Emergency contraception — RACGP Fellowship MCQ

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ModerateWomen's health and O&GEmergency contraceptionRACGP Fellowship

A 27-year-old woman requests emergency contraception 72 hours after unprotected intercourse. She weighs 92 kg, has no contraindications and wants the most effective option. What is the most appropriate management?

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Correct answer: B — Offer copper intrauterine device insertion if acceptable and available

The copper intrauterine device (IUD) is the most effective emergency contraceptive available (>99% effective) and is the optimal choice for this patient. Although she presents at exactly 72 hours, her body mass index of ~30.5 kg/m² places her in the obese category where oral levonorgestrel and ulipristal acetate show significantly reduced efficacy (pregnancy rates three times higher than normal BMI). The copper IUD remains highly effective regardless of weight, can be inserted up to 120 hours post-intercourse, and provides dual benefit: immediate emergency contraception plus long-term reversible contraception. Combined oral contraceptives in the Yuzpe regimen are not TGA-approved for emergency contraception and are inferior. Depot medroxyprogesterone is not indicated or recommended for emergency use. A pregnancy test is not required before offering emergency contraception, and it is not too late at 72 hours if the copper IUD is chosen.

Reference: Australian Prescriber. Emergency contraception: an overview. June 2026. https://australianprescriber.tg.org.au/articles/emergency-contraception-an-overview.html; RACGP. Ulipristal acetate – An update for Australian GPs. Australian Family Physician, May 2017.