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DMPA late reinjection — DFSRH MCQ

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HardProgestogen-only methodsDMPA late reinjectionDFSRH

A 28-year-old has been using DMPA injections but attends 15 weeks after her last dose. She had unprotected sex 4 days ago and has a negative pregnancy test today. She wants to continue injectable contraception. What is the most appropriate management?

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Correct answer: D — Offer EC, give DMPA if reasonably excluding pregnancy and use condoms 7 days

After more than 14 weeks from the last DMPA injection, ovulation risk returns unpredictably and EC is indicated if there has been recent UPSI. DMPA may be quick started when pregnancy is reasonably excluded, with 7 days of condoms and repeat pregnancy testing if appropriate. Giving ulipristal and immediate progestogen is suboptimal because progestogen may reduce UPA effectiveness.

Reference: FSRH Guideline Progestogen-only Injectable Contraception; FSRH Emergency Contraception