Reproductive Health — MCQs
On this page
A 33-year-old woman attends for insertion of a levonorgestrel intrauterine system for contraception and management of heavy menstrual bleeding. She has no history of pelvic infection and is in a stable relationship. During insertion, she experiences significant pain and the procedure is abandoned. What is the most appropriate next step in management?
A 56-year-old woman with a BMI of 38 kg/m² presents with moderate vasomotor symptoms and requests HRT. She had her last menstrual period 3 years ago. She has a history of non-alcoholic fatty liver disease and impaired glucose tolerance. Her blood pressure is 128/82 mmHg. She has never had venous thromboembolism. What is the most appropriate form of HRT to prescribe?
A 42-year-old woman with a history of migraine without aura has been using the combined oral contraceptive pill for 8 years. She now reports that over the past 6 months her migraines have changed character and she is experiencing visual disturbances with zigzag lines lasting about 20 minutes before the headache starts. She has had 3 such episodes. She smokes 5 cigarettes daily. What is the most appropriate management of her contraception?
A 53-year-old woman who has been taking continuous combined HRT for 6 months presents with a 4-day episode of vaginal bleeding. Her last menstrual period was 18 months ago. She has no abdominal pain or other symptoms. On examination, her abdomen is soft and non-tender. She is otherwise well with no significant medical history. What is the most appropriate initial investigation?
A 28-year-old woman presents 110 hours after unprotected sexual intercourse requesting emergency contraception. She is on day 18 of a regular 28-day menstrual cycle. She has no significant medical history and is not taking any regular medications. Her BMI is 24 kg/m². She had another episode of unprotected intercourse 8 days ago. What is the most appropriate management?
According to the UK Medical Eligibility Criteria (UKMEC), which of the following clinical scenarios represents a UKMEC 4 (unacceptable health risk) for the copper intrauterine device?
A 47-year-old woman presents with a 9-month history of hot flushes, night sweats, and mood changes. Her periods have become irregular, with the last one occurring 8 weeks ago. She requests HRT but is concerned about side effects. Her mother had a deep vein thrombosis at age 72 following hip replacement surgery. The patient's BMI is 27 kg/m² and blood pressure is 118/76 mmHg. What is the most appropriate initial HRT regimen?
A 35-year-old woman attends for review 3 years after copper IUD insertion for long-term contraception. She has no complaints and examination reveals the threads are visible. Her last menstrual period was 2 weeks ago. She plans to start trying for pregnancy in 6 months. What is the most appropriate management?
A 50-year-old woman presents with vasomotor symptoms and requests HRT. She has a history of stage 1 endometrial cancer treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy 18 months ago. Histology showed grade 1 endometrioid adenocarcinoma confined to the endometrium with no myometrial invasion. She has been discharged from oncology follow-up. What is the most appropriate management regarding HRT?
A 31-year-old woman with polycystic ovary syndrome presents requesting contraception. She has a BMI of 34 kg/m² and oligomenorrhoea. Her blood pressure is 132/84 mmHg on two separate occasions. She is a non-smoker with no personal or family history of venous thromboembolism. She prefers not to have a coil fitted. What is the most appropriate contraceptive option for this patient?
Reproductive Health UK Medical PG Practice Questions and MCQs
Question 71: A 33-year-old woman attends for insertion of a levonorgestrel intrauterine system for contraception and management of heavy menstrual bleeding. She has no history of pelvic infection and is in a stable relationship. During insertion, she experiences significant pain and the procedure is abandoned. What is the most appropriate next step in management?
- A. Prescribe mefenamic acid and attempt insertion again immediately
- B. Arrange insertion under general anaesthesia
- C. Prescribe misoprostol and reattempt insertion in one week
- D. Offer cervical priming with misoprostol and insertion under local anaesthetic in 2-4 hours (Correct Answer)
- E. Refer for hysteroscopic insertion
Explanation: ***Offer cervical priming with misoprostol and insertion under local anaesthetic in 2-4 hours*** - **Cervical priming** with **misoprostol** softens and dilates the cervix, which is highly effective in managing difficult or painful insertions by facilitating easier passage through the **cervical canal**. - Combining this with a **local anaesthetic** (e.g., paracervical block) significantly reduces the pain associated with the procedure, allowing for a successful second attempt in a clinical setting after the optimal 2-4 hours for misoprostol action. *Prescribe mefenamic acid and attempt insertion again immediately* - Reattempting the procedure immediately after a failed, painful attempt is likely to cause further **patient distress** and has a high probability of failure without addressing the physical barrier of a tight cervix. - While **NSAIDs** like **mefenamic acid** may help with cramping, they do not provide sufficient **cervical relaxation** or acute analgesia needed to overcome severe pain during the procedure. *Arrange insertion under general anaesthesia* - **General anaesthesia** carries significantly higher clinical risks and costs, and should only be considered after less invasive methods like **cervical priming** and **local anaesthesia** have failed. - Current guidelines recommend utilizing **office-based interventions** first to minimize the surgical burden on the patient. *Prescribe misoprostol and reattempt insertion in one week* - While **misoprostol** is useful for ripening the cervix, a delay of one week is unnecessary and may result in the patient losing confidence in the procedure or missing their **contraceptive window**. - The optimal effect of misoprostol for cervical priming typically occurs within **2-4 hours** after administration, making a same-day reattempt more efficient and appropriate. *Refer for hysteroscopic insertion* - **Hysteroscopy** is an invasive surgical procedure that is not indicated for a first-time failed insertion due to simple pain or **cervical resistance**. - This approach is typically reserved for complex cases where there is suspected **intrauterine pathology** or known anatomical abnormalities that prevent standard placement.
Question 72: A 56-year-old woman with a BMI of 38 kg/m² presents with moderate vasomotor symptoms and requests HRT. She had her last menstrual period 3 years ago. She has a history of non-alcoholic fatty liver disease and impaired glucose tolerance. Her blood pressure is 128/82 mmHg. She has never had venous thromboembolism. What is the most appropriate form of HRT to prescribe?
- A. Continuous combined oral HRT
- B. Continuous combined transdermal HRT (Correct Answer)
- C. Tibolone
- D. Oestrogen-only transdermal patch
- E. No HRT - recommend lifestyle measures and non-hormonal treatments only
Explanation: ***Continuous combined transdermal HRT***- **Continuous combined** therapy is necessary because the patient is postmenopausal (3 years since her last period) and has an **intact uterus**, requiring progesterone to prevent **endometrial hyperplasia**.- The **transdermal route** is preferred as it bypasses **first-pass hepatic metabolism**, making it safer for her **non-alcoholic fatty liver disease (NAFLD)** and reducing the elevated **venous thromboembolism (VTE) risk** associated with her **obesity (BMI 38)**.*Continuous combined oral HRT*- **Oral HRT** increases the risk of **venous thromboembolism (VTE)** by triggering the hepatic production of clotting factors, which is a significant concern in an **obese** patient.- Oral preparations can potentially worsen **non-alcoholic fatty liver disease (NAFLD)** and have a more negative impact on the **metabolic profile** compared to transdermal delivery.*Tibolone*- **Tibolone** is a synthetic steroid that undergoes **hepatic metabolism**, making it less ideal than transdermal options given the patient's **liver disease**.- While it has progestogenic and oestrogenic effects, it is generally not the first-line choice for patients with multiple metabolic risk factors like **impaired glucose tolerance** and obesity.*Oestrogen-only transdermal patch*- **Unopposed oestrogen** is contraindicated in women with an **intact uterus** as it significantly increases the risk of **endometrial carcinoma**.- A **progestogen** must be added to provide essential **endometrial protection** when prescribing HRT to a woman with a uterus.*No HRT - recommend lifestyle measures and non-hormonal treatments only*- **Obesity** and **impaired glucose tolerance** are not absolute contraindications to HRT; the benefits for alleviating **vasomotor symptoms** often outweigh the risks when the correct route and type are chosen.- While lifestyle modifications are beneficial, **hormone replacement therapy** remains the most effective treatment for moderate to severe **menopausal symptoms**, which the patient is experiencing.
Question 73: A 42-year-old woman with a history of migraine without aura has been using the combined oral contraceptive pill for 8 years. She now reports that over the past 6 months her migraines have changed character and she is experiencing visual disturbances with zigzag lines lasting about 20 minutes before the headache starts. She has had 3 such episodes. She smokes 5 cigarettes daily. What is the most appropriate management of her contraception?
- A. Continue the combined oral contraceptive pill as current migraine is still infrequent
- B. Stop the combined oral contraceptive pill immediately and arrange alternative contraception (Correct Answer)
- C. Switch to a progestogen-only pill and review in 3 months
- D. Reduce the dose of ethinylestradiol in her combined pill
- E. Continue current pill but add prophylactic aspirin
Explanation: ***Stop the combined oral contraceptive pill immediately and arrange alternative contraception*** - The patient has developed **migraine with aura**, characterized by **visual disturbances** like zigzag lines, which is an absolute contraindication (**UKMEC 4**) for combined oral contraceptive pills (COCPs). - The combination of **migraine with aura**, age **over 35**, and **smoking** significantly increases the risk of **ischemic stroke** with COCP use, necessitating immediate cessation. *Continue the combined oral contraceptive pill as current migraine is still infrequent* - The **frequency** of migraine attacks is not the primary concern; the **presence of aura** itself establishes the contraindication for COCPs, regardless of how often it occurs. - Continuing COCPs despite the development of **migraine with aura** significantly elevates the patient's risk of **thromboembolic events**, particularly **stroke**. *Switch to a progestogen-only pill and review in 3 months* - While a **progestogen-only pill (POP)** is a safe alternative (UKMEC 1 or 2), the immediate priority is to **stop the combined pill** due to the high-risk profile. - Reviewing in 3 months is insufficient; the patient requires **immediate counseling** on alternative contraception and the importance of avoiding the combined pill. *Reduce the dose of ethinylestradiol in her combined pill* - Reducing the dose of **ethinylestradiol** does not eliminate the increased risk of **ischemic stroke** associated with any estrogen-containing contraception in the presence of **migraine with aura**. - The **estrogen component** of the COCP, even at lower doses, remains the problematic factor and a **UKMEC 4** contraindication. *Continue current pill but add prophylactic aspirin* - Adding **prophylactic aspirin** does not sufficiently mitigate the significantly elevated risk of **ischemic stroke** caused by the interaction of **estrogen**, **migraine with aura**, and **smoking**. - The recommended management for a **UKMEC 4** contraindication is the **cessation** of the contraindicated medication, not attempting to counteract its risks with other drugs.
Question 74: A 53-year-old woman who has been taking continuous combined HRT for 6 months presents with a 4-day episode of vaginal bleeding. Her last menstrual period was 18 months ago. She has no abdominal pain or other symptoms. On examination, her abdomen is soft and non-tender. She is otherwise well with no significant medical history. What is the most appropriate initial investigation?
- A. Transvaginal ultrasound scan to measure endometrial thickness (Correct Answer)
- B. Outpatient hysteroscopy and endometrial biopsy
- C. Cervical smear test
- D. Serum FSH and LH levels
- E. Repeat examination in 4 weeks if bleeding has settled
Explanation: ***Transvaginal ultrasound scan to measure endometrial thickness*** - In a postmenopausal woman, any **unscheduled bleeding** after the first 6 months of continuous combined **HRT** must be investigated to rule out **endometrial cancer**. - **Transvaginal ultrasound (TVUS)** is the first-line investigation; an endometrial thickness of **≤4 mm** has a high negative predictive value for malignancy. *Outpatient hysteroscopy and endometrial biopsy* - This is an invasive procedure typically reserved for cases where the **TVUS** shows an endometrial thickness **>4 mm** or is inconclusive. - While it provides a definitive histological diagnosis, it is not the **initial** imaging modality recommended for first-line screening. *Cervical smear test* - This is a screening tool for **cervical intraepithelial neoplasia** and is not the primary investigation for suspected **endometrial pathology**. - Although a speculum exam is necessary to rule out cervical causes, the priority in postmenopausal bleeding is the **endometrium**. *Serum FSH and LH levels* - These levels are not clinically useful here as the patient is already confirmed to be **postmenopausal** and established on HRT treatment. - Hormonal testing does not help diagnose the cause of **bleeding** or rule out structural uterine abnormalities. *Repeat examination in 4 weeks if bleeding has settled* - Delaying investigation is inappropriate; unscheduled bleeding at the **6-month mark** of HRT requires prompt evaluation to exclude hyperplasia or malignancy. - Clinical guidelines mandate that persistent or new-onset bleeding after 6 months of HRT cannot be ignored as mere **breakthrough bleeding**.
Question 75: A 28-year-old woman presents 110 hours after unprotected sexual intercourse requesting emergency contraception. She is on day 18 of a regular 28-day menstrual cycle. She has no significant medical history and is not taking any regular medications. Her BMI is 24 kg/m². She had another episode of unprotected intercourse 8 days ago. What is the most appropriate management?
- A. Prescribe ulipristal acetate 30 mg as a single dose
- B. Insert a copper intrauterine device (Correct Answer)
- C. Prescribe levonorgestrel 1.5 mg as a single dose
- D. Prescribe double-dose ulipristal acetate due to the time elapsed
- E. Advise that emergency contraception is no longer effective and arrange pregnancy test
Explanation: ***Insert a copper intrauterine device***- The **copper intrauterine device (Cu-IUD)** is the most effective form of emergency contraception and can be inserted up to **120 hours (5 days)** after unprotected intercourse or up to 5 days after the **earliest estimated ovulation**.- Given the patient had intercourse 8 days ago (Day 10 of her cycle) and is now on Day 18 (likely 4 days post-ovulation), the Cu-IUD can prevent both fertilization and implantation from both episodes, including the earlier one. *Prescribe ulipristal acetate 30 mg as a single dose*- While **ulipristal acetate (UPA)** is licensed for use up to 120 hours, its primary mechanism is **delaying ovulation**, making it less effective or ineffective if ovulation has already occurred (which is likely by Day 18).- UPA would not be effective for the unprotected intercourse that occurred **8 days ago** as that falls outside its effective window and mechanism of action. *Prescribe levonorgestrel 1.5 mg as a single dose*- **Levonorgestrel (LNG)** emergency contraception is generally only effective if taken within **72 hours** after unprotected intercourse, making it unsuitable for a presentation at 110 hours.- Like UPA, LNG primarily works by **inhibiting ovulation** and is less effective once ovulation has taken place, or for earlier episodes of intercourse. *Prescribe double-dose ulipristal acetate due to the time elapsed*- There is no clinical evidence or licensed recommendation for a **double dose** of ulipristal acetate based on time elapsed since intercourse.- Double-dosing for oral emergency contraception is typically only considered for **levonorgestrel** in patients with a high **BMI (>26 kg/m²)**, which is not the case here (BMI 24 kg/m²). *Advise that emergency contraception is no longer effective and arrange pregnancy test*- This advice is incorrect because the **copper IUD** remains a highly effective option within the 120-hour window and up to 5 days post-ovulation, covering both episodes of unprotected intercourse.- While a pregnancy test would eventually be needed, it would be **too early** to reliably detect a pregnancy from the intercourse 8 days ago (now Day 18 of the cycle), and effective emergency contraception can still be offered.
Question 76: According to the UK Medical Eligibility Criteria (UKMEC), which of the following clinical scenarios represents a UKMEC 4 (unacceptable health risk) for the copper intrauterine device?
- A. Current pelvic inflammatory disease (Correct Answer)
- B. History of ectopic pregnancy
- C. Endometrial cancer awaiting treatment
- D. Unexplained vaginal bleeding
- E. Severe thrombocytopenia with platelet count of 30 × 10⁹/L
Explanation: ***Current pelvic inflammatory disease*** - Insertion of a **Copper IUD** in the presence of an active infection can facilitate **ascending infection**, significantly increasing the risk of worsening the condition. - It is classified as **UKMEC 4** because the absolute medical risk to the patient outweighs any contraceptive benefit until the infection is fully resolved. *History of ectopic pregnancy* - This scenario is classified as **UKMEC 1**, meaning there is no restriction on the use of the copper intrauterine device. - While an IUD does not protect against ectopic pregnancy as effectively as it protects against intrauterine pregnancy, a **prior history** is not a contraindication. *Endometrial cancer awaiting treatment* - This is typically classified as **UKMEC 4 for initiation**, but the management usually focuses on oncology protocols rather than standard family planning. - While it represents a contraindication, **active infection** like PID is often considered a more immediate and classic clinical risk for IUD insertion in primary care exams. *Unexplained vaginal bleeding* - **Unexplained vaginal bleeding** (suspicious for serious pathology) is categorized as **UKMEC 4** for initiation of a copper IUD. - However, in many clinical frameworks, **current PID** is considered the more definitive and immediate physiological contraindication compared to symptoms awaiting investigation. *Severe thrombocytopenia with platelet count of 30 × 10⁹/L* - Severe **thrombocytopenia** is classified as **UKMEC 3** for the copper IUD, meaning the risks generally outweigh the benefits. - This is due to the potential for increased **menstrual blood loss** and heavy bleeding, but it does not reach the absolute contraindication level of UKMEC 4.
Question 77: A 47-year-old woman presents with a 9-month history of hot flushes, night sweats, and mood changes. Her periods have become irregular, with the last one occurring 8 weeks ago. She requests HRT but is concerned about side effects. Her mother had a deep vein thrombosis at age 72 following hip replacement surgery. The patient's BMI is 27 kg/m² and blood pressure is 118/76 mmHg. What is the most appropriate initial HRT regimen?
- A. Sequential combined oral HRT
- B. Continuous combined oral HRT
- C. Sequential combined transdermal HRT (Correct Answer)
- D. Oestrogen-only transdermal HRT
- E. Tibolone
Explanation: ***Sequential combined transdermal HRT*** - This patient is **perimenopausal** (irregular periods with the last one 8 weeks ago); therefore, she requires a **sequential (cyclical)** regimen to provide endometrial protection and regular withdrawal bleeds. - **Transdermal HRT** is the preferred route as it avoids first-pass hepatic metabolism and does not increase the risk of **venous thromboembolism (VTE)**, which is ideal given her concern and family history. *Sequential combined oral HRT* - While the sequential component is correct for a perimenopausal woman, the **oral route** is associated with a higher risk of **VTE** compared to the transdermal route. - Oral oestrogen increases the production of clotting factors in the liver, making it less suitable for patients concerned about thrombosis. *Continuous combined oral HRT* - **Continuous combined HRT** is only indicated for **postmenopausal** women (at least 12 months after the last menstrual period). - Using this in a perimenopausal woman often lead to heavy, **unscheduled breakthrough bleeding** due to the patient's own endogenous oestrogen production. *Oestrogen-only transdermal HRT* - Oestrogen-only HRT is strictly contraindicated in women with an **intact uterus**. - Without a progestogen to oppose the oestrogen, there is a significant risk of **endometrial hyperplasia** and **endometrial cancer**. *Tibolone* - Tibolone is a synthetic compound with oestrogenic, progestogenic, and androgenic properties but is intended for **postmenopausal** use only. - If used in the perimenopausal period, it causes poor cycle control and a high incidence of **irregular vaginal bleeding**.
Question 78: A 35-year-old woman attends for review 3 years after copper IUD insertion for long-term contraception. She has no complaints and examination reveals the threads are visible. Her last menstrual period was 2 weeks ago. She plans to start trying for pregnancy in 6 months. What is the most appropriate management?
- A. Replace the IUD with a new copper IUD
- B. Remove the IUD now as she wishes to conceive soon
- C. Reassure and arrange review when she wishes to conceive (Correct Answer)
- D. Arrange hysteroscopy to check IUD position
- E. Advise changing to the levonorgestrel intrauterine system
Explanation: ***Reassure and arrange review when she wishes to conceive*** - Modern **Copper IUDs** are licensed for **5 to 10 years**; since this device was inserted 3 years ago and the patient is asymptomatic, it remains effective and safe to use.- Removing the IUD 6 months prior to the desired conception date is unnecessary and would leave the patient at risk of **unplanned pregnancy**, as fertility returns to baseline **immediately upon removal**.*Replace the IUD with a new copper IUD*- Replacing a functioning IUD after only 3 years is incorrect because the device has not reached the end of its **licensed lifespan**.- Routine replacement is not indicated unless the device is expired, displaced, or causing **refractory clinical issues**.*Remove the IUD now as she wishes to conceive soon*- Early removal is contraindicated because she explicitly stated she wants to start trying in **6 months**, not immediately.- Removing it now would necessitate the use of an alternative **short-acting contraceptive** method, which is less efficient than keeping the current IUD in situ.*Arrange hysteroscopy to check IUD position*- **Hysteroscopy** is an invasive procedure and is not indicated when **IUD threads are visible** during a speculum examination.- IUD position is generally confirmed via **ultrasound** only if the threads are missing or clinical symptoms like pelvic pain suggest displacement.*Advise changing to the levonorgestrel intrauterine system*- There is no clinical indication to switch to the **LNG-IUS** as the patient is happy with her current method and has no complaints like **heavy menstrual bleeding**.- Switching methods 6 months before planned conception is impractical and may cause side effects during the **hormonal adjustment** period.
Question 79: A 50-year-old woman presents with vasomotor symptoms and requests HRT. She has a history of stage 1 endometrial cancer treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy 18 months ago. Histology showed grade 1 endometrioid adenocarcinoma confined to the endometrium with no myometrial invasion. She has been discharged from oncology follow-up. What is the most appropriate management regarding HRT?
