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Vomiting with CHC — DFSRH MCQ

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ModerateCombined hormonal contraceptionVomiting with CHCDFSRH

A 29-year-old woman taking a standard 21/7 combined pill vomited repeatedly for 36 hours during week 1 and had UPSI the previous night. She is now well and asks what to do. What is the most appropriate management?

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

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Correct answer: B — Use missed-pill guidance and assess need for EC

The best answer is “Use missed-pill guidance and assess need for EC”. Repeated vomiting can impair absorption of combined oral contraception and is managed as missed pills. Because this occurred in week 1 with recent unprotected sex, emergency-contraception assessment and additional precautions are required. Immediate ulipristal followed by same-day CHC restart would need interaction-aware timing; stopping the whole pack or changing to DMPA without pregnancy follow-up is not the standard response.

Reference: CoSRH/FSRH, Combined Hormonal Contraception (January 2019, amended October 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf