Common Registration Assessment · Topic deep-dive
GPhC Contraception Questions
The Board of Assessors’ June 2025 feedback names reproductive healthcare and contraception as a weak area, with specific mention of managing common drug interactions. This page focuses on the patterns the GPhC actually tests — UKMEC suitability, missed-pill rules by method, emergency contraception choice, and enzyme-inducer interactions.
What the GPhC actually tests on this topic
- Combined hormonal contraception: indications, contraindications, UKMEC category 3 and 4 conditions
- Progestogen-only methods: pill, injection, implant, IUS
- Long-acting reversible contraception (LARC) options and their suitability
- Missed-pill rules: combined pill 24-hour and 48-hour windows, progestogen-only 3-hour and 12-hour windows by formulation
- Drug interactions: enzyme inducers (rifampicin, carbamazepine, phenytoin, St John’s wort) and what to do
- Emergency contraception: levonorgestrel, ulipristal acetate, copper IUD — windows and choice factors
Common pitfalls — from the Board of Assessors’ feedback
Wrong missed-pill window for the formulation
Traditional progestogen-only pills have a 3-hour window. Desogestrel-containing pills have a 12-hour window. Combined pills have a 24-hour rule for one missed pill and a 48-hour rule for two or more. Mixing these up is the most common missed-pill question error.
Enzyme inducers and combined hormonal contraception
A short course of enzyme-inducing antibiotic or anticonvulsant reduces combined hormonal contraception efficacy for the duration plus 28 days. Either change method or add a barrier method. The Board of Assessors specifically named drug interactions with contraception as a weak area.
Emergency contraception choice and timing
Levonorgestrel is licensed up to 72 hours. Ulipristal up to 120 hours. Copper IUD up to 120 hours or 5 days after expected ovulation, whichever is later — and the most effective method. Choice depends on time since unprotected intercourse, BMI, recent progestogen use, and patient preference.
UKMEC category misreading
UKMEC 3 means risks generally outweigh benefits; UKMEC 4 means unacceptable health risk. Many candidates conflate the two. A patient with a UKMEC 3 condition can sometimes still use the method with specialist input; a UKMEC 4 condition rules it out.
Sample practice questions
CRA-style practice questions, not real exam questions. The Board of Assessors does not endorse third-party question banks.
For an adult with type 2 diabetes who has no identified nutritional deficiency, which listed action is NOT a routine evidence-based diabetes management measure?
- A. Work towards regular physical activity suited to ability
- B. Discuss an individualised healthy eating plan
- C. Keep alcohol within recommended limits
- D. Take a daily multivitamin specifically to treat diabetes without an identified deficiency
- E. Review lifestyle and medication needs with the care team
Show worked answer
Correct answer: D
A drug undergoes extensive first-pass metabolism when swallowed. Which listed dosage form allows absorption directly into the systemic circulation, bypassing the liver at first pass?
- A. Oral immediate-release tablet
- B. Sublingual tablet
- C. Topical gel applied for local effect
- D. Oral solution
- E. Modified-release oral capsule
Show worked answer
Correct answer: B
Contraception — frequently asked
Which contraception guideline does the CRA test?
The UK Medical Eligibility Criteria (UKMEC) for contraceptive use, published by the Faculty of Sexual and Reproductive Healthcare (FSRH). The FSRH also publishes method-specific clinical effectiveness guidance which is the standard reference for missed-pill rules, emergency contraception, and enzyme-inducer management.
What is UKMEC?
A four-category system rating the safety of each contraceptive method for women with specific medical conditions. Category 1: no restriction. Category 2: advantages generally outweigh risks. Category 3: risks generally outweigh advantages — caution and specialist input required. Category 4: unacceptable health risk — do not use.
How does the CRA test contraception drug interactions?
Through scenario questions where the patient starts a new medication (often an enzyme inducer like rifampicin, carbamazepine, or St John’s wort) and you are asked what to do with their current contraception. The Board of Assessors flagged drug interactions specifically — practise the enzyme inducer patterns first.
Practise contraception questions in context
Across the full bank of GPhC exam questions — every format, with worked answers grounded in the Board of Assessors’ published feedback.