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HRT is not contraception — DFSRH MCQ

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HardSpecial CircumstancesHRT is not contraceptionDFSRH

A 49-year-old starts sequential HRT for vasomotor symptoms and still menstruates every 2 months. What contraception advice is correct?

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Correct answer: E — Continue a separate contraceptive method while using HRT

The best answer is “Continue a separate contraceptive method while using HRT”. Neither sequential nor continuous combined HRT is licensed as contraception, and ovarian activity can continue during perimenopause. Contraceptive choice should account for age, medical eligibility and whether an LNG-IUD could also provide endometrial protection with oestrogen therapy. Menopausal symptoms or infrequent bleeding alone do not establish loss of fertility.

Reference: CoSRH/FSRH, Contraception for Women Aged Over 40 Years (amended May 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-for-women-aged-over-40-years.pdf