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Unscheduled bleeding on CHC — DFSRH MCQ

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ModerateCombined hormonal contraceptionUnscheduled bleeding on CHCDFSRH

A 26-year-old woman has recurrent breakthrough bleeding on a combined pill taken with a 7-day hormone-free interval. She has no missed pills, no STI risk, normal blood pressure, and no contraindications. What is the most appropriate management?

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Correct answer: A — Offer an extended or tailored CHC regimen after excluding relevant causes

After checking adherence, pregnancy risk, STI risk and cervical screening status, a tailored CHC regimen can be offered for bleeding control. Permanent discontinuation is unnecessary when assessment is reassuring. DMPA may worsen irregular bleeding and should be counselled, while urgent colposcopy or antibiotics are not supported by this vignette. The pearl is to assess unscheduled bleeding systematically before changing methods.

Reference: FSRH Guideline: Combined Hormonal Contraception