Hyperemesis and oral contraception — DFSRH MCQ

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HardReproductive healthHyperemesis and oral contraceptionDFSRH

A 28-year-old using a combined pill has vomiting and diarrhoea for 4 days with norovirus. She missed two pills during the illness and had UPSI yesterday. She is now tolerating fluids. What is the most appropriate management?

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Correct answer: E — Assess for EC and advise precautions as for missed pills

The best answer is “Assess for EC and advise precautions as for missed pills”. Vomiting and severe diarrhoea can impair oral contraceptive absorption and should be managed similarly to missed pills, including EC assessment after UPSI. Simply resuming the next pill may not cover the risk episode. Non-oral methods can be discussed if recurrent gastrointestinal illness or adherence problems occur. Emergency-contraception choice requires the timing of every episode of UPSI, likely ovulation, weight or BMI, recent progestogen exposure, enzyme-inducing medicines, gastrointestinal absorption and the person’s willingness to use a copper IUD. The copper IUD remains the most effective option and is the only method effective after ovulation; oral agents mainly work by delaying ovulation and are not interchangeable in every scenario.

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