Contraception and Family Planning Practice Questions

Q: Which of the following is a health benefit of using combined oral contraceptives in pre-menopausal women?

Reduced risk of ovarian cancer. **Explanation:** **Why the correct answer is right:** Combined Oral Contraceptives (COCs) provide significant non-contraceptive health benefits, most notably a **reduced risk of ovarian cancer**. The underlying mechanism is the **suppression of ovulation**. By preventing the monthly "incessant ovulation" and the subsequent repeated trauma and repair of the ovarian epithelium, COCs decrease the risk of epithelial ovarian tumors. This protective effect is duration-dependent (increasing with longer use) and persists for up to 30 years after discontinuation. COCs also significantly reduce the risk of **endometrial cancer** (due to progestogen-induced endometrial atrophy) and **colorectal cancer**. **Why the incorrect options are wrong:** * **A & D (DVT and Ischemic Stroke):** COCs actually **increase** the risk of venous thromboembolism (VTE) and arterial strokes. The estrogen component (Ethinyl Estradiol) increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases antithrombin III, creating a pro-coagulant state. * **B (Migraine):** COCs can exacerbate migraines, particularly during the hormone-free interval (estrogen withdrawal). Furthermore, COCs are **contraindicated** in women with migraine with aura due to a significantly elevated risk of ischemic stroke. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** 50% reduction in Ovarian and Endometrial cancer risk. * **Benign Conditions:** COCs reduce the risk of Benign Breast Disease (e.g., fibroadenoma), Pelvic Inflammatory Disease (PID), and ectopic pregnancy. * **Menstrual Benefits:** Used to treat dysmenorrhea, menorrhagia, and PCOS. * **Absolute Contraindications (WHO Category 4):** Smokers >35 years (>15 cigarettes/day), history of VTE/Stroke, Migraine with aura, and Breast Cancer.

Q: Which of the following drugs is not used as emergency contraception?

Raloxifene. **Explanation:** The correct answer is **D. Raloxifene**. **Why Raloxifene is the correct answer:** Raloxifene is a **Selective Estrogen Receptor Modulator (SERM)** primarily used for the prevention and treatment of osteoporosis in postmenopausal women and to reduce the risk of invasive breast cancer. Unlike emergency contraceptives, it does not inhibit ovulation or prevent implantation. It has an anti-estrogenic effect on the breast and uterus but an estrogenic effect on the bone. **Analysis of Incorrect Options:** * **A. Levonorgestrel (LNG):** The most commonly used emergency contraceptive pill (ECP). It is a progestogen that works primarily by delaying or inhibiting ovulation. It is most effective when taken within 72 hours of unprotected intercourse. * **B. Mifepristone:** An anti-progestogen. In low doses (10–25 mg), it is highly effective as an emergency contraceptive by delaying ovulation and altering the endometrium. (Note: Higher doses are used for medical abortion). * **C. Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM). It is currently considered the "gold standard" for hormonal emergency contraception because it is effective up to 120 hours (5 days) after intercourse and can inhibit ovulation even just before it occurs. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective Method:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Yuzpe Regimen:** An older method using combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel); it is less effective and causes more side effects (nausea/vomiting) than LNG alone. * **Dose of LNG:** 1.5 mg as a single dose (or two doses of 0.75 mg 12 hours apart). * **Mechanism:** Emergency contraceptives work by preventing fertilization; they are **not** abortifacients and do not work if implantation has already occurred.

Q: Which among the following is the ideal contraception for lactating mothers?

Lactational amenorrhoea method. **Explanation:** The **Lactational Amenorrhoea Method (LAM)** is considered the ideal and most natural first-line contraceptive for breastfeeding mothers in the early postpartum period. **Why LAM is the Correct Answer:** LAM relies on the physiological suppression of ovulation caused by high levels of **Prolactin**. Suckling inhibits the release of Gonadotropin-Releasing Hormone (GnRH) from the hypothalamus, which in turn suppresses LH and FSH, preventing follicular development and ovulation. It is highly effective (>98%) if three criteria are met: 1. The mother is in the first 6 months postpartum. 2. She is practicing **exclusive breastfeeding** (day and night, no supplements). 3. She remains **amenorrhoeic**. **Analysis of Incorrect Options:** * **Combined Oral Contraceptive Pills (COCPs):** These are **contraindicated** in the first 6 weeks of lactation because estrogen suppresses milk production (hypogalactia) and increases the risk of thromboembolism in the early postpartum period. * **Progesterone-only Pill (POP):** While POPs are the hormonal method of choice for lactating women (as they do not affect milk volume), they are usually started only after 6 weeks or if LAM criteria are no longer met. * **Barrier Method:** While safe, they have higher failure rates compared to LAM and are generally used as a backup rather than the primary "ideal" physiological method. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal time to start IUCD:** Postpartum IUCD (PPIUCD) can be inserted within 48 hours of delivery or after 6 weeks (involution). * **DMPA (Injectable):** Should be avoided before 6 weeks postpartum in lactating mothers. * **Centchroman (Saheli):** A non-steroidal SERM; it is safe during lactation and is part of the National Family Planning Program (Antara program focuses on DMPA, Chhaya focuses on Centchroman).

