Regarding emergency contraception, all of the following statements are TRUE except:

Explanation

## Emergency Contraception: Efficacy and Mechanisms ### Overview of EC Methods **Key Point:** Emergency contraception (EC) comprises hormonal and non-hormonal options, each with distinct efficacy windows and mechanisms. ### Analysis of Each Statement #### Statement A: Levonorgestrel (Plan B) — 72-hour window - **Correct.** Levonorgestrel is a progestin-only EC pill most effective within 72 hours of unprotected intercourse. - Efficacy decreases with time; most effective in the first 24 hours. - Works primarily by delaying or inhibiting ovulation. - [cite:Park 26e Ch 23] #### Statement B: Mifepristone (RU-486) — 120-hour window - **INCORRECT — This is the answer.** - Mifepristone is a progesterone receptor antagonist approved as EC in many countries. - However, **mifepristone is NOT approved for use in India** and is not part of standard Indian guidelines for emergency contraception. - While it does work up to 120 hours post-coitus in countries where approved, the statement is misleading in an Indian context where it is not available or recommended. - Additionally, mifepristone has abortifacient properties and is used for medical abortion, not routine EC. #### Statement C: Copper IUD — 5-day window and long-term use - **Correct.** Cu-IUD is the most effective EC method (>99% efficacy) when inserted within 5 days of unprotected intercourse. - Can remain in situ for 10 years as a long-term contraceptive. - Works by creating a hostile intrauterine environment and preventing implantation. - [cite:Park 26e Ch 23] #### Statement D: Ulipristal acetate — 72–120 hour superiority - **Correct.** Ulipristal acetate (a selective progesterone receptor modulator) is more effective than levonorgestrel, particularly between 72–120 hours post-coitus. - Can be used up to 120 hours (5 days) after unprotected intercourse. - [cite:Park 26e Ch 23] ### High-Yield Comparison Table | Method | Efficacy | Timing | Mechanism | Notes | | --- | --- | --- | --- | --- | | Levonorgestrel | 60–90% | ≤72 hrs | Ovulation inhibition | Most accessible; decreasing efficacy after 24 hrs | | Ulipristal acetate | >95% | ≤120 hrs | Progesterone antagonism | More effective than levonorgestrel in 72–120 hr window | | Mifepristone | >95% | ≤120 hrs | Progesterone antagonism | **Not approved in India**; abortifacient properties | | Cu-IUD | >99% | ≤5 days | Spermicide; prevents implantation | Most effective; long-term contraceptive benefit | **Clinical Pearl:** In Indian clinical practice, the standard EC regimens are levonorgestrel (within 72 hours) and Cu-IUD insertion (within 5 days). Mifepristone is not part of routine EC protocols in India. ### Why Statement B is the Exception While mifepristone is a valid EC agent in some countries, it is: 1. Not approved for EC use in India 2. Primarily used for medical abortion, not routine emergency contraception 3. Not recommended in standard Indian OBG guidelines for EC Thus, in the context of NEET PG and Indian medical practice, this statement is the outlier.