Fibroid cavity distortion — DFSRH MCQ

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HardIntrauterine methodsFibroid cavity distortionDFSRH

A 39-year-old woman with a submucosal fibroid distorting the uterine cavity requests an intrauterine method. She has heavy bleeding and ultrasound confirms cavity distortion. What is the most appropriate contraceptive method?

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

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Correct answer: D — Etonogestrel implant

Significant cavity distortion makes intrauterine methods unsuitable or higher risk, so a non-intrauterine effective option such as implant should be discussed. Both copper IUDs and LNG-IUDs depend on safe fundal placement and are poor choices with cavity distortion. Selecting a different copper device does not overcome the anatomical problem. The pearl is that fibroid location matters more than the word fibroid itself.

Reference: UKMEC 2025; FSRH Guideline: Intrauterine Contraception