Methotrexate contraception — DFSRH MCQ
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Correct answer: E — Long-acting reversible contraception such as Cu-IUD or LNG-IUD
The best answer is “Long-acting reversible contraception such as Cu-IUD or LNG-IUD”. Methotrexate is teratogenic, so a highly effective LARC method should be strongly discussed if acceptable. Condoms alone and withdrawal have higher typical-use failure rates, which is important when pregnancy would be high risk. UPA is EC rather than planned contraception, and CHC may or may not be suitable but misses the central teratogenic risk counselling. The pearl is to escalate contraceptive reliability when medication makes pregnancy hazardous. Intrauterine-method decisions require separation of expected bleeding from pregnancy, partial expulsion, perforation and pelvic infection. Device position, pregnancy risk, recent intercourse and clinical stability determine whether treatment, removal, imaging or emergency contraception is needed. Pelvic infection is treated promptly, but an IUD is not removed routinely when the patient is improving on appropriate antibiotics.
Reference: CoSRH/FSRH, Intrauterine Contraception (March 2023, amended January 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf