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Perimenopause CHC risk assessment — DFSRH MCQ

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HardCombined hormonal contraceptionPerimenopause CHC risk assessmentDFSRH

A 51-year-old uses a desogestrel POP and is starting systemic HRT for vasomotor symptoms. She asks whether HRT replaces the need for contraception. Which advice is most appropriate?

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Correct answer: B — Continue contraception because HRT does not prevent pregnancy

The best answer is “Continue contraception because HRT does not prevent pregnancy”. HRT is not contraceptive, so contraception should continue until the relevant menopause stopping rule is met. A desogestrel POP can be used alongside HRT if otherwise suitable and may be continued to age 55. Starting CHC is not required to use HRT, while monthly FSH testing and an arbitrary one-month HRT interval do not provide contraceptive reassurance.

Reference: CoSRH/FSRH, Contraception for Women Aged Over 40 Years (amended May 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-for-women-aged-over-40-years.pdf