Contraception and Family Planning Practice Questions

Q: An Intrauterine Device (IUD) is not inserted during which of the following conditions?

Immediately after delivery (within 48 hours). ### Explanation The timing of IUD insertion is critical to minimize risks of expulsion, perforation, and infection. **Why Option C is the Correct Answer:** While IUDs *can* be inserted immediately postpartum (PPIUD), the question asks when it is **not** typically inserted based on standard clinical guidelines regarding safety and efficacy. In the context of traditional teaching and many standard protocols, the period between **48 hours and 6 weeks postpartum** is considered a contraindication for insertion. This is because the uterus is undergoing rapid involution, significantly increasing the risk of **spontaneous expulsion** and **uterine perforation**. Therefore, if not inserted within the first 48 hours, one must wait until the involution is complete (6 weeks). **Analysis of Other Options:** * **A & B (During/Within 10 days of menstruation):** This is the **ideal time** for interval insertion. It ensures the patient is not pregnant, and the cervical os is slightly dilated, making insertion easier and less painful. * **D (6-8 weeks after delivery):** This is known as **Postpartum Interval Insertion**. By this time, the uterus has returned to its non-pregnant size (involution complete), making it a safe and standard time for insertion. **High-Yield NEET-PG Pearls:** * **Ideal Time for Interval IUD:** Within 10 days of the LMP. * **Post-Abortal Insertion:** Can be done immediately after first-trimester abortion (if no infection). * **PPIUD (Postpartum IUD):** Must be done within **48 hours** (ideally within 10 minutes of placental delivery) or delayed until **6 weeks**. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding and Pain. * **Mechanism of Action (Cu-T):** Primarily spermicidal (causes a sterile inflammatory response).

Q: Replacement of a progestin-releasing intrauterine device should be done after how many years?

5 years. **Explanation:** The correct answer is **5 years**. **1. Why 5 years is correct:** The most common progestin-releasing intrauterine device (IUCD) is the **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, commercially known as Mirena. It contains 52 mg of Levonorgestrel, which is released at an initial rate of 20 µg/day. While the hormone levels gradually decline over time, the device maintains high contraceptive efficacy and therapeutic benefits (such as reducing menstrual blood loss) for a period of **5 years**. After this duration, the reservoir of progestin is depleted to a level where its reliability decreases, necessitating replacement. **2. Why the other options are incorrect:** * **1 year:** Progestasert (an older progesterone-only IUD) required annual replacement, but it is largely obsolete. Modern LNG-IUS devices are designed for long-term use. * **3 years:** This is the typical duration for the **progestin subdermal implant (Nexplanon)** or the lower-dose LNG-IUS (Skyla/Jaydess), but not the standard LNG-IUS. * **10 years:** This is the replacement interval for the **Copper T 380A**, which is a non-hormonal IUCD. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily works by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy (preventing implantation). * **Non-contraceptive uses:** It is the **Gold Standard (Medical management)** for Menorrhagia and Adenomyosis. * **Failure Rate:** It has a Pearl Index of approximately 0.2, making it as effective as sterilization. * **Recent Update:** While the FDA has recently approved Mirena for up to 8 years for contraception, for the purpose of NEET-PG and standard textbooks (Dutta/Williams), **5 years** remains the standard answer for replacement.

