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Major surgery and CHC — DFSRH MCQ

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HardCombined hormonal contraceptionMajor surgery and CHCDFSRH

A 37-year-old using CHC is booked for major lower-limb surgery with an expected three-week period of limited mobility. What is the most appropriate contraceptive plan?

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Correct answer: B — Stop CHC four weeks preoperatively and offer alternative contraception

The best answer is “Stop CHC four weeks preoperatively and offer alternative contraception”. CHC should be stopped at least 4 weeks before planned major surgery or expected limited mobility because oestrogen adds to perioperative VTE risk. A patch remains oestrogen-containing, aspirin is not a substitute for contraceptive safety management, and stopping all contraception risks an unintended pregnancy. A medically eligible progestogen-only or intrauterine option can bridge the period.

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