Contraception and Family Planning Practice Questions

Q: What is the progesterone release rate in Progestasert?

65 mg/day. **Explanation:** **Progestasert** is a first-generation hormone-releasing Intrauterine System (IUS). It is a T-shaped device made of ethylene-vinyl acetate copolymer. The vertical stem contains a reservoir of **38 mg of natural progesterone** mixed with barium sulfate (for radiopacity) and silicone oil. 1. **Why Option C is Correct:** The device is designed to release progesterone at a steady, controlled rate of **65 µg/day** (micrograms per day) directly into the uterine cavity. This local release causes endometrial atrophy and thickens cervical mucus, providing contraception for a period of **one year**, after which it must be replaced. 2. **Why Other Options are Incorrect:** * **Options A, B, and D:** These values (25, 40, and 80) do not correspond to the pharmacokinetics of Progestasert. It is crucial to note the unit: the release is in **micrograms (µg)**, not milligrams (mg). A release of 65 mg/day would be a massive overdose, as the total reservoir itself only contains 38 mg. 3. **High-Yield Clinical Pearls for NEET-PG:** * **Comparison with LNG-IUD (Mirena):** While Progestasert releases 65 µg/day of natural progesterone and lasts 1 year, Mirena releases **20 µg/day of Levonorgestrel** and is effective for 5–8 years. * **Mechanism:** Primarily local; it does not consistently inhibit ovulation. * **Side Effects:** A common disadvantage of Progestasert compared to Copper-T is a higher incidence of intermenstrual spotting and the requirement for annual replacement. * **Status:** Progestasert has largely been replaced by the more effective and longer-lasting LNG-IUS (Mirena) in clinical practice.

Q: Combined oral contraceptive pills act mainly by which mechanism?

Inhibition of ovulation. **Explanation:** **1. Why the Correct Answer is Right:** Combined Oral Contraceptive Pills (COCPs) contain both Estrogen (usually Ethinyl Estradiol) and Progestogen. Their primary mechanism of action is the **inhibition of ovulation** via negative feedback on the hypothalamo-pituitary-ovarian axis. * **Estrogen** suppresses **FSH** (Follicle Stimulating Hormone), which prevents the selection and maturation of a dominant follicle. * **Progestogen** suppresses the **LH surge** (Luteinizing Hormone), which is essential for the release of the ovum. While COCPs also cause thickening of cervical mucus and endometrial thinning, the **primary/main** mechanism is the suppression of ovulation. **2. Why Incorrect Options are Wrong:** * **Options B & C:** These are physiologically incorrect. COCPs actually **decrease** fallopian tube motility (due to the progestogen component), which slows the transport of the ovum. Early transport to the uterus would not prevent pregnancy; rather, a "hostile" endometrium or altered tubal transport are secondary effects, but they do not involve "increased motility." **3. NEET-PG High-Yield Pearls:** * **Most common side effect:** Breakthrough bleeding (especially with low-dose pills). * **Most serious side effect:** Venous Thromboembolism (VTE) due to the estrogen component (increases clotting factors II, VII, IX, and X). * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years), reduced PID, and improvement in dysmenorrhea. * **Drug Interactions:** Enzyme inducers like **Rifampicin** and anti-epileptics (Phenytoin, Carbamazepine) decrease the efficacy of COCPs. * **WHO Eligibility Criteria (Category 4 - Absolute Contraindication):** Smokers >35 years (>15 cigarettes/day), history of VTE, Migraine with aura, and Breast Cancer.

Q: Mifepristone is not used in which of the following conditions?

Threatened abortion. **Explanation:** **Mifepristone** is a potent **progesterone receptor antagonist**. Since progesterone is the "hormone of pregnancy" essential for maintaining the decidua and uterine quiescence, blocking its receptors leads to decidual breakdown, cervical softening, and increased uterine contractility. 1. **Why Threatened Abortion is the Correct Answer:** In a **threatened abortion**, the goal of management is to **save the pregnancy**. Progesterone supplementation is often used to support the pregnancy. Administering Mifepristone (an anti-progesterone) would actively promote the detachment of the embryo and induce uterine contractions, leading to an inevitable or complete abortion. Therefore, it is strictly contraindicated. 2. **Analysis of Other Options:** * **Fibroids (Leiomyoma):** Mifepristone is used off-label to reduce the size of fibroids and control heavy menstrual bleeding by inhibiting progesterone-dependent growth of the myoma. * **Ectopic Pregnancy:** While Methotrexate is the primary medical management, Mifepristone is sometimes used as an adjunct to increase the success rate of tubal resolution by causing trophoblastic degeneration. * **Molar Pregnancy:** Mifepristone can be used as a priming agent to soften the cervix before suction evacuation, although its use is more common in second-trimester terminations. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Competitive antagonist at progesterone and glucocorticoid receptors. * **Medical Abortion Regimen:** 200 mg Mifepristone (oral) followed by 800 mcg Misoprostol (vaginal/sublingual) after 24–48 hours. Effective up to 9 weeks (63 days) of gestation. * **Other Uses:** Emergency contraception (10 mg dose), induction of labor (in intrauterine fetal death), and management of Cushing’s Syndrome. * **Side Effects:** Nausea, abdominal cramps, and heavy bleeding.

Q: What is the most common side effect of progestin-only pills (POPs)?

Irregular bleeding. **Explanation:** The most common side effect of **Progestin-Only Pills (POPs)**, also known as the "mini-pill," is **irregular menstrual bleeding**. Unlike combined oral contraceptives (COCs), POPs do not contain estrogen. Estrogen is responsible for stabilizing the endometrium; without it, the endometrial lining becomes thin and unstable, leading to breakthrough bleeding, spotting, or amenorrhea. This is the primary reason for patient dissatisfaction and discontinuation of the method. **Analysis of Options:** * **A. Deep Vein Thrombosis (DVT):** This is a risk associated with **estrogen-containing** contraceptives. Estrogen increases the synthesis of clotting factors in the liver. Progestin-only methods do not significantly increase the risk of venous thromboembolism and are often the preferred choice for women with a history of DVT. * **C. Acne:** While some older progestins with androgenic activity can worsen acne, it is not the *most common* side effect. In fact, many modern progestins have minimal impact on skin. * **D. Hypertension:** Estrogen is the component primarily linked to blood pressure elevation via the renin-angiotensin-aldosterone system. POPs are generally considered safe for women with controlled hypertension. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** POPs primarily work by **thickening the cervical mucus**, preventing sperm penetration. They also cause endometrial thinning and, in some cycles, suppress ovulation. * **The "3-Hour Rule":** Traditional POPs (e.g., Norethindrone) must be taken at the same time every day. If a dose is delayed by **>3 hours**, it is considered a "missed pill," and backup contraception is required for 48 hours. * **Ideal Candidates:** POPs are the contraceptive of choice for **lactating mothers** (as they do not suppress milk production) and women with contraindications to estrogen (e.g., smokers >35 years, migraine with aura, or history of VTE).

Q: Which of the following is NOT an adverse effect of oral contraceptive pills?

Dysmenorrhea. **Explanation:** The correct answer is **D. Dysmenorrhea**. Combined Oral Contraceptive Pills (COCPs) are actually a primary medical treatment for dysmenorrhea, rather than a cause. **Why Dysmenorrhea is the correct choice:** COCPs work by inhibiting ovulation. This leads to a reduction in the production of endometrial prostaglandins (specifically PGF2α), which are the primary mediators of uterine contractions and pain during menstruation. By creating a thinner endometrial lining and preventing the "prostaglandin surge" associated with ovulatory cycles, COCPs significantly **relieve** dysmenorrhea. **Analysis of Incorrect Options:** * **A. Weight Gain:** Though often perceived as a minor side effect, estrogen can cause fluid retention and progestogens can increase appetite, leading to perceived or actual weight gain in some users. * **B. Hypertension:** Estrogen increases the hepatic production of angiotensinogen. This can activate the Renin-Angiotensin-Aldosterone System (RAAS), leading to a mild increase in blood pressure in susceptible individuals. * **C. Thromboembolism:** This is the most serious side effect. Estrogen increases the synthesis of clotting factors (II, VII, IX, X) and decreases anticoagulants like Protein S and Antithrombin III, significantly raising the risk of Venous Thromboembolism (VTE). **High-Yield NEET-PG Pearls:** * **Protective Effects:** COCPs reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Benign breast disease**. * **Risk Factors:** The risk of MI and Stroke is significantly higher in COCP users who are **smokers** and aged **>35 years**. * **Drug Interactions:** Enzyme inducers like **Rifampicin** and **Antiepileptics** (Phenytoin, Carbamazepine) decrease the efficacy of COCPs, leading to breakthrough bleeding or pregnancy.

Q: A 20-year-old girl experienced rape around the 13th day of her regular menstrual cycle. What is the best emergency contraception that can be offered?

Levonorgestrel tablets. **Explanation:** The correct answer is **Levonorgestrel (LNG) tablets**. In cases of sexual assault, emergency contraception (EC) should be provided as soon as possible to prevent unintended pregnancy. **Why Levonorgestrel is the best choice here:** While the Copper-T (Cu-T) is technically the most effective EC, **Levonorgestrel (1.5 mg single dose)** is considered the first-line medical management in rape victims due to several practical and clinical reasons. It is highly effective when taken within 72 hours (up to 120 hours), easy to administer, and does not require a pelvic examination or sterile procedure, which may be traumatic for a rape survivor. It works primarily by delaying ovulation. **Analysis of Incorrect Options:** * **A & D (COCPs and Ethinylestradiol):** The Yuzpe regimen (combined pills) is less effective and associated with significantly higher rates of nausea and vomiting compared to LNG. Pure Ethinylestradiol is not a standard EC protocol. * **B (Cu-T insertion):** Although Cu-T is the most effective EC (failure rate <0.1%), it is generally avoided as the *first* choice in rape cases due to the high risk of **Pelvic Inflammatory Disease (PID)**. Rape victims are at high risk for undiagnosed Sexually Transmitted Infections (STIs) like Chlamydia and Gonorrhea; inserting an IUD through an infected cervix can lead to ascending infection. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard EC:** Copper-T (most effective, can be used up to 5 days). * **Drug of Choice (DOC) for EC:** Levonorgestrel 1.5mg (Single dose). * **Ulipristal Acetate (30mg):** More effective than LNG, especially between 72–120 hours, but LNG remains the standard in many government protocols. * **Mifepristone:** Can be used as EC in low doses (10–25 mg). * **Rape Protocol:** Always prioritize psychological support and STI prophylaxis (Ceftriaxone, Azithromycin, and Tinidazole) alongside EC.

