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Acute viral hepatitis in an established combined hormonal contraceptive user — DFSRH MCQ

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EasyLiver DiseaseAcute viral hepatitis in an established combined hormonal contraceptive userDFSRH

A 29-year-old woman has taken a combined oral contraceptive containing ethinylestradiol and levonorgestrel for 18 months. She develops jaundice and anorexia and is diagnosed with acute hepatitis A. Her alanine aminotransferase is 1460 IU/L and bilirubin is 91 micromol/L. Her INR is 1.0, she has no encephalopathy, and her symptoms are improving. She has had no vomiting or diarrhoea and takes no interacting medication. She wishes to continue her current contraception. What is the most appropriate contraceptive advice?

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

Reveal the answer and explanation

Correct answer: B — Continue the combined oral contraceptive because acute viral hepatitis is UKMEC 2 for continuation

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

She has active acute viral hepatitis but is already an established user of combined hormonal contraception (CHC). FSRH distinguishes initiation from continuation: acute viral hepatitis or a flare is UKMEC 3 for initiating CHC but UKMEC 2 for continuation. UKMEC 2 means that the advantages generally outweigh the theoretical or proven risks, so she may continue her preferred pill. Her preserved synthetic function, clinical improvement and absence of impaired absorption or drug interactions provide no separate reason to discontinue it. A is incorrect because UKMEC 1 applies to viral hepatitis carrier status and chronic hepatitis without an acute flare, not active acute hepatitis. B is incorrect because the scheduled hormone-free interval is part of an established regimen and does not convert continuation into new initiation. C is incorrect because the non-CHC hormonal methods are UKMEC 1 in acute viral hepatitis, and established CHC use is UKMEC 2. E attracts candidates who recall the UKMEC 3 classification but fail to distinguish initiation from continuation. Stopping CHC would be required for a UKMEC 4 hepatic condition, such as severe decompensated cirrhosis or hepatocellular adenoma, neither of which is present.

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: UKMEC 2016 (April 2016, amended September 2019) — https://www.fsrh.org/Common/Uploaded%20files/Standards-and-Guidance/fsrh-ukmec-full-book-2019.pdf