Q: What is the dose of centchroman?

30 mg. **Explanation:** **Centchroman (Ormeloxifene)** is a non-steroidal, non-hormonal Selective Estrogen Receptor Modulator (SERM) developed by CDRI, Lucknow. It is marketed under the brand names **Saheli** and **Chhaya** in the National Family Planning Programme of India. **Why 30 mg is correct:** The standard contraceptive dose of Centchroman is **30 mg**. The dosage schedule follows a unique "loading phase" to achieve steady-state plasma levels: * **First 3 months:** 30 mg twice weekly (e.g., Sunday and Wednesday). * **From the 4th month onwards:** 30 mg once weekly, regardless of the menstrual cycle. **Analysis of incorrect options:** * **60 mg:** While 60 mg doses are sometimes used in the treatment of Abnormal Uterine Bleeding (AUB) or mastalgia, it is not the standard dose for contraception. * **120 mg & 240 mg:** These are supratherapeutic doses for contraception and are not used in clinical practice for this indication. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** It acts as an estrogen antagonist in the uterus (preventing implantation by altering the endometrium) and an agonist in the bones/CVS. It does not suppress ovulation. * **Side Effects:** The most common side effect is **delayed menstruation** (prolonged cycles), occurring in about 8% of users. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease. * **Pearl:** It is the only contraceptive that does not interfere with the hypothalamic-pituitary-ovarian axis, making it safe for breastfeeding mothers (Category: L1/Safe).

Q: Tubal ligation is reported to have decreased the risk of?

Ovarian cancer. **Explanation:** **Correct Answer: B. Ovarian Cancer** Tubal ligation is a significant protective factor against ovarian cancer, reducing the risk by approximately **30–50%**. The underlying medical concept involves two main theories: 1. **Prevention of Ascending Carcinogens:** It blocks the passage of potential carcinogens (like talc or asbestos) and inflammatory mediators from the lower genital tract to the ovaries. 2. **Origin of Serous Cancer:** Modern research suggests that many "ovarian" cancers (specifically High-Grade Serous Carcinomas) actually originate in the fimbrial end of the fallopian tube (STIC lesions). Tubal ligation disrupts this pathway and often involves partial salpingectomy, removing the tissue of origin. **Analysis of Incorrect Options:** * **A. Functional ovarian cysts:** Tubal ligation does not affect ovulation or the hormonal feedback loop; therefore, the incidence of functional cysts remains unchanged. * **C. Breast cancer:** There is no established physiological link between tubal sterilization and a decreased risk of breast cancer. * **D. Salpingitis:** While tubal ligation prevents ascending infection from reaching the peritoneal cavity (reducing the risk of Pelvic Inflammatory Disease/PID), it does not necessarily prevent infection of the proximal tubal stump itself (salpingitis). The reduction in **ovarian cancer** is the more classically tested and significant epidemiological association. **High-Yield Clinical Pearls for NEET-PG:** * **OCPs** also decrease the risk of ovarian cancer (by ~50% if used for >5 years). * **Hysterectomy** also provides a protective effect against ovarian cancer. * The most common site of ectopic pregnancy after failed tubal ligation is the **isthmus**. * **Failure rate (Pearl Index):** For Pomeroy’s technique, it is approximately 0.1–0.5%. The most common cause of failure is **recanalization**.

