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Assessment — DFSRH MCQ

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EasyAssessmentDFSRH

A 30-year-old woman requests a 52 mg levonorgestrel intrauterine device 4 months after an uncomplicated vaginal birth. She has remained amenorrhoeic and breastfeeds during the day, but her infant has received two formula feeds daily since 6 weeks of age and routinely sleeps for 8 hours without a breastfeed overnight. She has used no contraception and had unprotected sexual intercourse 14 days ago, with no intercourse since. A high-sensitivity urine pregnancy test today is negative, and she has no symptoms or signs of pregnancy. She is medically eligible for both intrauterine contraception and a desogestrel progestogen-only pill. Which is the most appropriate assessment and plan?

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

Reveal the answer and explanation

Correct answer: D — Regard pregnancy as not excluded, quick-start desogestrel with condoms for 2 days, and insert the levonorgestrel intrauterine device after a negative test 21 days after intercourse

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

She does not satisfy the lactational amenorrhoea criteria for reasonably excluding pregnancy. Although she is amenorrhoeic and less than 6 months postpartum, regular formula feeding and an 8-hour overnight interval mean that she is not fully or nearly fully breastfeeding; reduced suckling permits recovery of ovarian activity before menstruation returns. The negative urine test is also too early to exclude pregnancy resulting from intercourse 14 days ago. A high-sensitivity test becomes suitable for this purpose at least 21 days after the last unprotected intercourse. The LNG-IUD should therefore not be inserted today. Desogestrel can be quick-started as bridging contraception despite an unresolved risk of very early pregnancy, with condoms or abstinence for the first 2 days and repeat testing at day 21. A is attractive because she is amenorrhoeic and under 6 months postpartum, but all lactational criteria must be met. B overinterprets an early negative test. C is inappropriate because intercourse occurred more than 5 days ago and there is no menstrual history from which to establish that insertion is within 5 days of earliest likely ovulation. D correctly defers intrauterine contraception but unnecessarily withholds a suitable quick-start hormonal method.

Reference: FSRH Guideline: Intrauterine Contraception (March 2023, amended January 2025) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf FSRH Guideline: Progestogen-only Pills (August 2022, amended April 2026) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-ceu-clinical-guideline-progestogen-only-pills-aug22-amended-11july-2023-.pdf FSRH Guideline: Contraception After Pregnancy (January 2017, amended October 2020) — https://fsrh.org/Common/Uploaded%20files/documents/contraception-after-pregnancy-guideline-oct2020.pdf