficacy, followed by ulipristal acetate.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.