BMI and oral emergency contraception — DFSRH MCQ

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HardEmergency contraceptionBMI and oral emergency contraceptionDFSRH

A 32-year-old using a desogestrel POP took her last pill yesterday and now needs oral EC 72 hours after UPSI. She declines a copper IUD. Which oral option avoids concern that recent progestogen may reduce ulipristal efficacy?

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Correct answer: E — Levonorgestrel EC with immediate continuation of the POP

The best answer is “Levonorgestrel EC with immediate continuation of the POP”. Recent progestogen exposure may reduce ulipristal’s ability to delay ovulation, so levonorgestrel EC is the appropriate oral choice when the copper IUD is declined in this scenario. The POP can continue immediately after levonorgestrel, with product-specific additional precautions and a pregnancy test 21 days after the last UPSI. Emergency-contraception choice requires the timing of every episode of UPSI, likely ovulation, weight or BMI, recent progestogen exposure, enzyme-inducing medicines, gastrointestinal absorption and the person’s willingness to use a copper IUD. The copper IUD remains the most effective option and is the only method effective after ovulation; oral agents mainly work by delaying ovulation and are not interchangeable in every scenario.

Reference: CoSRH/FSRH, Emergency Contraception (amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf