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High BMI and oral EC — DFSRH MCQ

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ModerateEmergency contraceptionHigh BMI and oral ECDFSRH

A 35-year-old woman with BMI 38 kg/m2 requests emergency contraception 36 hours after UPSI. She declines copper IUD after counselling. What would you advise this patient?

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Correct answer: C — Discuss that oral EC may be less effective and consider ulipristal rather than levonorgestrel

Higher BMI may reduce effectiveness of oral EC, particularly levonorgestrel, while Cu-IUD effectiveness is not known to be affected by weight. If Cu-IUD is declined, ulipristal is usually preferred if suitable. Counselling should be transparent rather than withholding care.

Reference: FSRH Emergency Contraception Guideline 2017 amended 2023; FSRH UPA breastfeeding statement 2025; BNF