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Late DMPA injection and UPSI — DFSRH MCQ

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HardProgestogen-only methodsLate DMPA injection and UPSIDFSRH

A 28-year-old woman using DMPA returns 15 weeks after her last injection and reports UPSI 3 days ago. Pregnancy test is negative, she declines an IUD, and wants to continue DMPA. What is the most appropriate management?

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

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Correct answer: D — Offer oral emergency contraception, give DMPA today if appropriate, and arrange pregnancy test follow-up

After more than 14 weeks since DMPA, UPSI can indicate EC, and same-day continuation may be considered with follow-up pregnancy testing when pregnancy cannot yet be excluded. Treating 15 weeks as fully covered is unsafe. UPA followed immediately by progestogen is problematic, delaying contraception increases risk, and LNG-IUD is not EC. The pearl is that late injectable attendance requires both EC thinking and quick-start follow-up.

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