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UPA after recent progestogen — DFSRH MCQ

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HardEmergency contraceptionUPA after recent progestogenDFSRH

A 30-year-old on a desogestrel POP missed pills for 3 days and had UPSI yesterday. She restarted the POP this morning before attending for EC. BMI is 24 kg/m2 and she declines a copper IUD. What is the most appropriate oral EC option?

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Correct answer: E — Use LNG EC after recent POP use rather than UPA

The best answer is “Use LNG EC after recent POP use rather than UPA”. Recent desogestrel use may reduce the effectiveness of ulipristal acetate, so levonorgestrel is generally the preferred oral EC when a copper IUD is declined. Restarting the POP does not retrospectively protect intercourse that occurred while pills were missed. The person also needs missed-pill advice, ongoing contraception and pregnancy-test follow-up as indicated.

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