- A. Prescribe continuous combined HRT as she has had a hysterectomy
- B. Prescribe oestrogen-only HRT as the risk of recurrence is very low (Correct Answer)
- C. Prescribe vaginal oestrogen only for symptom management
- D. Prescribe tibolone as an alternative to conventional HRT
- E. Advise that HRT is absolutely contraindicated due to her cancer history
Explanation: ***Prescribe oestrogen-only HRT as the risk of recurrence is very low*** - In patients with **stage 1, grade 1 endometrioid adenocarcinoma** and no myometrial invasion, the risk of recurrence is extremely low, making HRT a viable option for **vasomotor symptoms**. - Since the patient has undergone a **total abdominal hysterectomy**, progesterone is not required, and **oestrogen-only HRT** is the standard approach to avoid unnecessary side effects. *Prescribe continuous combined HRT as she has had a hysterectomy* - **Continuous combined HRT** includes progestogen, which is primarily used to protect the **endometrium** from hyperplasia or malignancy in women who still have a uterus. - In a patient who has had a **hysterectomy**, adding progestogen is unnecessary and may slightly increase the risk of **breast cancer** compared to oestrogen alone. *Prescribe vaginal oestrogen only for symptom management* - **Vaginal oestrogen** is effective only for **genitourinary syndrome of menopause** (atrophic vaginitis) and does not provide systemic relief for **vasomotor symptoms** like hot flushes. - This patient specifically requests management for vasomotor symptoms, which require **systemic HRT** for adequate control. *Prescribe tibolone as an alternative to conventional HRT* - **Tibolone** is a synthetic steroid with oestrogenic, progestogenic, and androgenic properties, but it is typically not the first-line choice in post-cancer patients unless specifically indicated. - Standard **oestrogen-only therapy** has more robust evidence for safety and efficacy in low-risk, early-stage endometrial cancer survivors compared to tibolone. *Advise that HRT is absolutely contraindicated due to her cancer history* - While endometrial cancer is oestrogen-dependent, HRT is **not absolutely contraindicated** in patients with successfully treated, **low-grade, early-stage primary disease**. - Evidence suggests that systemic HRT does not significantly increase the risk of recurrence or mortality in women with **Stage 1 disease** after appropriate surgical treatment.
Question 80: A 31-year-old woman with polycystic ovary syndrome presents requesting contraception. She has a BMI of 34 kg/m² and oligomenorrhoea. Her blood pressure is 132/84 mmHg on two separate occasions. She is a non-smoker with no personal or family history of venous thromboembolism. She prefers not to have a coil fitted. What is the most appropriate contraceptive option for this patient?
- A. Combined oral contraceptive pill
- B. Progestogen-only pill
- C. Depot medroxyprogesterone acetate injection
- D. Etonogestrel contraceptive implant (Correct Answer)
- E. Progesterone-only emergency contraception until blood pressure controlled
Explanation: ***Etonogestrel contraceptive implant*** - This is a **Long-Acting Reversible Contraceptive (LARC)** and is categorized as **UKMEC 1** for this patient, meaning there are no restrictions on its use despite her BMI and blood pressure. - It provides highly effective contraception for 3 years without the **user-dependence** associated with oral pills, which is beneficial for managing her PCOS symptoms. *Combined oral contraceptive pill* - Although often used in PCOS to regulate cycles, her **BMI of 34 kg/m²** and **borderline hypertension** (132/84 mmHg) increase the risks associated with estrogen-containing methods. - The **Combined Hormonal Contraceptive (CHC)** is generally avoided or used with caution (UKMEC 2/3) when multiple cardiovascular risk factors like obesity and elevated BP are present. *Progestogen-only pill* - This is a safe option (**UKMEC 1**), but it is considered less ideal than a LARC because its efficacy depends on **consistent daily administration**. - It does not offer the same high level of long-term contraceptive security as the **subdermal implant** for a patient seeking reliable protection. *Depot medroxyprogesterone acetate injection* - While effective, the **Depot injection** is frequently associated with **weight gain**, which is undesirable in a patient who is already obese (**BMI 34 kg/m²**). - There are also concerns regarding a reduction in **bone mineral density** with long-term use, making it a second-line choice compared to the implant. *Progesterone-only emergency contraception until blood pressure controlled* - Emergency contraception is only indicated after **unprotected sexual intercourse**, which is not the primary presentation here. - Her blood pressure (132/84 mmHg) is not high enough to contraindicate the immediate initiation of a **progestogen-only** maintenance contraceptive.
Practice by Chapter
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free