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Missed desogestrel POP and EC — DFSRH MCQ

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HardProgestogen-only methodsMissed desogestrel POP and ECDFSRH

A 30-year-old woman using a desogestrel POP missed tablets for 44 hours and had unprotected sex before restarting. She attends 3 days later, is not taking enzyme inducers, and declines a Cu-IUD. What is the most appropriate management?

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Correct answer: C — Offer levonorgestrel emergency contraception and advise precautions until efficacy returns

After a late or missed desogestrel POP with UPSI before contraceptive efficacy is re-established, EC is indicated; LNG is often selected when recent progestogen use may reduce UPA effectiveness. The 12-hour window applies to routine lateness, but this history exceeds the relevant missed-pill threshold. Restarting POP immediately after UPA is problematic, and LNG-IUD is not recommended as EC. The pearl is to distinguish missed-pill rules from emergency contraception decisions after UPSI.

Reference: FSRH Guideline: Emergency Contraception; FSRH Guideline: Progestogen-only Pills