skip to main content

Fibromyalgia — DFSRH MCQ

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

EasyFibromyalgiaFibromyalgiaDFSRH

A 34-year-old woman with fibromyalgia requests emergency contraception. Topiramate 100 mg daily was commenced off-label several years ago by a specialist and has been continued after review because she reports sustained benefit. She has used a desogestrel progestogen-only pill for 18 months and reports taking every pill correctly. She had condomless sexual intercourse 72 hours ago. There has been no other intercourse during the preceding 3 weeks, and a high-sensitivity urine pregnancy test is negative. She wishes to avoid pregnancy for at least 5 years. She is medically eligible for intrauterine contraception, has no symptoms or identified risk of sexually transmitted infection, and would accept a copper intrauterine device. Which is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — Insert a copper intrauterine device today and retain it for ongoing contraception

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

Topiramate should be treated as a potential enzyme inducer regardless of dose because its induction is dose-dependent but pharmacokinetic variability and its teratogenicity warrant caution. It may therefore reduce the effectiveness of the desogestrel pill despite perfect adherence. Emergency contraception should be considered after this intercourse. A copper IUD inserted within 5 days of intercourse is the most effective emergency contraceptive, is unaffected by enzyme induction and provides the highly effective ongoing contraception she wants. B is a legitimate fallback if a copper IUD is declined or unavailable: FSRH advises considering double-dose levonorgestrel emergency contraception with enzyme inducers. Its effectiveness in this setting is uncertain, however, and continuing a potentially compromised pill is inferior when she accepts an unaffected long-acting method. C is unsuitable because enzyme inducers may reduce ulipristal exposure; recent progestogen use may also impair ulipristal's ovulation-delaying effect. D offers ongoing contraception unaffected by topiramate but, under current UK FSRH guidance, the levonorgestrel IUD is not recommended as emergency contraception. E overlooks the pharmacokinetic interaction: correct pill-taking does not remove the risk of reduced progestogen exposure.

Reference: 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 FSRH Guideline: Emergency Contraception (March 2017, amended July 2023) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf 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