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High BMI emergency contraception — DFSRH MCQ

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HardEmergency contraceptionHigh BMI emergency contraceptionDFSRH

A 27-year-old with BMI 34 kg/m2 presents 48 hours after condom failure. She takes no medicines, pregnancy test is negative and she wants the most effective EC but declines an IUD after counselling. What is the most appropriate management?

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Correct answer: C — Offer ulipristal acetate emergency contraception

The best answer is “Offer ulipristal acetate emergency contraception”. A copper IUD is the most effective emergency contraception, but if it is declined, ulipristal acetate is generally the preferred oral option close to ovulation and in a person with BMI 34 kg/m² when it is suitable. Higher BMI may reduce oral EC effectiveness, but it is not a reason to withhold oral EC. A pregnancy test 48 hours after intercourse cannot exclude pregnancy from that event, and neither CHC nor DMPA is emergency contraception.

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