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DMPA late injection — DFSRH MCQ

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HardProgestogen-only contraceptionDMPA late injectionDFSRH

A 25-year-old is 16 weeks after her last DMPA injection. She had unprotected sex 4 days ago, wishes to continue DMPA and has a negative urine pregnancy test today. Which management plan is most appropriate?

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Correct answer: C — Offer Cu-IUD and choose EC before DMPA reinjection if declined

The best answer is “Offer Cu-IUD and choose EC before DMPA reinjection if declined”. DMPA is regarded as on time up to 14 weeks after the previous injection, so this presentation requires emergency-contraception assessment. A copper IUD is the most effective EC option. If oral EC is chosen, levonorgestrel permits immediate DMPA quick start, whereas DMPA should be delayed for 5 days after ulipristal acetate; both routes need clear additional-precaution and pregnancy-test advice. A test today cannot exclude pregnancy from intercourse 4 days ago.

Reference: CoSRH/FSRH, Progestogen-only Injectable Contraception (December 2014, amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/progestogen-only-injectable-december-2014-amended-11july2023.pdf