Contraception and Family Planning Practice Questions

Q: A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?

Nexplanon. ***Nexplanon*** - This **etonogestrel implant** offers highly effective, **long-acting reversible contraception (LARC)** for up to three years, making it an excellent choice for a young woman seeking a long-term option. - It has a failure rate of less than 0.1% and is **progestin-only**, avoiding estrogen-related risks. *Combined oral contraceptives* - While effective, these require **daily adherence**, which might not be ideal for someone specifically requesting *long-term* and *reversible* contraception without daily commitment. - They also carry a slightly higher risk of **venous thromboembolism (VTE)** compared to progestin-only methods. *Diaphragm* - This is a **barrier method** requiring proper insertion, removal, and use with spermicide for each act of intercourse, making it less convenient for *long-term reversible* contraception. - Its typical use failure rate is significantly higher (around 12%) compared to LARC methods. *Chhaya* - Chhaya, or Saheli, is a **non-steroidal oral contraceptive** taken twice a week for the first three months, then once a week. - While it is a contraceptive option, it still requires regular weekly adherence and is not considered a **long-acting reversible contraceptive (LARC)** like an implant or IUD.

Q: Indication for removal of IUDs include which of the following ? 1. Perforation of uterus 2. Pregnancy with device in situ 3. One year after menopause 4. Persistent migraine Select the correct answer using the code given below :

1, 2 and 4. ***Correct Answer: 1, 2 and 4*** **Statement 1 - Perforation of uterus:** ✅ **Valid indication** - Uterine perforation is a serious complication where the IUD punctures the uterine wall - This is an **absolute indication** for immediate removal to prevent further damage, infection, or injury to adjacent organs - Requires prompt surgical intervention **Statement 2 - Pregnancy with device in situ:** ✅ **Valid indication** - IUD should be removed if the strings are visible and removal is feasible - Removal reduces risks of **spontaneous abortion** (50% vs 25%), **septic abortion**, **preterm labor**, and **chorioamnionitis** - If strings are not visible, removal attempts may cause more harm than leaving it in place **Statement 4 - Persistent migraine:** ✅ **Valid indication (especially for hormonal IUDs)** - Relevant primarily for **levonorgestrel-releasing IUDs** (LNG-IUS) - Some women experience exacerbated or new-onset migraines due to hormonal fluctuations - Persistent or worsening migraines, especially **migraines with aura**, may warrant IUD removal - Less relevant for copper IUDs which have no hormonal effects *Statement 3 - One year after menopause:* ❌ **NOT an absolute indication** - While general guidelines suggest removal 1 year after menopause (if inserted after age 40), this is **NOT mandatory** - **Copper IUDs** can remain in place until age 55 if inserted after age 40, providing continued contraception - **LNG-IUS** may be retained for **endometrial protection** in women receiving estrogen replacement therapy - Removal is only necessary if the device is past its effective lifespan or causing symptoms - The decision should be individualized based on patient circumstances

Q: How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?

4. **4** - **Extended continuous regimens** of combined oral contraceptive pills typically involve taking active pills for 84 days, followed by a 7-day placebo or hormone-free interval. - This regimen results in **four withdrawal bleeds per year**, as opposed to thirteen for conventional cyclic regimens. *6* - This frequency of withdrawal bleeding would be more common with regimens that have shorter active pill cycles, such as 21 days active with 7 days off, but not with typical extended continuous use. - While some custom regimens might approach this frequency, it is not the standard for "extended continuous" which aims to reduce bleeding frequency. *3* - A frequency of three withdrawal bleeds per year would imply a longer continuous active pill phase than the typical 84 days, such as 112 days on active pills followed by a 7-day break. - While such regimens exist, they are less commonly described as the standard "extended continuous" which typically refers to the 84/7 day cycle. *5* - Five withdrawal bleeds per year is not a standard frequency for either conventional cyclic or typical extended continuous oral contraceptive regimens. - It would require an unusual cycle length for active pills and break days that does not correspond to common prescribing patterns.

