Quick-start contraception — DRCOG MCQ
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Correct answer: E — Give oral EC, quick-start the implant with method-specific precautions, and test 21 days after intercourse
The best answer is “Give oral EC, quick-start the implant with method-specific precautions, and test 21 days after intercourse”. A pregnancy test at 72 hours cannot exclude pregnancy from this intercourse, so oral emergency contraception is addressed first. When a copper IUD is declined, the requested implant can be quick-started after choosing oral EC, with the start timing and additional precautions adapted to whether levonorgestrel or ulipristal was used. A pregnancy test 21 days after the last unprotected intercourse provides the necessary safety net, waiting for the next period creates avoidable risk of further unprotected intercourse. UK contraceptive decisions use UKMEC 2025, not US MEC, and require method-specific rather than class-wide reasoning. Oestrogen-related stroke and thrombosis risks may rule out CHC while leaving progestogen-only or intrauterine methods available. Emergency contraception and quick-start decisions additionally require precise timing and follow-up pregnancy testing.
Reference: CoSRH/FSRH, Quick Starting Contraception: https://www.cosrh.org/Common/Uploaded%20files/documents/1fsrh-guideline-quick-starting-contraception-april-2017.pdf CoSRH/FSRH, Emergency Contraception: https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf