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Perimenopause FSH on POP — DFSRH MCQ

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HardSpecial circumstancesPerimenopause FSH on POPDFSRH

A healthy 52-year-old has used DMPA for 9 years, is amenorrhoeic and wants to continue it. She has no fracture history, but no longer needs its non-contraceptive benefits. Which plan best reflects UK guidance?

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Correct answer: D — Advise switching method, while allowing continued DMPA after individual benefit–risk review

The best answer is “Advise switching method, while allowing continued DMPA after individual benefit–risk review”. After age 50, DMPA users should be counselled about switching to another contraceptive method because of age-related concern about bone and cardiovascular health. Continued use is not automatically prohibited, but it requires an individual review of benefits, risks, alternatives and ongoing need, repeated regularly if she chooses to continue. Amenorrhoea caused by DMPA does not establish menopause, and a single FSH result is not a stand-alone stopping rule in this setting. CHC is not a routine bone-protection substitute after age 50.

Reference: CoSRH/FSRH, Contraception for Women Aged Over 40 Years (amended May 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-contraception-for-women-aged-over-40-years.pdf | CoSRH/FSRH, Progestogen-only Injectable Contraception (amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/progestogen-only-injectable-december-2014-amended-11july2023.pdf