Q: Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ? 1. Copper-T 380A 2. Implants 3. LNG-IUS Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - **Long-acting reversible contraceptives (LARCs)** include all methods that are effective for an extended period, do not require daily attention, and are reversible. The **Copper-T 380A intra-uterine device (IUD)**, **subdermal implants**, and the **levonorgestrel-releasing intra-uterine system (LNG-IUS)** all fit this description. - These methods are highly effective due to minimal user error and provide contraception for several years, making them ideal for long-term birth control. *1 and 3 only* - This option incorrectly excludes **implants**, which are a well-established and highly effective form of LARC, offering contraception for up to three years. - While Copper-T 380A and LNG-IUS are indeed LARCs, the exclusion of implants makes this option incomplete. *1 and 2 only* - This option incorrectly excludes the **levonorgestrel-releasing intra-uterine system (LNG-IUS)**, which is an increasingly popular and effective LARC, providing contraception for up to five years. - The LNG-IUS is a hormonal LARC often used for both contraception and managing heavy menstrual bleeding. *2 and 3 only* - This option incorrectly excludes the **Copper-T 380A IUD**, which is a non-hormonal LARC. - The Copper-T 380A is one of the most widely used LARCs globally, offering highly effective contraception for up to ten years.

Q: Which of the following are correct regarding 'Chhaya' contraceptive ? 1. It has potent anti-estrogenic and weak estrogenic property. 2. Failure rate is 1 - 4 per HWY (Hundred Women Years) of use. 3. It inhibits ovulation. 4. It creates asynchrony between zygote and endometrium. Select the correct answer using the code given below :

1, 2 and 4. ***1, 2 and 4*** - **Chhaya (Centchroman)** is a **non-steroidal oral contraceptive** that acts primarily through its **anti-estrogenic effects** on the endometrium, while also possessing weak estrogenic properties. - Its mechanism of action leads to **asynchrony between the zygote and endometrium**, preventing implantation, and it has a reported **failure rate of 1-4 per 100 women-years**. *1, 3 and 4* - This option incorrectly includes the statement that Chhaya **inhibits ovulation**. Chhaya is a **non-hormonal contraceptive** and does not primarily prevent ovulation; rather, it makes the uterus unreceptive to implantation. - Its main contraceptive effect is through altering the endometrium, which does not typically include an anovulatory mechanism. *2, 3 and 4* - This option is incorrect because Chhaya **does not inhibit ovulation**. This mechanism is typically associated with hormonal contraceptives, which suppress the hypothalamic-pituitary-ovarian axis. - The primary action of Chhaya is on the endometrium, making it unsuitable for implantation, not preventing the release of an egg. *1, 2 and 3* - This option is incorrect because Chhaya **does not inhibit ovulation**. While it has potent anti-estrogenic and weak estrogenic properties (1) and a failure rate of 1-4 per HWY (2), it does not act by preventing egg release (3). - Its contraceptive efficacy is mainly due to its impact on the endometrial lining and ovum transport.

Q: Consider the following statements regarding LNG-20 (Mirena) : 1. It is a T-shaped IUD filled with natural hormone progesterone. 2. It is associated with a low pregnancy rate (2 per 1000 women). 3. It is associated with a large number of ectopic pregnancies. 4. It is associated with lower menstrual blood loss as compared to copper IUDs. Which of the statements given above is/are correct?

