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DMPA and VTE history — DFSRH MCQ

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HardUKMECDMPA and VTE historyDFSRH

A 36-year-old with recurrent unprovoked DVT is stable on anticoagulation. She declines intrauterine contraception and wants an injectable because anticoagulation has made her periods troublesome. Which plan best applies UKMEC and her bleeding priorities?

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

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Correct answer: E — Classify DMPA as UKMEC 3 and discuss a POP or implant

The best answer is “Classify DMPA as UKMEC 3 and discuss a POP or implant”. For a history of recurrent VTE, DMPA is UKMEC 3 because its risks usually outweigh benefits; anticoagulation does not convert it to category 1. A POP or implant may offer acceptable non-oestrogen contraception and can improve bleeding for some users, although bleeding patterns must be discussed. CHC remains inappropriate, while leaving her without contraception is unnecessary.

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