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Malabsorptive bariatric surgery and CHC — DFSRH MCQ

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HardCombined hormonal contraceptionMalabsorptive bariatric surgery and CHCDFSRH

A 32-year-old had Roux-en-Y gastric bypass 18 months ago and has diarrhoea several times a week. Her BMI is 26 kg/m² and she has no other contraindication to combined hormonal contraception. She asks whether a UKMEC 1 safety category means an oral combined pill will be fully reliable. Which answer is most accurate?

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Correct answer: A — Choose non-oral contraception; UKMEC safety does not predict efficacy

The best answer is “Choose non-oral contraception; UKMEC safety does not predict efficacy”. UKMEC categories describe safety, not contraceptive efficacy. Procedures with a malabsorptive component, especially with ongoing diarrhoea or vomiting, can reduce the effectiveness of oral contraception even when an individual has no other safety restriction. Dose doubling is not a recommended workaround. A non-oral method can avoid the absorption concern; bariatric surgery does not make every hormonal method unreliable.

Reference: CoSRH, UK Medical Eligibility Criteria for Contraceptive Use 2025: https://www.cosrh.org/Common/Uploaded%20files/documents/UKMEC_2025.pdf