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EC after UPA and quick start implant — DFSRH MCQ

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HardEmergency contraceptionEC after UPA and quick start implantDFSRH

A 24-year-old receives ulipristal for UPSI on cycle day 13 and wants an implant fitted today before travelling. Pregnancy test is negative and she understands follow-up. What is the most appropriate management?

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Correct answer: B — Delay implant five days or explain reduced UPA efficacy

The best answer is “Delay implant five days or explain reduced UPA efficacy”. Progestogen started immediately after ulipristal can reduce ulipristal’s ability to delay ovulation. The usual approach is to wait 5 days before implant insertion, then use additional precautions until the implant becomes effective; quick starting can be considered only after clear counselling about the potential reduction in EC efficacy and pregnancy-test follow-up. A levonorgestrel IUD is not the standard emergency-IUD option in this scenario.

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