Q: Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

Condoms. **Explanation:** **Correct Option: C. Condoms** The primary material used in the manufacturing of most standard male and female condoms is **natural rubber latex**. In patients with a known latex allergy, exposure can trigger hypersensitivity reactions ranging from localized contact dermatitis and pruritus to life-threatening systemic anaphylaxis. For these patients, non-latex alternatives such as polyurethane, polyisoprene, or nitrile condoms must be used. **Analysis of Incorrect Options:** * **A. Oral Contraceptives:** These are hormonal medications (estrogen and/or progestogen) administered systemically. They do not contain latex and have no cross-reactivity with latex proteins. * **B. Intrauterine Device (IUD):** Copper T (Cu-T) and Levonorgestrel-releasing IUDs (Mirena) are composed of plastic (polyethylene), barium sulfate, and copper or hormones. They are latex-free and safe for these patients. * **C. Laparoscopic Tubal Ligation:** This is a surgical procedure. While surgical gloves were historically latex-based, the procedure itself (and the clips/rings used for occlusion) does not inherently involve latex. In modern practice, latex-free gloves are used for allergic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Latex-Fruit Syndrome:** Patients allergic to latex often show cross-reactivity with certain fruits, most commonly **Avocado, Banana, Kiwi, and Chestnut**. * **Diaphragms and Cervical Caps:** Like condoms, these are often made of latex and are also contraindicated. * **Non-Latex Condoms:** Polyurethane condoms are thinner and provide good sensitivity but have a higher breakage and slippage rate compared to latex. * **Spermicides:** Nonoxynol-9 is the most common spermicide used with barrier methods; it does not contain latex but can cause vaginal irritation.

Q: Non-contraceptive benefits of oral contraceptive agents are against the development of all of the following except?

Cervical carcinoma. Combined Oral Contraceptive Pills (COCPs) provide significant non-contraceptive health benefits by suppressing ovulation and regulating hormonal fluctuations. However, they do not protect against **Cervical Carcinoma**; in fact, long-term use (typically >5 years) is associated with a slightly increased risk of cervical cancer, likely due to increased susceptibility to HPV infection and lifestyle factors. ### Why the other options are incorrect: * **Ectopic Pregnancy:** COCPs prevent ectopic pregnancy by the primary mechanism of inhibiting ovulation. If there is no ovum, fertilization cannot occur, virtually eliminating the risk of any pregnancy. * **Endometrial Carcinoma:** The progestogen component in COCPs opposes the proliferative effect of estrogen on the endometrium, leading to atrophy. This reduces the risk of endometrial cancer by approximately 50%, a benefit that persists for years after discontinuation. * **Ovarian Carcinoma:** By suppressing ovulation, COCPs reduce "incessant ovulation" and the repeated trauma to the ovarian epithelium. This reduces the risk of epithelial ovarian cancer by about 40-50%. ### High-Yield Clinical Pearls for NEET-PG: * **Protective Effect:** COCPs are protective against **Endometrial, Ovarian, and Colorectal cancers**, as well as Benign Breast Disease and Pelvic Inflammatory Disease (PID). * **Increased Risk:** COCPs are associated with an increased risk of **Cervical cancer, Breast cancer, and Hepatic adenoma**. * **Therapeutic Uses:** They are first-line treatments for Dysmenorrhea, Menorrhagia (DUB), and Polycystic Ovary Syndrome (PCOS). * **Duration:** The protective effect against ovarian and endometrial cancer increases with the duration of use and lasts for up to 15–20 years after stopping the pill.

Q: Unsuccessfulness of Depot Medroxyprogesterone Acetate (DMPA) has been primarily because of which of the following?

Breakthrough bleeding. **Explanation:** The primary reason for the "unsuccessfulness" of DMPA (marketed as Antara in India) refers to its **high discontinuation rate** rather than its contraceptive efficacy. 1. **Why Breakthrough Bleeding (BTB) is correct:** DMPA is a progestogen-only injectable. The lack of estrogen leads to an unstable endometrium, causing irregular spotting or breakthrough bleeding, especially in the first 3–6 months. This side effect is the most common reason women stop using the method, leading to its perceived "unsuccessfulness" in long-term family planning programs. Over time, this usually progresses to amenorrhea, which can also be a cause for discontinuation due to cultural myths or fear of pregnancy. 2. **Analysis of Incorrect Options:** * **Effect on lactation:** DMPA is actually the **contraceptive of choice in lactating mothers** (after 6 weeks postpartum) as it does not affect the quality or quantity of breast milk. * **Delay in return of fertility:** While DMPA causes a significant delay (average 7–10 months after the last dose), it is a known pharmacological profile of the drug. While it may deter some users, it is not the leading cause of mid-treatment discontinuation compared to bleeding. * **Failure rate:** DMPA is highly effective. Its Pearl Index is **0.2–0.3**, making it one of the most reliable reversible contraceptives. **High-Yield Clinical Pearls for NEET-PG:** * **Dosage:** 150 mg intramuscularly every 3 months (12 weeks). * **Mechanism:** Primarily inhibits ovulation by suppressing the LH surge. * **Side Effects:** Weight gain (most common metabolic side effect) and a reversible decrease in **Bone Mineral Density (BMD)**. * **Amenorrhea:** By the end of 1 year, approximately 50–60% of users develop amenorrhea.

Q: For effective protection after unprotected intercourse, one single tablet of levonorgestrel 0.75mg has already been taken. When should the next dose be taken?

1 tablet after 12 hours. **Explanation:** The question refers to the **Yuzpe regimen** or the traditional two-dose Levonorgestrel (LNG) emergency contraceptive protocol. **1. Why Option B is Correct:** The standard emergency contraceptive dose for Levonorgestrel is **1.5 mg**. When using the 0.75 mg formulation, the protocol requires two doses to reach the therapeutic threshold. The second 0.75 mg tablet must be taken exactly **12 hours** after the first dose. This timing ensures sustained hormonal levels to effectively delay or inhibit ovulation, which is the primary mechanism of action. **2. Why Other Options are Incorrect:** * **Options A & D:** Waiting 24 hours is incorrect because the plasma half-life and pharmacokinetics of LNG in this regimen are optimized for a 12-hour interval. Delaying the second dose reduces efficacy. * **Option C:** Taking two tablets (1.5 mg) 12 hours after an initial 0.75 mg dose would result in a total dose of 2.25 mg, which is unnecessary and increases the risk of side effects like nausea and vomiting without providing additional contraceptive benefit. **3. NEET-PG High-Yield Clinical Pearls:** * **The "Gold Standard" Change:** While the 12-hour split dose is the traditional method, the WHO now recommends a **single dose of 1.5 mg (e.g., i-Pill, 72-HOURS)** as it is equally effective and improves patient compliance. * **Time Window:** LNG is effective if taken within **72 hours** of unprotected intercourse, though efficacy is highest within the first 24 hours. * **Mechanism:** It primarily works by preventing the LH surge; it does **not** work if implantation has already occurred (it is not an abortifacient). * **Most Effective EC:** The **Copper-T (IUCD)** remains the most effective emergency contraceptive if inserted within 5 days. * **Ulipristal Acetate:** A selective progesterone receptor modulator (30 mg) is now preferred over LNG for use up to 120 hours (5 days).

Q: Oral contraceptive pills are contraindicated in all of the following conditions except:

Polycystic ovarian disease. **Explanation:** The correct answer is **Polycystic Ovarian Disease (PCOD/PCOS)**. In fact, Combined Oral Contraceptive Pills (COCPs) are considered the **first-line management** for PCOS. They help regulate menstrual cycles, provide endometrial protection against hyperplasia (by counteracting unopposed estrogen), and treat hyperandrogenism (hirsutism and acne) by increasing Sex Hormone Binding Globulin (SHBG), which lowers free testosterone levels. **Analysis of Contraindications (WHO Medical Eligibility Criteria - Category 4):** The other options represent absolute contraindications to COCPs due to the increased risk of thromboembolism and cardiovascular events associated with the estrogen component: * **Smoking in a patient ≥35 years:** Smoking significantly synergizes with estrogen to increase the risk of myocardial infarction and stroke. It is an absolute contraindication if the patient smokes ≥15 cigarettes/day and is over 35. * **Coronary Occlusion (Ischemic Heart Disease):** Estrogen increases the synthesis of clotting factors and promotes a pro-thrombotic state, which can exacerbate or trigger further coronary events. * **Cerebrovascular Disease:** A history of stroke or TIA is a Category 4 contraindication because COCPs increase the risk of ischemic stroke. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (Mnemonic: ACHES):** **A**bdominal pain (Gallbladder disease/Tumors), **C**hest pain (IHD), **H**eadaches (Migraine with aura), **E**ye problems (Vascular disease), **S**evere leg pain (DVT). * **Breast Cancer:** COCPs are absolutely contraindicated in current breast cancer. * **Liver Disease:** Active viral hepatitis or decompensated cirrhosis are contraindications. * **PCOS Benefit:** COCPs containing **Cyproterone acetate** or **Drospirenone** are preferred in PCOS for their superior anti-androgenic properties.

Q: An intrauterine device (IUD) should not be inserted in which of the following conditions?

Immediate postpartum period. **Explanation:** The correct answer is **D. Immediate postpartum period**. This question focuses on the **WHO Medical Eligibility Criteria (MEC)** for contraceptive use. **Why Option D is correct:** According to WHO MEC Category 4 (Absolute Contraindication), an IUD should not be inserted between **48 hours and 4 weeks postpartum**. During this period, the risk of **expulsion** is highest due to uterine involution, and there is an increased risk of perforation. *Note: IUD insertion is safe within the first 48 hours (PPIUD) or after 4 weeks (interval insertion).* **Analysis of Incorrect Options:** * **A & C (Genital bleeding of unknown origin / Suspected cervical malignancy):** These are **Category 4** contraindications for *initiation* of an IUD. However, in the context of this specific question (often sourced from standard textbooks like Dutta), the "Immediate Postpartum Period" (48h–4wks) is highlighted as the specific temporal contraindication regarding the timing of insertion. * **B (Postpartum endometritis):** This is a **Category 4** contraindication. However, it is an infective complication rather than a physiological timing contraindication. **High-Yield NEET-PG Pearls:** * **WHO MEC Category 4 (Absolute Contraindications) for Cu-T:** 1. Pregnancy. 2. Unexplained vaginal bleeding (until evaluated). 3. Current PID or Purulent cervicitis. 4. Gestational Trophoblastic Disease (with high hCG). 5. Cervical or Endometrial Cancer (awaiting treatment). 6. Distorted uterine cavity (Fibroids). 7. Pelvic Tuberculosis. * **Ideal Time for Insertion:** 3–7 days of the menstrual cycle (to rule out pregnancy and ensure an open internal os). * **Most common side effect:** Bleeding (Menorrhagia). * **Most common reason for removal:** Pain and Bleeding.

Q: All of the following are considered procedures for female sterilization, EXCEPT?

Laparoscopic puerperal sterilization. **Explanation:** The core concept behind this question lies in the timing and physiological constraints of postpartum sterilization. **Why Option C is the correct answer:** **Puerperal sterilization** refers to tubal ligation performed within the first week (usually 24–48 hours) after delivery. During the early puerperium, the uterus is an abdominal organ (enlarged), and the fallopian tubes are easily accessible via a small sub-umbilical incision. Therefore, **Mini-laparotomy** is the preferred and standard method for puerperal sterilization. **Laparoscopy is contraindicated** in the immediate puerperium because the enlarged uterus increases the risk of injury during trocar insertion, and the increased vascularity of the pelvic organs poses a higher risk of bleeding. **Analysis of other options:** * **A. Mini-lap tubal ligation:** The most common method used in mass sterilization camps and for postpartum (puerperal) sterilization. It involves a small abdominal incision (Pomeroy’s technique is most common). * **B. Laparoscopic tubal ligation:** The gold standard for **interval sterilization** (performed 6 weeks after delivery). It uses Falope rings or Filshie clips. * **C. Hysteroscopic tubal occlusion:** A non-incisional method (e.g., Essure, though now largely discontinued) where micro-inserts are placed into the fallopian tubes via the cervix. **High-Yield NEET-PG Pearls:** * **Ideal time for Puerperal Sterilization:** 24–48 hours postpartum (not before 24 hours to allow for neonatal assessment). * **Preferred Technique:** Pomeroy’s method (Modified) is the most popular due to its simplicity and efficacy. * **Failure Rates:** Failure is highest in laparoscopic clips and lowest in surgical excision (Pomeroy). * **Interval Sterilization:** Best performed during the follicular phase of the menstrual cycle.

Q: Oral contraceptive pills are contraindicated in all except?

