A 30-year-old multiparous woman attends the clinic 5 days after unprotected intercourse. She is concerned about pregnancy. Which of the following emergency contraceptive methods is MOST appropriate at this time point?

Explanation

## Emergency Contraception at 5 Days Post-Intercourse **The copper-containing IUD (Cu-IUD) is the most effective emergency contraceptive method when inserted up to 5 days (120 hours) after unprotected intercourse.** ### Mechanism of Action: - Cu-IUD works primarily by preventing sperm transport and fertilization - It can also prevent implantation if fertilization has occurred - Effectiveness: >99% when inserted within 5 days of intercourse ### Timeline Comparison: | Method | Effective Window | Efficacy | |--------|------------------|----------| | **Levonorgestrel** | Within 72 hours | ~60% (decreases with time) | | **Cu-IUD** | Within 120 hours (5 days) | >99% | | **Ulipristal acetate** | Within 120 hours | ~98% | | **Mifepristone** | Not emergency contraception | Abortifacient | ### Key Points: - **High-Yield:** Cu-IUD is the gold standard for emergency contraception, especially beyond 72 hours - At 5 days post-intercourse, levonorgestrel efficacy has significantly declined - Cu-IUD is suitable for multiparous women (no contraindication to IUD use) - Mifepristone is an abortifacient, not emergency contraception **Clinical Pearl:** Cu-IUD can be inserted up to 5 days after intercourse or even up to 5 days after ovulation, making it superior to hormonal methods for delayed presentations.