A 28-year-old woman presents to the emergency department 18 hours after unprotected intercourse. She is requesting emergency contraception. Which of the following is the most common regimen used for emergency contraception in India?

Explanation

## Emergency Contraception: Most Common Regimen **Key Point:** Levonorgestrel 1.5 mg as a single dose is the most commonly used and recommended emergency contraceptive in India and globally. ### Efficacy & Timing - Most effective when given within **72 hours** of unprotected intercourse - Can be used up to 120 hours, but efficacy decreases with time - Reduces pregnancy risk by approximately **60–90%** depending on timing - Works primarily by **delaying or inhibiting ovulation** ### Mechanism of Action 1. Inhibits or delays the LH surge 2. Prevents or delays ovulation 3. Alters endometrial morphology (secondary effect) 4. Does NOT disrupt an established pregnancy ### Comparison of Emergency Contraceptive Options | Regimen | Timing | Efficacy | Availability in India | Notes | |---------|--------|----------|----------------------|-------| | **Levonorgestrel 1.5 mg** | Within 72 hrs (up to 120 hrs) | 60–90% | Very common, OTC | Gold standard; most accessible | | Mifepristone 10 mg | Within 72 hrs | 85–90% | Limited; restricted use | Progesterone antagonist; not first-line | | Ulipristal acetate 30 mg | Within 120 hrs | 95% | Rare in India | Selective progesterone receptor modulator; expensive | | Copper T | Within 5 days | >99% | Available | Most effective; requires insertion; not suitable for all | **High-Yield:** Levonorgestrel is the **most commonly prescribed** emergency contraceptive in India because it is: - Widely available as an OTC medication - Affordable - No medical contraindications - Easy to administer (single oral dose) - Well-tolerated **Clinical Pearl:** The "window of opportunity" is **72 hours** for levonorgestrel; however, it can be used up to 120 hours with declining efficacy. Earlier administration = better efficacy. **Warning:** Levonorgestrel is **NOT effective if ovulation has already occurred**. It must be given *before* the LH surge. ### Why Copper T is Not the Most Common Although copper IUD is the most effective emergency contraceptive (>99% efficacy), it is not the "most common" because: - Requires clinical insertion - Invasive procedure - Not suitable for all women (e.g., those with copper allergy, anatomical abnormalities) - Requires trained provider availability - Higher cost and complexity compared to oral levonorgestrel