Correct Answer: B. 30 mg
Ulipristal acetate is a selective progesterone receptor modulator (SPRM) approved for emergency contraception within 120 hours (5 days) of unprotected intercourse. The standard dose for emergency contraception is 30 mg as a single oral dose. This dose has been established through clinical trials (ELLA trial) and is recommended by international bodies including the WHO, FIGO, and Indian guidelines (FOGSI). Ulipristal is more effective than levonorgestrel, particularly in the 72–120-hour window post-intercourse, because it delays or inhibits ovulation even when the LH surge has already begun. The 30 mg single dose achieves optimal serum concentrations for progesterone receptor antagonism without requiring dose escalation. In Indian clinical practice, ulipristal is increasingly preferred over levonorgestrel for emergency contraception due to its superior efficacy profile, especially in women with higher BMI. The drug should be taken as soon as possible after unprotected intercourse, ideally within 72 hours but effective up to 120 hours.
Why the other options are wrong
A. 600 mg — This is wrong because 600 mg is 20 times the recommended dose and would cause severe adverse effects including nausea, vomiting, and potential hepatotoxicity. This represents a gross overdose and is not supported by any clinical trial or guideline. NBE may include this to test whether students confuse ulipristal dosing with other hormonal contraceptives or medications requiring higher doses. C. 60 mg — This is wrong because 60 mg is double the recommended dose and exceeds the therapeutic window established in the ELLA trial. Higher doses do not improve efficacy and increase the risk of adverse effects without additional contraceptive benefit. This is a common distractor that tests whether students know the precise dose rather than approximating. D. 300 mg — This is wrong because 300 mg is 10 times the recommended dose and would result in severe toxicity. This option may trap students who confuse ulipristal with other medications (e.g., mifepristone for medical abortion, which uses higher doses) or who incorrectly scale up from other emergency contraceptive regimens.
High-Yield Facts
- Ulipristal acetate 30 mg is the standard single oral dose for emergency contraception within 120 hours of unprotected intercourse.
- Ulipristal is effective up to 120 hours (5 days) post-intercourse, superior to levonorgestrel which is effective only up to 72 hours.
- Ulipristal is a selective progesterone receptor modulator (SPRM), not a progestin, allowing it to work even after LH surge has begun.
- ELLA trial established ulipristal's superiority over levonorgestrel, particularly in the 72–120-hour window and in women with BMI >25 kg/m².
- Ulipristal is contraindicated in pregnancy and should not be used if pregnancy is already confirmed; it is not an abortifacient at emergency contraceptive doses.
Mnemonics
30 for Ulipristal 30 mg = Ulipristal (single dose). Remember: 30 is the magic number for SPRM emergency contraception; levonorgestrel uses 1.5 mg (much lower) because it's a different class. ELLA = 5 days ELLA trial = 120 hours (5 days) window. Ulipristal works up to day 5; levonorgestrel only up to day 3. ELLA = Extended window, Levonorgestrel Limitation.
NBE Trap
NBE may pair ulipristal with levonorgestrel dosing (1.5 mg) to trap students who confuse the two emergency contraceptives. Additionally, offering 60 mg and 300 mg tests whether students have memorized the precise dose or are guessing based on "higher dose = stronger effect."
Clinical Pearl
In Indian clinical practice, a 25-year-old woman presenting within 96 hours of unprotected intercourse should receive ulipristal 30 mg as first-line emergency contraception, especially if BMI >25 kg/m² or if levonorgestrel has already failed. Counsel her that this is not an abortifacient and does not protect against STIs; follow-up contraception counseling is essential.
_Reference: FOGSI Guidelines on Emergency Contraception; WHO Medical Eligibility Criteria for Contraceptive Use; Harrison Ch. 297 (Contraception)_