CHC with rifampicin — DFSRH MCQ

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HardCombined hormonal contraceptionCHC with rifampicinDFSRH

A 25-year-old using the combined patch starts rifampicin-based treatment for tuberculosis. She had sex without condoms 3 days ago and wants to avoid pregnancy. BMI is 21 kg/m2 and pregnancy test is negative. What is the most appropriate management?

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Correct answer: D — Offer a copper IUD for EC and ongoing contraception

The best answer is “Offer a copper IUD for EC and ongoing contraception”. Rifampicin is a potent enzyme inducer that reduces CHC effectiveness and also makes ulipristal unsuitable. A copper IUD is unaffected and is the most effective emergency and ongoing method. If oral EC is used when Cu-IUD is declined, double-dose levonorgestrel is considered, but it is less effective than Cu-IUD. 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, Combined Hormonal Contraception (January 2019, amended October 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf