Contraception and Family Planning Practice Questions

Q: What is the ideal contraceptive in the given scenario?

Oral contraceptive pill. ***Oral contraceptive pill*** - Provides excellent **contraceptive efficacy** (>99%) while offering dual benefits of **cycle regulation** and **hormonal balance** in young women with irregular cycles or PCOS. - Contains **estrogen and progestin** that help regulate menstrual cycles, reduce **dysmenorrhea**, and improve **acne** in reproductive-age women. *Intrauterine device (Cu-T)* - **Cu-T** may cause increased **menstrual bleeding** and **dysmenorrhea**, worsening existing menstrual irregularities. - Not ideal for young women with **heavy or irregular periods** as it can exacerbate these symptoms. *Barrier method* - Provides **lower contraceptive efficacy** (85-95%) compared to hormonal methods, requiring consistent proper use. - Offers **no hormonal benefits** for cycle regulation, dysmenorrhea relief, or management of conditions like PCOS. *Depot medroxyprogesterone acetate (Depo-Provera)* - Can cause **irregular bleeding** or **amenorrhea**, potentially masking underlying menstrual disorders in young women. - Associated with **bone density loss** and **weight gain**, making it less suitable for young women who need long-term contraception.

Q: What is the absolute contraindication for prescribing oral contraceptive pills in a woman of reproductive age group?

Congenital hyperlipidemia. **Explanation:** The correct answer is **Congenital hyperlipidemia**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which significantly impacts lipid metabolism. Estrogen increases the synthesis of triglycerides and VLDL in the liver. In patients with congenital hyperlipidemia, COCPs can trigger severe hypertriglyceridemia, leading to a high risk of **acute pancreatitis** and accelerating atherosclerosis, thereby increasing the risk of cardiovascular events. According to the WHO Medical Eligibility Criteria (MEC), known dyslipidemias are classified as **MEC Category 4** (absolute contraindication). **Analysis of Incorrect Options:** * **Epilepsy:** This is a **relative contraindication**. The primary concern is not safety, but efficacy; enzyme-inducing anti-epileptic drugs (like Phenytoin or Carbamazepine) increase the metabolism of OCPs, leading to contraceptive failure. * **Diabetes Mellitus:** It is a relative contraindication (**MEC 2/3**). OCPs can be used in diabetics without vascular complications. It becomes an absolute contraindication only if there is associated nephropathy, retinopathy, neuropathy, or if the duration of diabetes is >20 years. * **Hypertension:** It is a relative contraindication (**MEC 3**) if blood pressure is well-controlled (140–159/90–99 mmHg). It becomes an absolute contraindication (**MEC 4**) only if BP is ≥160/100 mmHg or if there is associated vascular disease. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (MEC 4):** Smoker >35 years (≥15 cigarettes/day), History of DVT/PE, Ischemic heart disease, Stroke, Breast cancer (current), Migraine with aura, and Decompensated Cirrhosis. * **Best OCP for Lactating Mothers:** Progestogen-only pills (POPs), as estrogen suppresses lactation. * **Non-contraceptive benefit:** OCPs reduce the risk of Ovarian and Endometrial cancers.

Q: Which is the most likely complication of an IUD?

None of the above. **Explanation:** The correct answer is **None of the above** because the most common complications of an Intrauterine Device (IUD) are **increased menstrual bleeding (menorrhagia)** and **pelvic pain**. Since these are not listed among the options, "None of the above" is the most appropriate choice. **Analysis of Options:** * **A. Hypofibrinogenemia:** This is not a complication of IUD use. It is typically associated with obstetric emergencies like Abruptio Placentae, Amniotic Fluid Embolism, or prolonged Intrauterine Fetal Death (IUFD). * **B. Sterility:** IUDs do not cause permanent sterility. Fertility returns immediately upon removal. While Pelvic Inflammatory Disease (PID) can lead to tubal factor infertility, the risk is primarily limited to the first 20 days post-insertion due to pre-existing infection or poor aseptic technique, not the device itself. * **C. Cervical tear:** This is an extremely rare mechanical injury that might occur during a difficult insertion but is not considered a standard or likely complication of the device. **High-Yield NEET-PG Pearls:** 1. **Most common side effect:** Excessive menstrual bleeding (especially with Cu-T). 2. **Most common reason for removal:** Excessive bleeding and pain. 3. **Most common cause of IUD failure:** Expulsion (most common in the first year, during menstruation). 4. **Ectopic Pregnancy:** An IUD does not *cause* ectopic pregnancy, but if a woman becomes pregnant with an IUD in situ, the *likelihood* that the pregnancy is ectopic is higher compared to the general population. 5. **Perforation:** Most common during the act of insertion (incidence 1 in 1000).

Q: What is the primary mechanism of action of combined oral contraceptive pills?

Prevent release of ovum from the ovary. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is the **inhibition of ovulation** (prevention of the release of the ovum). COCPs contain both estrogen and progestogen, which exert negative feedback on the hypothalamo-pituitary-ovarian axis. Estrogen primarily suppresses **FSH** (Follicle Stimulating Hormone), preventing follicular development, while progestogen suppresses the **LH** (Luteinizing Hormone) surge, which is essential for ovulation. **Analysis of Options:** * **Option A (Incorrect):** While COCPs do prevent fertilization as a secondary result of there being no egg, the *primary* physiological action occurs earlier in the cycle by halting ovulation. * **Option B (Correct):** As explained, the suppression of the LH surge prevents the ovary from releasing an egg. * **Option C (Incorrect):** This is a secondary mechanism. Progestogens cause endometrial atrophy, making the lining unreceptive, but this only occurs if ovulation and fertilization were to bypass the primary mechanism. * **Option D (Incorrect):** While progestogens thicken the cervical mucus to create a barrier for sperm penetration, they do not directly reduce the intrinsic motility of the sperm itself. **NEET-PG High-Yield Pearls:** 1. **Triple Action of COCPs:** 1) Inhibition of ovulation (Primary), 2) Thickening of cervical mucus (Hostile mucus), and 3) Endometrial atrophy (Prevents implantation). 2. **The "Mini-pill" (POPs):** Unlike COCPs, Progestogen-Only Pills primarily act by thickening cervical mucus; they do not consistently inhibit ovulation. 3. **Non-contraceptive benefits:** COCPs reduce the risk of ovarian and endometrial cancers, ectopic pregnancy, and benign breast disease. 4. **Failure Rate:** The Pearl Index for COCPs with perfect use is 0.1 per 100 woman-years.

Q: Which one of the following statements regarding the female contraceptive "Today" is true?

It is a polyurethane foam saturated with nonoxynol.. **Explanation:** **1. Why Option A is Correct:** "Today" is the brand name for a **vaginal contraceptive sponge**. It is a small, circular device made of **polyurethane foam** that is saturated with 1000 mg of **Nonoxynol-9**, a potent spermicide. It works through a triple mechanism: * **Chemical:** It releases the spermicide to kill sperm. * **Mechanical:** It acts as a physical barrier over the cervix. * **Absorption:** The foam absorbs the semen, preventing sperm from entering the cervical canal. It provides protection for up to 24 hours. **2. Why the Other Options are Incorrect:** * **Option B:** This describes a **Low-Dose Combined Oral Contraceptive Pill (COCP)**. While these are common, "Today" is a barrier method, not a hormonal pill. * **Option C:** This describes a **Standard-Dose COCP** (specifically a formulation like Ovral). The dosage of Ethinyl Oestradiol (0.3 mg) mentioned here is actually quite high/toxic; standard pills usually contain 0.03 mg (30 mcg). * **Option D:** **Gossypol** is a polyphenolic compound derived from cottonseed oil investigated as a **male contraceptive** (it inhibits sperm production). It is not used in "Today" and has been largely abandoned due to side effects like permanent infertility and hypokalemia. **3. NEET-PG High-Yield Pearls:** * **Nonoxynol-9:** It is a surfactant that destroys the sperm cell membrane. Note: It does **not** protect against HIV/STIs and may actually increase transmission risk by causing vaginal irritation. * **Toxic Shock Syndrome (TSS):** Users should be warned not to leave the sponge in for more than 30 hours due to the risk of TSS. * **Failure Rate:** The Pearl Index for the sponge is higher (approx. 12–24 per 100 woman-years) compared to OCPs or IUCDs, especially in parous women.

Q: Use of oral contraceptives decreases the incidence of all of the following except?

Hepatic adenoma. **Explanation:** The correct answer is **C. Hepatic adenoma**. Combined Oral Contraceptive Pills (COCPs) are associated with several non-contraceptive benefits, but they also carry specific metabolic and neoplastic risks. **Hepatic adenoma** is a rare, benign liver tumor that is actually **increased** by the use of COCPs. The risk is dose-dependent and duration-dependent, linked primarily to the estrogen component which can stimulate hepatocyte proliferation. **Why other options are incorrect:** * **Ectopic pregnancy:** COCPs decrease the overall risk of ectopic pregnancy because they are highly effective at preventing ovulation and conception. If there is no pregnancy, there is no risk of an ectopic one. * **Epithelial ovarian malignancy:** COCPs provide a significant protective effect against ovarian cancer (approx. 40-50% reduction). This is due to the suppression of "incessant ovulation," which reduces trauma to the ovarian epithelium. This protection persists for years after discontinuation. * **Pelvic Inflammatory Disease (PID):** Progestogens in COCPs thicken the cervical mucus, creating a physical barrier that prevents the upward migration of pathogens (like *N. gonorrhoeae*) into the upper reproductive tract. **High-Yield NEET-PG Pearls:** * **Protective Effects of COCPs:** Decreased risk of Endometrial cancer, Ovarian cancer (Epithelial), Benign breast disease, PID, and Iron deficiency anemia (due to reduced menstrual flow). * **Increased Risks of COCPs:** Hepatic adenoma, Venous Thromboembolism (VTE), Hypertension, and a slight increase in the risk of Cervical cancer (linked to HPV persistence) and Breast cancer. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of VTE, smokers >35 years (>15 cigarettes/day), and estrogen-dependent tumors.

Q: What is the minimum effective dose of estrogen in oral contraceptive pills (OCPs)?

20 mcg. **Explanation:** The correct answer is **20 mcg**. The evolution of Combined Oral Contraceptive Pills (COCPs) has been characterized by a steady reduction in the dose of estrogen (Ethinyl Estradiol) to minimize side effects while maintaining contraceptive efficacy. 1. **Why 20 mcg is correct:** Modern "low-dose" OCPs typically contain 20–35 mcg of Ethinyl Estradiol. Clinical studies have established that **20 mcg** is the minimum effective dose required to consistently suppress follicle-stimulating hormone (FSH) and prevent ovulation. While ultra-low-dose pills (15 mcg) exist, 20 mcg remains the standard minimum threshold for reliable efficacy in conventional practice. 2. **Why other options are incorrect:** * **30 mcg:** This is a common dosage in "low-dose" pills (e.g., Mala-N and Mala-D contain 30 mcg), but it is not the *minimum* effective dose. * **50 mcg:** Pills containing ≥50 mcg are termed "high-dose" pills. These are rarely used today due to a significantly higher risk of venous thromboembolism (VTE) and cardiovascular complications. * **40 mcg:** This is an intermediate dose used in older formulations but does not represent the minimum threshold. **High-Yield Clinical Pearls for NEET-PG:** * **Mala-N & Mala-D:** Contain 30 mcg Ethinyl Estradiol + 0.15 mg Levonorgestrel. * **Centchroman (Saheli):** A Non-steroidal, Selective Estrogen Receptor Modulator (SERM). Dosage: 30 mg twice weekly for 3 months, then once weekly. * **Mechanism of Action:** Estrogen primarily inhibits **FSH** (preventing follicular development), while Progesterone inhibits **LH surge** (preventing ovulation) and thickens cervical mucus. * **VTE Risk:** The risk of thromboembolism is directly proportional to the dose of estrogen. This is why the shift toward 20 mcg is clinically significant.

Q: Which of the following intrauterine devices has the minimum failure rate?

Levonorgestrel IUD. The efficacy of an Intrauterine Device (IUD) is primarily determined by its mechanism of action and the surface area of the active component. ### **Explanation of the Correct Answer** **C. Levonorgestrel IUD (LNG-20) / Mirena:** This is the most effective reversible contraceptive method available. It has a failure rate of approximately **0.2 per 100 woman-years**, which is comparable to surgical sterilization. Its superior efficacy is due to a dual mechanism: it acts as a local foreign body and releases 20 µg of levonorgestrel daily. This thickens cervical mucus (preventing sperm penetration), causes endometrial atrophy (preventing implantation), and occasionally inhibits ovulation. ### **Analysis of Incorrect Options** * **A. Progestasert:** This was a first-generation hormonal IUD that released natural progesterone. It had a higher failure rate (approx. 2.0%) and a short lifespan (1 year), making it less effective than modern LNG-IUDs. * **B. Cu T-380 A:** This is the most effective copper IUD with a failure rate of **0.6–0.8 per 100 woman-years**. While highly effective and the "gold standard" for non-hormonal IUDs, its failure rate is slightly higher than the LNG-IUD. * **D. T Cu-200:** This is an older generation copper IUD with a smaller surface area (200 $mm^2$). Lower copper surface area correlates with higher failure rates (approx. 2.0–3.0%). ### **NEET-PG High-Yield Pearls** * **Most effective overall contraceptive:** Implant (Nexplanon) > LNG-IUD > Vasectomy. * **Life span of IUDs:** Cu T-380A (10 years), LNG-20/Mirena (5–7 years), Cu T-200 (3 years). * **Ideal Candidate for LNG-IUD:** Women with Menorrhagia (DUB) or Endometriosis, as it significantly reduces menstrual blood loss. * **Commonest side effect:** For Copper T, it is **bleeding**; for LNG-IUD, it is **amenorrhea/spotting**.

Q: A couple requires emergency contraception four days after unprotected intercourse. What is the recommended contraceptive method?

Copper T 380 IUD. ### Explanation **Correct Option: B. Copper T 380 IUD** The key to this question lies in the **timing of emergency contraception (EC)**. The patient is presenting **four days (96 hours)** after unprotected intercourse. * **Copper T 380 IUD:** This is the most effective method of emergency contraception. It can be inserted up to **5 days (120 hours)** after unprotected intercourse or up to 5 days after the earliest expected date of ovulation. It works primarily by preventing fertilization and interfering with implantation. It has a failure rate of less than 0.1%. **Why other options are incorrect:** * **A. Oral contraceptive pills (OCPs):** Standard OCPs are not used as EC unless taken in specific high doses (Yuzpe regimen). Even then, they are less effective than the IUD and generally recommended within 72 hours. * **C. Yuzpe method:** This involves combined estrogen-progestogen pills. It must be initiated within **72 hours** for optimal efficacy and is associated with significant side effects like nausea and vomiting. * **D. Low dose progestogen-only pills:** While Levonorgestrel (LNG) 1.5mg is a common EC, it is most effective within 72 hours. While it can be used up to 120 hours, its efficacy decreases significantly after 72 hours compared to the Copper IUD. **High-Yield NEET-PG Pearls:** 1. **Gold Standard:** The Copper IUD is the most effective EC and provides ongoing long-term contraception. 2. **Ulipristal Acetate (30mg):** This is the most effective *oral* EC and can be used up to **120 hours** (5 days). However, if the Copper IUD is an option, it remains superior. 3. **Levonorgestrel (LNG):** Recommended dose is 1.5 mg (single dose) or 0.75 mg (two doses 12 hours apart). 4. **Mechanism:** EC methods primarily work by delaying ovulation; however, the Copper IUD also prevents implantation. EC **cannot** disrupt an already established pregnancy (it is not an abortifacient).

Q: A woman was taking progestin-only pills for contraception. Which side-effect is not likely to occur?

Dysmenorrhea. **Explanation:** Progestin-only pills (POPs), often called the "minipill," primarily work by thickening cervical mucus and thinning the endometrial lining. In many women, they also inhibit ovulation. **Why Dysmenorrhea is the correct answer:** Dysmenorrhea (painful menstruation) is primarily caused by high levels of **prostaglandins** released during the shedding of a secretory endometrium. Progestins cause endometrial atrophy and often lead to anovulation. By thinning the uterine lining and reducing menstrual flow (or causing amenorrhea), POPs actually **improve or treat dysmenorrhea** rather than causing it. Therefore, it is the "least likely" side effect. **Analysis of Incorrect Options:** * **Acne:** Progestins (especially older generations like Levonorgestrel) have varying degrees of **androgenic activity**. This can stimulate sebaceous glands, leading to acne and oily skin. * **Amenorrhea:** Due to the continuous administration of progestin without an estrogen-induced proliferative phase, the endometrium becomes thin and atrophic. This frequently results in irregular spotting or complete cessation of menses (amenorrhea). * **Obesity:** Weight gain is a commonly reported side effect of hormonal contraceptives, including POPs, often attributed to increased appetite or fluid retention associated with progestogenic effects. **High-Yield NEET-PG Pearls:** * **Mechanism of Action:** The primary mechanism of POPs is **cervical mucus thickening**. Inhibition of ovulation occurs in only about 60-80% of cycles. * **The "3-Hour Rule":** Traditional POPs must be taken at the same time every day; a delay of more than 3 hours requires backup contraception for 48 hours. * **Ideal Candidate:** POPs are the contraceptive of choice for **lactating mothers** (as they don't suppress milk production) and women with contraindications to estrogen (e.g., history of DVT or smokers >35 years).

Question 1

What is the ideal contraceptive in the given scenario?

Accepted Answer

Oral contraceptive pill

Answer

Intrauterine device (Cu-T)

Answer

Barrier method

Answer

Depot medroxyprogesterone acetate (Depo-Provera)

Question 2

What is the absolute contraindication for prescribing oral contraceptive pills in a woman of reproductive age group?

Accepted Answer

Congenital hyperlipidemia

Answer

Epilepsy

Answer

Diabetes mellitus

Answer

Hypertension

Question 3

Which is the most likely complication of an IUD?

Accepted Answer

None of the above

Answer

Hypofibrinogenemia

Answer

Sterility

Answer

Cervical tear

Question 4

What is the primary mechanism of action of combined oral contraceptive pills?

Accepted Answer

Prevent release of ovum from the ovary

Answer

Prevent fertilization

Answer

Prevent implantation of a fertilized ovum

Answer

Reduce sperm motility

Question 5

Which one of the following statements regarding the female contraceptive "Today" is true?

Accepted Answer

It is a polyurethane foam saturated with nonoxynol.

Answer

It is an oral pill containing norethisterine acetate 1.0mg and ethinyl oestradiol 0.03 mg.

Answer

It is an oral pill containing D-norgesterel 0.50 mg and ethinyl oestradiol 0.3 mg.

Answer

It is made of gossypol, a derivative obtained from cottonseed oil.

Question 6

Use of oral contraceptives decreases the incidence of all of the following except?

Accepted Answer

Hepatic adenoma

Answer

Ectopic pregnancy

Answer

Epithelial ovarian malignancy

Answer

Pelvic inflammatory disease

Question 7

What is the minimum effective dose of estrogen in oral contraceptive pills (OCPs)?

Accepted Answer

20 mcg

Answer

30 mcg

Answer

40 mcg

Answer

50 mcg

Question 8

Which of the following intrauterine devices has the minimum failure rate?

Accepted Answer

Levonorgestrel IUD

Answer

Progestase

Answer

Cu T-380 A

Answer

T Cu -200

Question 9

A couple requires emergency contraception four days after unprotected intercourse. What is the recommended contraceptive method?

Accepted Answer

Copper T 380 IUD

Answer

Oral contraceptive pills

Answer

Yuzpe method

Answer

Low dose progestogen-only pills

Question 10

A woman was taking progestin-only pills for contraception. Which side-effect is not likely to occur?

Accepted Answer

Dysmenorrhea

Answer

Acne

Answer

Amenorrhea

Answer

Obesity

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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