Q: An X-ray pelvis in AP view shows the presence of:

Uterine sounding to check the position of a dislodged IUD. ***Uterine sounding to check the position of a dislodged IUD*** - On AP pelvis X-ray, a **metallic uterine sound** appears as a radiopaque linear structure within the uterine cavity used to locate the **dislodged IUD**. - The **IUD** itself appears as a radiopaque T-shaped or coil-shaped device that may be displaced from its normal intrauterine position. *Endoscopic removal of ureteric stones* - This procedure involves **cystoscopy** or **ureteroscopy**, which are not visible on plain X-ray imaging. - **Ureteric stones** may be visible on X-ray, but the endoscopic instruments are not radiopaque enough to be clearly seen. *Uterine sounding to check for the site of a uterine tear* - **Uterine perforation** or tears are **soft tissue injuries** that are not directly visible on plain X-ray. - Diagnosis of uterine tears typically requires **contrast studies** or **cross-sectional imaging** like CT or MRI. *Pelvic trauma* - While pelvic trauma can show **bone fractures** and **foreign objects** on X-ray, this option doesn't specifically relate to the procedural findings described. - **Traumatic injuries** would show different radiographic patterns like **fracture lines**, **hematomas**, or **displaced bone fragments**.

Q: Which of the following is NOT used as emergency contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While Danazol (an attenuated androgen) was historically investigated for various gynecological conditions like endometriosis, it has **no proven efficacy** as an emergency contraceptive (EC) and is not part of any standard EC protocol. **Analysis of Options:** * **Copper T 200B:** This is the **most effective** method of emergency contraception. If inserted within 5 days (120 hours) of unprotected intercourse, it prevents implantation by causing a sterile inflammatory reaction in the endometrium. * **RU486 (Mifepristone):** This is a potent anti-progestin. In low doses (10 mg or 25 mg), it acts as a highly effective EC by delaying or inhibiting ovulation. (Note: 600 mg is used for medical abortion). * **High-dose Estrogen:** Historically, high doses of estrogens (e.g., Ethinylestradiol 5mg for 5 days) were used as EC. While effective, they are no longer preferred due to severe side effects like nausea and vomiting. They have been largely replaced by the **Yuzpe Regimen** (Combined Pills) or Levonorgestrel (LNG). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper-T (Failure rate <0.1%). * **Drug of Choice (DOC):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate (30 mg):** A selective progesterone receptor modulator (SPRM) effective up to **120 hours** (5 days) and is more effective than LNG in obese women. * **Yuzpe Regimen:** Consists of 100 mcg Ethinylestradiol + 0.5 mg Norgestrel, repeated after 12 hours.

Question 1

A 28-year-old P1L1 had a Copper-T inserted 2 years ago. On examination, Copper-T threads are not seen. Ultrasound shows the Copper-T partly in the abdominal cavity. What is the method of removal?

Accepted Answer

Laparoscopy

Answer

Hysteroscopy

Answer

No removal needed (wait and watch)

Answer

IUCD hook

Question 2

Which of the following is a health benefit of using combined oral contraceptives in pre-menopausal women?

Accepted Answer

Reduced risk of ovarian cancer

Answer

Reduced risk of deep vein thrombosis

Answer

Reduced risk of migraine

Answer

Reduced risk of ischemic stroke

Question 3

Which of the following drugs is not used as emergency contraception?

Accepted Answer

Raloxifene

Answer

Levonorgestrel

Answer

Mifepristone

Answer

Ulipristal acetate

Question 4

Which of the following statements is NOT true regarding progestin-only contraceptives?

Accepted Answer

The pill is taken on alternate days.

Answer

Also known as mini-pills.

Answer

Have minimal effect on carbohydrate metabolism.

Answer

Associated with a high incidence of irregular bleeding.

Question 5

Which among the following is the ideal contraception for lactating mothers?

Accepted Answer

Lactational amenorrhoea method

Answer

Barrier method

Answer

Combined oral contraceptive pill

Answer

Progesterone-only pill

Question 6

What is the dose of centchroman?

Accepted Answer

30 mg

Answer

60 mg

Answer

120 mg

Answer

240 mg

Question 7

What is a contraindication for the use of an intrauterine contraceptive device (IUCD)?

Accepted Answer

All of the above

Answer

Previous cesarean section

Answer

Pelvic inflammatory disease (PID)

Answer

Uterine malformation

Question 8

Tubal ligation is reported to have decreased the risk of?

Accepted Answer

Ovarian cancer

Answer

Functional ovarian cysts

Answer

Breast cancer

Answer

Salpingitis

Question 9

An X-ray pelvis in AP view shows the presence of:

Accepted Answer

Uterine sounding to check the position of a dislodged IUD

Answer

Endoscopic removal of ureteric stones

Answer

Uterine sounding to check for the site of a uterine tear

Answer

Pelvic trauma

Question 10

Which of the following is NOT used as emergency contraception?

Accepted Answer

Danazol

Answer

Copper T 200B

Answer

RU486

Answer

High dose Estrogen

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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