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Combined Hormonal Contraception — DFSRH MCQ

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EasyCombined Hormonal ContraceptionDFSRH

A 36-year-old woman is scheduled for elective total knee arthroplasty in 4 weeks, followed by an expected period of substantially reduced mobility. She uses a combined contraceptive vaginal ring correctly and inserted her current ring 10 days ago. She has had no problems with the method and wishes to maintain effective contraception and resume it when safe. She has no other venous thromboembolism risk factors. Which management plan is most appropriate?

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

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Correct answer: B — Remove the ring now, start a progestogen-only pill without additional precautions, and consider restarting the ring 2 weeks after complete remobilisation

Planned major lower-limb surgery with reduced mobility adds a substantial transient venous thromboembolism risk to that associated with combined hormonal contraception. FSRH recommends stopping CHC and switching to an alternative method at least 4 weeks before planned major surgery or an expected period of limited mobility. She should therefore remove the ring now. Because she is in the second week of correctly used CHC, she can switch immediately to a progestogen-only pill without additional contraceptive precautions. The ring should not be resumed until 2 weeks after complete remobilisation. A and E continue oestrogen exposure too close to, or through, the high-risk perioperative period; routine thromboprophylaxis does not replace planned preoperative discontinuation when this is feasible. B correctly stops the ring now, but unnecessary condoms are specified and partial weight-bearing is not equivalent to complete remobilisation. D creates an avoidable interruption in effective contraception, and a fixed interval from surgery is inappropriate because the timing of safe resumption depends on complete remobilisation rather than the operation date.

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 NuvaRing Summary of Product Characteristics (Revised May 2026) — https://www.medicines.org.uk/emc/product/6449/smpc