UKMEC bariatric surgery and oral methods — DFSRH MCQ

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HardUKMECUKMEC bariatric surgery and oral methodsDFSRH

A 36-year-old eight months after Roux-en-Y bypass has intermittent diarrhoea, BMI 33 kg/m² and heavy menstrual bleeding. She wants a reversible method that also treats bleeding. Which best fits?

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Correct answer: A — 52 mg LNG-IUD for bleeding control and contraception

The best answer is “52 mg LNG-IUD for bleeding control and contraception”. A 52 mg LNG-IUD avoids gastrointestinal absorption and treats heavy menstrual bleeding, addressing both priorities. A copper IUD also avoids absorption but can worsen bleeding. Oral methods may be less reliable with malabsorptive surgery and diarrhoea, while implant bleeding is unpredictable rather than a dependable treatment. Combined hormonal contraception must be assessed by applying oestrogen-related arterial and venous risk, the exact timing of incorrect use, drug interactions and the need for emergency contraception. A non-oestrogen method may be acceptable even when CHC is not. Missed-use advice depends on whether the hormone-free interval was extended, rather than simply on the number of tablets mentioned.

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