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Progestogen method and unexplained bleeding — DFSRH MCQ

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HardProgestogen-only contraceptionProgestogen method and unexplained bleedingDFSRH

A 46-year-old DMPA user reports new heavy bleeding after 5 years of amenorrhoea. She has obesity and has not had cervical screening for 8 years. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Pregnancy test, pelvic assessment and referral pathway for abnormal bleeding

New heavy bleeding after long amenorrhoea needs assessment for pregnancy, cervical disease and endometrial pathology, especially with risk factors. Method-related bleeding should not be assumed. The contraceptive review is also a safety-netting opportunity.

Reference: FSRH Progestogen-only Pills Guideline; FSRH Progestogen-only Implant Guideline; FSRH Progestogen-only Injectable Guideline; UKMEC 2025; BNF