Q: Which of the following statements about DMPA (Depot Medroxyprogesterone Acetate) is FALSE?

It typically causes weight loss.. **Explanation:** **Why Option C is the correct (False) statement:** Depot Medroxyprogesterone Acetate (DMPA) is clinically associated with **weight gain**, not weight loss. This is one of its most common side effects and a frequent reason for discontinuation. The weight gain is attributed to both an increase in appetite (anabolic effect of progestogen) and an increase in body fat deposition. Studies show an average gain of 1.5–2.5 kg in the first year of use. **Analysis of other options:** * **Option A (True):** DMPA is a highly effective contraceptive. With perfect use, the failure rate is approximately **0.3 per 100 woman-years**, making it comparable to sterilization and LARC methods. * **Option B (True):** The standard dose for the intramuscular (IM) formulation is **150 mg every 12 weeks (3 months)**. It is usually administered in the gluteal or deltoid muscle. * **Option D (True):** High-dose progestogens like DMPA can decrease insulin sensitivity and lead to **mild glucose intolerance**. While usually not clinically significant in healthy women, it requires caution in patients with pre-existing diabetes. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge. It also thickens cervical mucus. * **Amenorrhea:** About 50% of users develop amenorrhea after one year of use (a "benefit" for women with menorrhagia). * **Bone Mineral Density (BMD):** Long-term use is associated with a reversible decrease in BMD. The FDA provides a "Black Box Warning" for use exceeding 2 years. * **Return to Fertility:** There is a **delayed return to fertility**, taking an average of 7–10 months after the last injection. * **Anticonvulsant Effect:** DMPA is the contraceptive of choice for women with epilepsy as it raises the seizure threshold.

Question 1

What is the progesterone release rate in Progestasert?

Accepted Answer

65 mg/day

Answer

25 mg/day

Answer

40 mg/day

Answer

80 mg/day

Question 2

Induction of abortion is best achieved by which of the following methods?

Accepted Answer

PGE2 gel

Answer

Oxytocin

Answer

Stripping of the membranes

Answer

Estrogen

Question 3

Combined oral contraceptive pills act mainly by which mechanism?

Accepted Answer

Inhibition of ovulation

Answer

Increased motility of fallopian tubes

Answer

Early transport of the sperm and ovum to the uterine cavity

Answer

None of the above

Question 4

Which contraceptive method should be avoided in patients with epilepsy?

Accepted Answer

Oral contraceptive pills (OCPs)

Answer

Condom

Answer

Intrauterine contraceptive device (IUCD)

Answer

Levonorgestrel-releasing intrauterine system (Mirena)

Question 5

Mifepristone is not used in which of the following conditions?

Accepted Answer

Threatened abortion

Answer

Fibroid

Answer

Ectopic pregnancy

Answer

Molar pregnancy

Question 6

What is the most common side effect of progestin-only pills (POPs)?

Accepted Answer

Irregular bleeding

Answer

Deep vein thrombosis (DVT)

Answer

Acne

Answer

Hypertension

Question 7

Oral contraceptive pills should be initiated on which day of the menstrual cycle?

Accepted Answer

The 1st day

Answer

The 5th day

Answer

The 3rd day

Answer

When menses cease

Question 8

Which of the following is NOT an adverse effect of oral contraceptive pills?

Accepted Answer

Dysmenorrhea

Answer

Weight gain

Answer

Hypertension

Answer

Thromboembolism

Question 9

A 20-year-old girl experienced rape around the 13th day of her regular menstrual cycle. What is the best emergency contraception that can be offered?

Accepted Answer

Levonorgestrel tablets

Answer

Combined oral contraceptive pills

Answer

Intrauterine contraceptive device (Cu-T) insertion

Answer

Ethinylestradiol tablets

Question 10

Which of the following statements about DMPA (Depot Medroxyprogesterone Acetate) is FALSE?

Accepted Answer

It typically causes weight loss.

Answer

The failure rate is approximately 0.3 per 100 woman-years.

Answer

It is administered as 150 mg every 3 months.

Answer

Glucose intolerance can occur with its use.

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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