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Raised blood pressure detected during combined hormonal contraceptive follow-up — DFSRH MCQ

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HardMonitoringRaised blood pressure detected during combined hormonal contraceptive follow-upDFSRH

A 32-year-old woman attends a specialist sexual and reproductive health service for annual review of her combined oral contraceptive. She uses a 21/7 preparation containing ethinylestradiol 30 micrograms and levonorgestrel and is on day 15 of her current packet. She has taken every tablet correctly, with no vomiting or interacting medication, and had condomless intercourse yesterday. Her blood pressure was normal before starting the pill. Today, an initial automated reading is 151/96 mmHg. After appropriate rest and correct cuff positioning, repeat readings are 148/94 mmHg and 146/92 mmHg. She is asymptomatic, does not smoke, has a BMI of 26 kg/m² and has no other cardiovascular risk factors. She has no contraindication to progestogen-only contraception and wishes to continue an oral method. Which is the most appropriate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Stop the combined pill, start a desogestrel progestogen-only pill immediately without additional precautions, and arrange ambulatory blood pressure monitoring

The repeated, properly taken clinic blood pressure is within the 140–159/90–99 mmHg range. CHC use at this level is UKMEC 3: its risks usually outweigh its benefits. FSRH advises that raised blood pressure identified in a specialist or pharmacy setting should prompt provision of suitable alternative effective contraception and referral for blood-pressure assessment, rather than continued estrogen exposure. Hypertension is not diagnosed from this consultation alone. NICE recommends ABPM when clinic blood pressure is between 140/90 and 180/120 mmHg; hypertension is confirmed by a daytime ABPM average of at least 135/85 mmHg. She is in week 3 of correctly used CHC. FSRH switching guidance permits immediate initiation of a desogestrel POP without additional contraceptive precautions. Condomless intercourse yesterday does not require emergency contraception because ovulation suppression has been maintained and effective contraception continues without a gap. A and E inappropriately continue CHC despite a UKMEC 3 blood-pressure range; reducing the estrogen dose does not remove the contraindicating exposure. B provides unnecessarily less effective interim contraception despite an immediately available suitable method. D incorrectly treats protected intercourse as an emergency-contraception indication and adds unnecessary precautions. If ABPM excludes hypertension and subsequent blood-pressure measurements are acceptable, CHC eligibility may be reassessed.

Reference: FSRH Guideline: Combined Hormonal Contraception (January 2019, amended October 2023) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf FSRH Guideline: Progestogen-only Pills (August 2022, amended April 2026) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-ceu-clinical-guideline-progestogen-only-pills-aug22-amended-11july-2023-.pdf NICE NG136: Hypertension in adults—diagnosis and management (Published 28 August 2019, last updated 26 February 2026) — https://www.nice.org.uk/guidance/ng136/chapter/recommendations