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CHC continuous regimen bleeding — DFSRH MCQ

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ModerateCombined hormonal contraceptionCHC continuous regimen bleedingDFSRH

A 29-year-old woman has used a combined pill continuously for 4 months to avoid withdrawal bleeding. She has light unscheduled spotting, a negative pregnancy test, no pelvic pain and no STI risk. Blood pressure is 116/74 mmHg. What is the most appropriate management?

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Correct answer: A — Reassure and consider a short hormone-free interval

Unscheduled bleeding is common with continuous CHC and, after pregnancy and infection concerns are addressed, reassurance and a short planned hormone-free interval can be appropriate. Urgent imaging, antibiotics, or unscheduled cervical screening are not indicated from this benign presentation. Persistent, heavy or postcoital bleeding would change the assessment.

Reference: FSRH Guideline Combined Hormonal Contraception