skip to main content

Perioperative management of combined hormonal contraception — DFSRH MCQ

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

EasyImmobilityPerioperative management of combined hormonal contraceptionDFSRH

A 29-year-old woman is listed for day-case hysteroscopic polypectomy in 6 weeks. General anaesthesia is expected to last 25 minutes. She will be discharged the same day and is expected to walk normally immediately after recovery, with no postoperative restriction of mobility. She takes a combined oral contraceptive containing ethinylestradiol and levonorgestrel. She has a BMI of 24 kg/m², does not smoke, and has no personal or family history of venous thromboembolism. She wishes to avoid an unnecessary change of contraception. Which is the most appropriate contraception-related perioperative plan?

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

Reveal the answer and explanation

Correct answer: A — Continue the combined oral contraceptive without a contraception-related perioperative change

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

The decisive features are an anticipated operating and anaesthetic duration below 30 minutes and the absence of postoperative immobilisation. FSRH UKMEC classifies this as minor surgery without immobilisation, for which combined hormonal contraception is category 1: there is no restriction on use. Her otherwise low venous thromboembolism risk does not create a separate indication to interrupt contraception or prescribe thromboprophylaxis. A adds a contraception-specific intervention that is not required for this scenario; mechanical prophylaxis should instead follow the procedure's independent perioperative VTE assessment. B is unnecessary because she remains medically eligible for combined hormonal contraception and has expressed a preference to continue it. D is the appropriate planned strategy for major elective surgery, leg surgery or surgery involving prolonged immobilisation: combined hormonal contraception should be stopped 4 weeks beforehand, an oestrogen-free alternative offered, and combined contraception restarted no earlier than 2 weeks after full mobilisation. Those criteria are absent here. E resembles the contingency recommended when indicated preoperative discontinuation has not been possible, such as urgent major surgery, when pharmacological and mechanical thromboprophylaxis may be required. It would expose this low-risk ambulatory patient to unnecessary treatment. The combined oral contraceptive should therefore be continued unchanged.

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 UK Medical Eligibility Criteria for Contraceptive Use (April 2016; amended September 2019) — https://www.fsrh.org/Common/Uploaded%20files/Standards-and-Guidance/fsrh-ukmec-full-book-2019.pdf