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Pregnancy Prevention Programme — DFSRH MCQ

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EasyPregnancy Prevention ProgrammeDFSRH

A 30-year-old woman attends requesting removal of her 52 mg levonorgestrel-releasing intrauterine system because she wishes to conceive. She takes topiramate 100 mg daily for migraine prophylaxis and has no history of epilepsy. Her migraines are well controlled, and she intends to start trying for pregnancy immediately after device removal. She asks whether she can continue topiramate until a pregnancy test becomes positive. Which is the most appropriate management plan?

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Correct answer: D — Defer removal, arrange prescriber-led discontinuation or substitution of topiramate, and continue the intrauterine system until 4 weeks after the last dose

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

Topiramate is contraindicated during pregnancy when used for migraine prophylaxis. A person planning pregnancy should therefore have treatment reviewed and, where appropriate, discontinued or changed to a pregnancy-compatible alternative before attempting conception. This should be prescriber-led rather than undertaken abruptly without a treatment plan. The topiramate Pregnancy Prevention Programme requires effective contraception throughout treatment and for at least 4 weeks after the final dose. Her levonorgestrel intrauterine system is a highly effective method whose contraceptive effectiveness is not reduced by topiramate. It should therefore remain in situ until that post-treatment interval has elapsed. A is incorrect because waiting for a positive pregnancy test permits embryonic exposure during early organogenesis. C uses an inadequate 7-day interval and advises unsupervised cessation. D appropriately involves the prescriber but omits the required 4-week post-treatment contraception. E avoids exposure but imposes an unnecessary 3-month delay; the specified interval for topiramate is 4 weeks. The decisive features are that topiramate is being used for migraine rather than essential seizure control, conception is planned, and contraception must continue beyond the final dose.

Reference: Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme (20 June 2024) — https://www.gov.uk/drug-safety-update/topiramate-topamax-introduction-of-new-safety-measures-including-a-pregnancy-prevention-programme Topiramate 15 mg Hard Capsule — Summary of Product Characteristics (2026) — https://www.medicines.org.uk/emc/product/102433/smpc FSRH Clinical Guidance: Drug Interactions with Hormonal Contraception (May 2022) — https://www.fsrh.org/Common/Uploaded%20files/documents/drug-interactions-with-hormonal-contraception-5may2022.pdf