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Cu-IUD declined near ovulation — DFSRH MCQ

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HardEmergency contraceptionCu-IUD declined near ovulationDFSRH

A 35-year-old with regular 26-day cycles had UPSI on day 11 and presents on day 15 with right-sided mittelschmerz earlier that day. BMI is 20 kg/m2 and pregnancy test is negative. She declines Cu-IUD. What is the most appropriate oral EC?

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Correct answer: A — Ulipristal acetate with advice on follow-up testing

The best answer is “Ulipristal acetate with advice on follow-up testing”. When oral EC is chosen, ulipristal acetate is generally more effective than levonorgestrel close to the likely time of ovulation. No oral EC is expected to work after ovulation has actually occurred, but ovulation pain is not sufficiently reliable to justify withholding EC in this uncertain presentation. A pregnancy test at presentation is too early for the recent exposure, so follow-up testing is essential.

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