Uterine fibroids. **Explanation:** Combined Oral Contraceptive Pills (COCPs) contain estrogen and progesterone, which significantly influence systemic physiology. Understanding their contraindications is crucial for NEET-PG. **Why Uterine Fibroids is the Correct Answer:** Uterine fibroids are **not** a contraindication for COCPs. In fact, COCPs are often used as a medical management strategy for fibroids to control the associated heavy menstrual bleeding (menorrhagia). While estrogen can theoretically stimulate fibroid growth, low-dose modern pills do not typically cause significant enlargement and provide the benefit of cycle regulation. **Analysis of Incorrect Options (Contraindications):** * **Intermittent Vaginal Bleeding:** Undiagnosed abnormal vaginal bleeding is an absolute contraindication. COCPs can mask the symptoms of underlying malignancies (like endometrial or cervical cancer) which must be ruled out before starting hormonal therapy. * **History of Thromboembolism:** Estrogen increases the synthesis of clotting factors in the liver and decreases anticoagulants like Protein S. A history of DVT or pulmonary embolism is a Category 4 contraindication (unacceptable health risk) due to the high risk of recurrence. * **Cardiac Abnormalities:** Conditions such as ischemic heart disease, complicated valvular disease, or severe hypertension are contraindications because the estrogen component increases the risk of stroke and myocardial infarction. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Medical Eligibility Criteria (MEC) Category 4 (Absolute Contraindications):** Smoker >35 years (≥15 cigarettes/day), History of Thromboembolism, Migraine with aura, Breast cancer (current), and Liver tumors. * **Benefit:** COCPs are **protective** against Ovarian and Endometrial cancers. * **Drug Interaction:** Rifampicin is the most potent inducer of hepatic enzymes that decreases COCP efficacy.

Question 1

An Intrauterine Device (IUD) is not inserted during which of the following conditions?

Accepted Answer

Immediately after delivery (within 48 hours)

Answer

During menstruation

Answer

Within 10 days of the beginning of menstruation

Answer

6-8 weeks after delivery

Question 2

Replacement of a progestin-releasing intrauterine device should be done after how many years?

Accepted Answer

5 years

Answer

1 year

Answer

3 years

Answer

10 years

Question 3

Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

Accepted Answer

Condoms

Answer

Oral contraceptives

Answer

Intrauterine device (IUD)

Answer

Laparoscopic tubal ligation

Question 4

Non-contraceptive benefits of oral contraceptive agents are against the development of all of the following except?

Accepted Answer

Cervical carcinoma

Answer

Ectopic pregnancy

Answer

Endometrial carcinoma

Answer

Ovarian carcinoma

Question 5

Unsuccessfulness of Depot Medroxyprogesterone Acetate (DMPA) has been primarily because of which of the following?

Accepted Answer

Breakthrough bleeding

Answer

Effect on lactation

Answer

Delay in return of fertility

Answer

Failure rate

Question 6

For effective protection after unprotected intercourse, one single tablet of levonorgestrel 0.75mg has already been taken. When should the next dose be taken?

Accepted Answer

1 tablet after 12 hours

Answer

1 tablet after 24 hours

Answer

2 tablets after 12 hours

Answer

2 tablets after 24 hours

Question 7

Oral contraceptive pills are contraindicated in all of the following conditions except:

Accepted Answer

Polycystic ovarian disease

Answer

Smoking in a patient 35 years or older

Answer

Coronary occlusion

Answer

Cerebrovascular disease

Question 8

An intrauterine device (IUD) should not be inserted in which of the following conditions?

Accepted Answer

Immediate postpartum period

Answer

Genital bleeding of unknown origin

Answer

Postpartum endometritis

Answer

Suspected cervical malignancy

Question 9

All of the following are considered procedures for female sterilization, EXCEPT?

Accepted Answer

Laparoscopic puerperal sterilization

Answer

Mini-lap tubal ligation

Answer

Laparoscopic tubal ligation

Answer

Hysteroscopic tubal occlusion

Question 10

Oral contraceptive pills are contraindicated in all except?

Accepted Answer

Uterine fibroids

Answer

Intermittent vaginal bleeding

Answer

History of thromboembolism

Answer

Cardiac abnormalities

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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