2 and 4. ***Correct Option: Statements 2 and 4*** - **Statement 2 is TRUE**: The Mirena IUD (LNG-20) is highly effective with a very **low pregnancy rate** (approximately 0.2% or 2 per 1000 women per year), making it one of the most reliable forms of contraception. This high efficacy is due to the continuous release of levonorgestrel, which thickens cervical mucus, thins the uterine lining, and inhibits sperm function. - **Statement 4 is TRUE**: Mirena is associated with **significantly reduced menstrual blood loss** compared to copper IUDs. In fact, many women experience amenorrhea (absence of periods) or very light bleeding, which is one of its therapeutic benefits. This makes it useful for treating menorrhagia (heavy menstrual bleeding). *Incorrect Statement 1* - The Mirena IUD contains **synthetic levonorgestrel** (a progestin), NOT natural progesterone. While it is T-shaped, the hormone component is incorrectly described in this statement. *Incorrect Statement 3* - Mirena is NOT associated with a large number of ectopic pregnancies. While there may be a slight increase in the *proportion* of pregnancies that are ectopic IF conception occurs with an IUD in place, the **overall absolute risk of ectopic pregnancy is significantly reduced** compared to women not using contraception. This is because the overall pregnancy rate is so low. *Option: 2, 3 and 4* - Incorrect because statement 3 is false. Mirena does not cause a large number of ectopic pregnancies. *Option: 1, 3 and 4* - Incorrect because both statements 1 and 3 are false. Statement 1 incorrectly identifies the hormone as natural progesterone (it's synthetic levonorgestrel), and statement 3 falsely claims a large number of ectopic pregnancies. *Option: 1 and 2* - Incorrect because statement 1 is false (contains levonorgestrel, not natural progesterone), and this option omits the true statement 4 about reduced menstrual blood loss.

Q: Which of the following conditions are indications of removal of intrauterine device? 1. Persistent irregular uterine bleeding 2. Perforation of uterus 3. Pyelonephritis 4. Pregnancy with device in situ Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Persistent irregular uterine bleeding** that does not respond to medical management is an indication for IUD removal according to WHO guidelines and standard clinical practice. After ruling out other causes and attempting conservative management, persistent problematic bleeding warrants removal. - **Uterine perforation** by an IUD is a serious complication requiring immediate removal to prevent further injury, infection, migration of the device, or damage to adjacent organs. - **Pregnancy with an IUD in situ** increases the risk of complications including septic abortion, miscarriage, preterm birth, and chorioamnionitis. If the IUD strings are visible, removal is recommended (preferably in the first trimester). *1 and 2* - While these are both valid indications, this option is incomplete as it omits pregnancy with IUD in situ, which is also a strong indication for removal. *2 and 4* - Both uterine perforation and pregnancy with IUD are indications for removal, but this option incorrectly excludes persistent irregular uterine bleeding, which is also an indication when unresponsive to treatment. *1, 2 and 3* - **Pyelonephritis** (kidney infection) is not an indication for IUD removal as it is a urinary tract infection unrelated to IUD use. The IUD does not cause or complicate pyelonephritis, and treatment involves appropriate antibiotics without device removal.

Q: Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?

Suspected pregnancy. ***Suspected pregnancy*** - Insertion of an IUCD into a pregnant uterus is an **absolute contraindication** (WHO MEC Category 4). - Can lead to **septic abortion**, **miscarriage**, **uterine perforation**, or **ectopic pregnancy complications**. - **Pregnancy must be ruled out** before IUCD insertion through history, examination, and urine pregnancy test if indicated. *Age > 35 years* - Age alone is **not a contraindication** for IUCD insertion. - IUCDs are safe and highly effective for women over 35 years. - In fact, IUCDs are often preferred for older reproductive-age women due to high efficacy and non-hormonal options. *Severe dysmenorrhea* - **Not an absolute contraindication** for IUCD insertion. - **Copper IUCDs** may worsen dysmenorrhea and should be used with caution. - **Levonorgestrel-releasing IUCDs (LNG-IUS)** are actually **therapeutic** for severe dysmenorrhea and reduce menstrual blood loss. - The type of IUCD can be selected based on the clinical scenario. *Multiple sexual partners* - **Not a contraindication** for IUCD insertion per WHO Medical Eligibility Criteria. - While multiple partners increase STI risk, this can be addressed through **STI screening** and **barrier contraception counseling**. - IUCDs do not increase risk of PID in women without current cervical infection. - The outdated concern about PID risk has been refuted by modern evidence.

