skip to main content

Acute severe ulcerative colitis in a combined hormonal contraceptive user — DFSRH MCQ

Instant feedback + full explanation. One question, done properly.

EasyUlcerative ColitisAcute severe ulcerative colitis in a combined hormonal contraceptive userDFSRH

A 29-year-old woman is admitted with acute severe ulcerative colitis. She is receiving intravenous corticosteroids and is currently spending most of the day in bed. She has no history of venous thromboembolism. She uses a combined hormonal contraceptive patch. Use has been correct, and her second patch of the current cycle was applied 3 days ago. She requests an etonogestrel implant, declines intrauterine contraception and accepts the possibility of unpredictable bleeding. Pregnancy is reasonably excluded, she takes no enzyme-inducing medication, and an accredited implant fitter is available. Which is the most appropriate contraceptive plan?

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

Reveal the answer and explanation

Correct answer: B — Remove the patch and insert the etonogestrel implant today, without additional contraceptive precautions

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as E

Active severe ulcerative colitis, hospitalisation and substantial immobility compound venous thromboembolism risk. FSRH UKMEC advises avoiding combined hormonal methods when a person with inflammatory bowel disease is unwell or bed-bound; the patch’s transdermal delivery avoids gastrointestinal absorption problems but does not remove its oestrogen-related thrombotic risk. The etonogestrel implant is a suitable non-oestrogen method whose effectiveness is not reduced by inflammatory bowel disease or diarrhoea. She is in week 2 of correctly used combined hormonal contraception, having completed more than 7 consecutive days of use. FSRH switching guidance therefore permits immediate implant insertion without additional contraceptive precautions. B applies a generic quick-start rule despite established ovulation suppression from correct week-2 CHC use. C provides unnecessary continued oestrogen exposure at a time of increased thrombotic risk. D similarly prolongs avoidable CHC exposure and delays provision of the chosen method; additional precautions are not required for the stated switch timing. E is incorrect because active ulcerative colitis is not a reason to defer implant insertion, provided the usual procedural requirements are met. Inpatient VTE assessment and thromboprophylaxis remain separate responsibilities of the admitting team.

Reference: UK Medical Eligibility Criteria for Contraceptive Use (2016) — https://www.fsrh.org/Common/Uploaded%20files/Standards-and-Guidance/fsrh-ukmec-full-book-2019.pdf FSRH Guideline: Progestogen-only Implant (February 2021; amended July 2023) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-guideline-progestogen-only-implants.pdf