Repeated UPSI after LNG-EC — DFSRH MCQ

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HardEmergency contraceptionRepeated UPSI after LNG-ECDFSRH

A 22-year-old takes levonorgestrel EC after condom failure and has further UPSI 3 days later. She presents within 24 hours of the second episode and declines a Cu-IUD. What is the most appropriate management?

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Correct answer: A — Offer further oral EC and ongoing contraception advice

The best answer is “Offer further oral EC and ongoing contraception advice”. Oral EC does not provide contraceptive cover for later UPSI, so further EC can be offered after a new risk episode when Cu-IUD is declined. The first LNG dose does not protect the full cycle. Repetition of oral EC in a cycle may be appropriate, LNG-IUD is not EC, and a same-day pregnancy test cannot exclude either recent episode. The pearl is that EC consultations must include advice about subsequent sex. Emergency-contraception choice requires the timing of every episode of UPSI, likely ovulation, weight or BMI, recent progestogen exposure, enzyme-inducing medicines, gastrointestinal absorption and the person’s willingness to use a copper IUD. The copper IUD remains the most effective option and is the only method effective after ovulation; oral agents mainly work by delaying ovulation and are not interchangeable in every scenario.

Reference: CoSRH/FSRH, Emergency Contraception (amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf