Contraception and Family Planning Practice Questions

Q: What is the most common side effect of an Intrauterine Contraceptive Device (IUCD) that necessitates its removal?

Pain. The correct answer is **Pain (Option B)**. ### **Explanation** While **bleeding** (menorrhagia or intermenstrual spotting) is statistically the **most common side effect** overall associated with IUCD use, **pain** (dysmenorrhea or pelvic cramping) is the **most common reason for medical removal** of the device. The underlying medical concept is based on patient tolerance: most women can manage or be treated for increased menstrual flow with NSAIDs or antifibrinolytics. However, persistent or severe pelvic pain is often perceived as intolerable or indicative of complications (like displacement or PID), leading both the patient and the clinician to opt for removal. ### **Analysis of Incorrect Options** * **A. Bleeding:** This is the most frequent side effect, but it is second to pain as a reason for discontinuation/removal. * **C. Pelvic Infection:** While IUCDs (specifically the insertion process) slightly increase the risk of Pelvic Inflammatory Disease (PID) in the first 20 days, it is a relatively rare complication and not the primary reason for removal. * **D. Ectopic Pregnancy:** An IUCD significantly reduces the *absolute* risk of ectopic pregnancy by preventing pregnancy overall. However, if a woman *does* conceive with an IUCD in situ, the *relative* risk that the pregnancy is ectopic is higher. ### **High-Yield Clinical Pearls for NEET-PG** * **Most common side effect:** Bleeding. * **Most common cause for removal:** Pain. * **Most common complication:** Expulsion (most likely to occur in the first 3 months, during menstruation). * **Ideal time for insertion:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Mechanism of Action (Cu-T):** Primarily a sterile inflammatory response in the endometrium which is spermicidal.

Q: Centchroman is:

A nonsteroidal oral contraceptive. **Explanation:** **Centchroman (Ormeloxifene)** is a unique **non-steroidal, non-hormonal oral contraceptive** developed by the Central Drug Research Institute (CDRI), Lucknow, India. It belongs to the class of **Selective Estrogen Receptor Modulators (SERMs)**. It works by antagonizing estrogen receptors in the uterus, thereby altering the endometrial receptivity and preventing the implantation of the blastocyst. Since it does not suppress ovulation, the normal hormonal milieu of the body remains undisturbed. **Analysis of Options:** * **Option A & B:** While SERMs are sometimes explored for estrogen-dependent conditions, Centchroman is primarily indicated and marketed as a contraceptive and for the treatment of Dysfunctional Uterine Bleeding (DUB). It is not the standard "new drug" for fibroids (where Ulipristal or GnRH analogues are used) or endometriosis (where Dienogest or GnRH analogues are preferred). * **Option C:** Centchroman is an **oral pill**, not an injectable. Common injectables include DMPA (Antara program) and NET-EN. * **Option D:** This is correct as Centchroman is the only non-steroidal oral contraceptive pill available, famously known by the brand names **Saheli** or **Chhaya** (under the National Family Planning Program). **High-Yield Clinical Pearls for NEET-PG:** * **Dosage Schedule:** 30 mg **twice weekly** for the first 3 months, followed by **once weekly** thereafter. * **Major Side Effect:** The most common side effect is a **prolonged menstrual cycle** (delayed periods), which occurs in about 8% of users. * **Safety Profile:** It has no steroid-related side effects like weight gain, nausea, or mood swings, and it is safe for use during **lactation**. * **Other Uses:** It is highly effective in treating **Mastalgia** and **Dysfunctional Uterine Bleeding (DUB)**.

Q: Which of the following is NOT an absolute contraindication for oral contraceptive pills?

Smoking. In the context of Combined Oral Contraceptive Pills (COCPs), it is crucial to distinguish between **Absolute Contraindications (WHO Category 4)** and **Relative Contraindications (WHO Category 3)**. ### Why Smoking is the Correct Answer Smoking is **not** an absolute contraindication for all women. According to the WHO Medical Eligibility Criteria (MEC), smoking is only an absolute contraindication (Category 4) if the woman is **$\geq$ 35 years old and smokes $\geq$ 15 cigarettes per day**. For women under 35 or those who smoke fewer than 15 cigarettes, it is considered a relative contraindication. Therefore, "Smoking" as a standalone option is not an absolute contraindication. ### Why Other Options are Wrong (Absolute Contraindications) * **Valvular Heart Disease:** If complicated by pulmonary hypertension, atrial fibrillation, or a history of subacute bacterial endocarditis, it is Category 4 due to the high risk of thromboembolism. * **Migraine with Focal Aura:** Estrogen increases the risk of ischemic stroke. Migraine with aura at any age is a Category 4 contraindication. * **History of Breast Cancer:** Breast cancer is a hormone-dependent tumor. Any current or past history of breast cancer is Category 4 because exogenous estrogen can stimulate tumor growth or recurrence. ### High-Yield Clinical Pearls for NEET-PG * **Mnemonic for Absolute Contraindications (C-H-E-C-K):** **C**ancer (Breast/Genital), **H**eart disease/Hypertension ($\geq$160/100), **E**mbolism (DVT/PE), **C**oagulation disorders, **K**liver (Liver) disease/Cirrhosis. * **Undiagnosed Vaginal Bleeding:** This is an absolute contraindication until malignancy is ruled out. * **Postpartum:** COCPs are contraindicated for the first 3 weeks postpartum due to high VTE risk, and for 6 months if breastfeeding (Category 4).

Q: Which of the following is NOT true about Nexplanon?

Is an estrogen subdermal implant. **Explanation:** **Nexplanon** is a long-acting reversible contraceptive (LARC) that consists of a single-rod subdermal implant. **Why Option C is correct:** Nexplanon is **not** an estrogen implant; it contains **68 mg of Etonogestrel**, which is a third-generation **progestin** (a derivative of desogestrel). It does not contain any estrogen, making it a safe alternative for women who have contraindications to estrogen-containing contraceptives (e.g., history of thromboembolism or breastfeeding). **Why the other options are incorrect:** Nexplanon works through a multi-modal mechanism of action typical of progestins: * **Option A (Suppresses ovulation):** This is the primary mechanism. It inhibits the LH surge required for ovulation. * **Option B (Induces endometrial atrophy):** Progestins alter the endometrial lining, making it thin and unfavorable for the implantation of a blastocyst. * **Option D (Increases cervical mucus viscosity):** It thickens the cervical mucus, creating a physical barrier that prevents sperm penetration into the upper reproductive tract. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** It is effective for **3 years**. * **Insertion Site:** Subdermally in the non-dominant upper arm (over the triceps). * **Radiopacity:** Unlike its predecessor (Implanon), Nexplanon is **radiopaque**, meaning it can be localized via X-ray or CT if it migrates or is difficult to palpate. * **Side Effects:** The most common side effect and reason for discontinuation is **irregular/unpredictable menstrual bleeding**. * **Failure Rate:** It is the most effective form of reversible contraception, with a Pearl Index of approximately 0.05.

Q: Which of the following is NOT an absolute contraindication for oral contraceptive pills?

Endometriosis. **Explanation:** The correct answer is **Endometriosis**. In fact, Combined Oral Contraceptive Pills (COCPs) are a **first-line medical treatment** for endometriosis. They work by inducing a state of "pseudopregnancy," leading to the atrophy of endometrial tissue and providing relief from dysmenorrhea and chronic pelvic pain. **Analysis of Options:** * **A. Pregnancy:** COCPs are absolutely contraindicated in pregnancy as they are unnecessary and pose a theoretical risk of hormonal interference with fetal development. * **B. Thromboembolic disorder:** Estrogen increases the synthesis of clotting factors (II, VII, IX, X) and decreases Antithrombin III. A history of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), or known thrombogenic mutations is a Category 4 contraindication (WHO MEC) due to the high risk of fatal recurrence. * **C. Hepatic failure:** Steroid hormones are metabolized in the liver. In active hepatic failure, hepatitis, or cirrhosis, the liver cannot process these hormones, leading to toxicity and further hepatic strain. **High-Yield Clinical Pearls for NEET-PG:** * **WHO Medical Eligibility Criteria (MEC) Category 4 (Absolute Contraindications):** * Smokers >35 years old (≥15 cigarettes/day). * History of Stroke or Ischemic Heart Disease. * Breast Cancer (current). * Migraine with Aura (due to increased stroke risk). * Uncontrolled Hypertension (>160/100 mmHg). * **Protective Effects:** COCPs significantly reduce the risk of **Ovarian and Endometrial cancers** (this protection persists for years after discontinuation). * **Non-contraceptive uses:** Management of PCOD, DUB, and Endometriosis.

Q: What is the optimal gestational age for pregnancy termination?

Second trimester. **Explanation:** The question refers to the **optimal timing for termination of pregnancy in cases of severe maternal medical complications** (such as severe pre-eclampsia or cardiac disease) or **lethal fetal anomalies** where the goal is to balance maternal safety with the technical ease of the procedure. **Why the Second Trimester is correct:** In clinical practice and competitive exams, the second trimester (specifically between 13–20 weeks) is often considered the "optimal" window for elective or therapeutic termination when early diagnosis was missed. While first-trimester procedures are technically simpler, many structural anomalies and genetic markers are only detectable via mid-trimester scans (Level II ultrasound) or amniocentesis. Furthermore, modern induction protocols (using Misoprostol) make second-trimester termination highly effective with lower risks of uterine perforation compared to late-term surgical interventions. **Analysis of Incorrect Options:** * **First Trimester:** While safest for the mother (lowest complication rate), it is often too early to diagnose many major fetal structural malformations. * **Third Trimester:** This is the least optimal time. The fetus has reached viability, making termination ethically and legally complex (MTP Act restrictions). Surgically, it carries the highest risk of hemorrhage and uterine rupture. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Act (India) Update:** Termination is now legal up to **24 weeks** for specific categories (survivors of sexual assault, minors, fetal anomalies). * **Method of Choice:** For 12 weeks, **Medical Induction** (Misoprostol ± Mifepristone) or Dilatation & Evacuation (D&E) is used. * **Golden Rule:** The risk of maternal mortality increases by roughly 38% for each additional week of gestation beyond 8 weeks.

Q: All of the following are true regarding menstrual regulation except:

It can be performed up to 12 weeks of gestation.. **Explanation:** **Menstrual Regulation (MR)** is a procedure used to terminate a suspected pregnancy before it is clinically confirmed by a pregnancy test or ultrasound. It involves the aspiration of the endometrial lining using a Karman’s cannula and a syringe (Manual Vacuum Aspiration). **1. Why Option C is the correct answer (The Exception):** Menstrual Regulation is strictly performed within **14 days of a missed period** (i.e., up to 6 weeks of gestation). It cannot be performed up to 12 weeks. Beyond 6–7 weeks, the procedure is classified as a standard MTP (Manual or Electric Vacuum Aspiration), as the products of conception become too large for the small-gauge cannulas used in MR. **2. Analysis of other options:** * **Option A:** In India, MR is legally governed by the **MTP Act**. Even though a pregnancy test might not be performed, the procedure must be documented and conducted by a registered medical practitioner at an approved center. * **Option B:** Because the procedure is done very early (within 2 weeks of a missed period), the gestational sac is tiny and the vascularity of the uterus is minimal, leading to **significantly less blood loss** compared to later-term abortions. * **Option D:** MR is a quick, outpatient procedure (taking 5–10 minutes). It is usually performed under **local anesthesia (paracervical block)** or no anesthesia at all; general anesthesia is not required. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** MR is done within 42 days from the Last Menstrual Period (LMP). * **Equipment:** Uses a **Karman’s Cannula** (usually 4–6 mm) and a 60cc syringe. * **Complication:** The most common complication is **incomplete evacuation** due to the very early stage of pregnancy. * **MTP Act Update:** Remember that under the 2021 amendment, the upper limit for MTP in specific categories is 24 weeks, but MR remains an early-intervention technique.

Q: Use of oral contraceptives increases the risk of which of the following cancers?

Breast cancer. Combined Oral Contraceptive Pills (COCPs) exert a dual effect on oncogenesis, acting as a protective factor for some cancers while slightly increasing the risk for others. **Why Breast Cancer is the Correct Answer:** The risk of **Breast Cancer** is slightly increased in current and recent users of COCPs (Relative Risk ≈ 1.24). This is attributed to the stimulatory effect of exogenous estrogen and progesterone on mammary epithelial cell proliferation. However, this risk is transient; it returns to baseline approximately 10 years after discontinuing the medication. Additionally, COCPs increase the risk of **Cervical Cancer** (linked to duration of use >5 years) and **Hepatocellular Adenoma/Carcinoma**. **Why Other Options are Incorrect:** * **Ovarian Cancer:** COCPs are highly **protective** against epithelial ovarian cancer. By suppressing ovulation ("ovarian rest"), they reduce repetitive trauma to the ovarian epithelium. This protection persists for up to 30 years after cessation. * **Colon Cancer:** COCPs are associated with a **reduced risk** (approx. 18-20% reduction) of colorectal cancer. The mechanism likely involves the reduction of bile acid synthesis and the presence of estrogen receptors in the colonic mucosa which may inhibit cell growth. * **Endometrial Cancer:** Though not listed, COCPs significantly **reduce** the risk of endometrial cancer due to the progestogen component antagonizing estrogen-induced endometrial hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect:** Ovarian, Endometrial, and Colorectal cancers. * **Increased Risk:** Breast, Cervical, and Liver (Hepatic Adenoma) cancers. * **Benign Benefit:** COCPs significantly reduce the risk of **Benign Breast Disease** (e.g., fibroadenoma, cystic changes), despite the slight increase in malignant risk. * **Duration:** The protective effect against Ovarian and Endometrial cancers increases with the duration of use.

Question 1

What is the most common side effect of an Intrauterine Contraceptive Device (IUCD) that necessitates its removal?

Accepted Answer

Pain

Answer

Bleeding

Answer

Pelvic infection

Answer

Ectopic pregnancy

Question 2

Centchroman is:

Accepted Answer

A nonsteroidal oral contraceptive

Answer

A new drug for fibroids

Answer

A new drug for endometriosis

Answer

An injectable contraceptive

Question 3

Which of the following conditions can be indicated for Medical Termination of Pregnancy (MTP)?

Accepted Answer

If maternal health is in danger

Answer

Pregnancy caused by rape

Answer

Husband is willing but mother is not agreeing

Answer

Pregnancy after contraceptive failure

Question 4

Which of the following is NOT an absolute contraindication for oral contraceptive pills?

Accepted Answer

Smoking

Answer

Valvular heart disease

Answer

Migraine with focal aura

Answer

History of breast cancer

Question 5

With DMPA, the next injection may be taken latest by:

Accepted Answer

17 weeks

Answer

12 weeks

Answer

13 weeks

Answer

15 weeks

Question 6

Which of the following is NOT true about Nexplanon?

Accepted Answer

Is an estrogen subdermal implant

Answer

Suppresses ovulation

Answer

Induces endometrial atrophy

Answer

Increases cervical mucus viscosity

Question 7

Which of the following is NOT an absolute contraindication for oral contraceptive pills?

Accepted Answer

Endometriosis

Answer

Pregnancy

Answer

Thromboembolic disorder

Answer

Hepatic failure

Question 8

What is the optimal gestational age for pregnancy termination?

Accepted Answer

Second trimester

Answer

First trimester

Answer

Third trimester

Answer

None of the above

Question 9

All of the following are true regarding menstrual regulation except:

Accepted Answer

It can be performed up to 12 weeks of gestation.

Answer

It comes under the Medical Termination of Pregnancy (MTP) Act.

Answer

Blood loss is typically less compared to other methods.

Answer

General anesthesia is generally not required.

Question 10

Use of oral contraceptives increases the risk of which of the following cancers?

Accepted Answer

Breast cancer

Answer

Colon cancer

Answer

Ovarian cancer

Answer

All of the above

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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