Q: Which of the following is not an absolute contraindication for insertion of intrauterine device (IUD) ?

Severe dysmenorrhea. ***Severe dysmenorrhea*** - While IUDs (especially copper IUDs) can exacerbate **dysmenorrhea** and **menorrhagia** in some women, it is not an absolute contraindication for insertion. Progestin-releasing IUDs can even improve dysmenorrhea. - The decision to insert an IUD in a patient with severe dysmenorrhea requires careful consideration of the **type of IUD** and potential benefits versus risks, but it is not an outright medical barrier. *Puerperal sepsis* - **Puerperal sepsis** indicates an active infection of the genital tract following childbirth. - Inserting an IUD into an infected uterus carries a high risk of worsening the infection, potentially leading to **septic shock** or **pelvic inflammatory disease (PID)**. *Pelvic tuberculosis* - **Pelvic tuberculosis** is a chronic inflammatory infection of the reproductive organs. - The presence of active pelvic tuberculosis makes the uterus and surrounding tissues highly susceptible to further infection or exacerbation of the existing disease with IUD insertion, leading to severe complications and **abscess formation**. *Endometrial cancer* - **Endometrial cancer** is a malignancy of the uterine lining. - Inserting an IUD into a uterus with cancer could potentially **disseminate cancer cells**, complicate treatment, or mask the progression of the disease.

Question 1

A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her ?

Accepted Answer

Nexplanon

Answer

Combined oral contraceptives

Answer

Diaphragm

Answer

Chhaya

Question 2

Which of the following are the absolute contraindications for the use of combined oral contraceptive pills ?

1. Severe hypertension
2. Pregnancy
3. Diabetes with retinopathy
4. Gall bladder disease

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 3 and 4

Question 3

Indication for removal of IUDs include which of the following ?

1. Perforation of uterus
2. Pregnancy with device in situ
3. One year after menopause
4. Persistent migraine

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1 and 3 only

Question 4

How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?

Accepted Answer

4

Answer

6

Answer

3

Answer

5

Question 5

Which of the following are examples of LARC (Long Acting Reversible Contraceptives) ?

1. Copper-T 380A 
2. Implants 
3. LNG-IUS

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

1 and 3 only

Answer

1 and 2 only

Answer

2 and 3 only

Question 6

Which of the following are correct regarding 'Chhaya' contraceptive ?

1. It has potent anti-estrogenic and weak estrogenic property.

2. Failure rate is 1 - 4 per HWY (Hundred Women Years) of use.

3. It inhibits ovulation.

4. It creates asynchrony between zygote and endometrium.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 7

Consider the following statements regarding LNG-20 (Mirena) :

1. It is a T-shaped IUD filled with natural hormone progesterone.
2. It is associated with a low pregnancy rate (2 per 1000 women).
3. It is associated with a large number of ectopic pregnancies.
4. It is associated with lower menstrual blood loss as compared to copper IUDs.

Which of the statements given above is/are correct?

Accepted Answer

2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1 and 2

Question 8

Which of the following conditions are indications of removal of intrauterine device?

1. Persistent irregular uterine bleeding
2. Perforation of uterus
3. Pyelonephritis
4. Pregnancy with device in situ

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1 and 2

Answer

2 and 4

Answer

1, 2 and 3

Question 9

Which of the following is a contraindication for insertion of Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Suspected pregnancy

Answer

Age > 35 years

Answer

Severe dysmenorrhea

Answer

Multiple sexual partners

Question 10

Which of the following is not an absolute contraindication for insertion of intrauterine device (IUD) ?

Accepted Answer

Severe dysmenorrhea

Answer

Puerperal sepsis

Answer

Pelvic tuberculosis

Answer

Endometrial cancer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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