Contraception and Family Planning Practice Questions

Q: Centchroman, a non-hormonal contraceptive pill, is taken orally:

Twice a week for the first three months, then once a week.. **Explanation:** **Centchroman (Ormeloxifene)** is a unique Selective Estrogen Receptor Modulator (SERM) developed by CDRI, Lucknow. It is the world’s first non-steroidal, non-hormonal oral contraceptive pill. **1. Why Option B is Correct:** The standard dosage schedule for Centchroman (marketed as **Saheli** or **Chhaya**) is **30 mg twice a week for the first 3 months**, followed by **once a week** thereafter. The twice-weekly loading dose is necessary to achieve steady-state plasma concentrations and ensure immediate contraceptive efficacy. It is ideally started on the first day of the menstrual cycle. **2. Why Other Options are Incorrect:** * **Option A:** Daily dosing is characteristic of Combined Oral Contraceptive Pills (COCPs) or Progesterone-Only Pills (POPs). Centchroman has a long half-life (approx. 170 hours), making daily administration unnecessary and potentially toxic. * **Option C & D:** Thrice-weekly or five-month loading periods do not align with the pharmacokinetics of the drug. Clinical trials established that a 3-month twice-weekly regimen provides the optimal balance between efficacy (Pearl Index ~1.3–1.8) and safety. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** It acts as an estrogen antagonist in the uterus (preventing implantation by altering the endometrium) and as a weak agonist in other tissues. It does not suppress ovulation in most cycles. * **Side Effects:** The most common side effect is **delayed menstruation** (prolonged cycles), which occurs in about 8% of users. It does not cause nausea, weight gain, or mood swings typical of hormonal pills. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease. * **Government Initiative:** Under the National Family Planning Programme (Antara program), it is distributed free of cost as **'Chhaya'**.

Q: What menstrual abnormality is typically seen in a woman using a subdermal progesterone implant for contraception?

Metrorrhagia. **Explanation:** Subdermal progesterone implants (e.g., Nexplanon/Implanon) primarily work by suppressing ovulation and thickening cervical mucus. However, their effect on the endometrium is the primary cause of menstrual changes. **Why Metrorrhagia is correct:** The continuous, low-dose release of progestogen leads to **endometrial atrophy** and an unstable endometrial lining. This results in **irregular, unpredictable spotting or breakthrough bleeding (metrorrhagia)**. This is the most common reason for discontinuation of the method. While some women eventually develop amenorrhea, irregular bleeding remains the hallmark side effect during the initial months of use. **Analysis of Incorrect Options:** * **A. Menorrhagia:** Heavy menstrual bleeding is rare with progestogen-only methods. In fact, these implants typically reduce total menstrual blood loss. * **C. Polymenorrhea:** While cycles may become frequent, the bleeding pattern is usually too irregular to be classified as regular frequent cycles (polymenorrhea); it is better described as unscheduled spotting. * **D. Amenorrhea:** While approximately 20% of users may develop amenorrhea after one year, it is less "typical" or characteristic in the early phase compared to the high incidence of irregular spotting. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Nexplanon contains **Etonogestrel** (68 mg). * **Duration:** Effective for **3 years**. * **Mechanism:** Primarily inhibits ovulation (suppresses LH surge). * **Failure Rate:** It is the **most effective** reversible contraceptive method (Pearl Index ~0.05). * **Contraindication:** Active breast cancer or unexplained vaginal bleeding.

Q: What is the preferred investigation to confirm the presence of an intrauterine device (IUD) when its strings are not visible?

Ultrasound (USG). **Explanation:** When the strings of an Intrauterine Device (IUD) are not visible during a speculum examination (a condition known as "Missing Strings"), the primary clinical concern is to differentiate between **expulsion**, **malposition**, or **uterine perforation**. **1. Why Ultrasound (USG) is the Correct Answer:** Ultrasound is the **first-line investigation** of choice because it is non-invasive, cost-effective, and lacks ionizing radiation. It is highly sensitive in confirming the intrauterine location of the device. A properly placed IUD will appear as a highly echogenic (bright) linear structure with posterior acoustic shadowing within the endometrial cavity. **2. Why Other Options are Incorrect:** * **Pelvic X-ray:** This is the second-line investigation. It is only performed if the USG fails to locate the IUD in the uterus. An X-ray (including the abdomen and pelvis) helps identify an extrauterine IUD (perforation) or confirm expulsion if the device is absent from the film. * **CT Abdomen:** While CT can locate a perforated IUD, it is not the initial investigation due to high radiation doses and unnecessary cost. * **MRI Pelvis:** MRI is rarely indicated for IUD localization. While safe, it is expensive and provides no significant diagnostic advantage over USG or X-ray in this context. **Clinical Pearls for NEET-PG:** * **Initial Step:** If strings are missing, the first step is to rule out pregnancy and then perform a USG. * **Uterine Perforation:** If USG shows an empty uterus and the patient did not notice the IUD falling out, an **X-ray Abdomen/Pelvis (Erect and Supine)** is mandatory to locate the device in the peritoneal cavity. * **Management of Perforation:** A perforated IUD (especially Copper-T) must be removed via **Laparoscopy** due to the risk of adhesion formation.

Q: Which of the following mechanisms best explains the contraceptive effect of birth control pills that contain both synthetic estrogen and progestin?

Inhibition of ovulation. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is the **inhibition of ovulation** via negative feedback on the hypothalamic-pituitary-ovarian axis. 1. **Why Option B is Correct:** * **Progestin component:** This is the most critical factor. It suppresses the secretion of Luteinizing Hormone (LH), thereby preventing the **LH surge** necessary for ovulation. * **Estrogen component:** It suppresses Follicle Stimulating Hormone (FSH) secretion, which prevents the recruitment and selection of a dominant follicle. Together, they ensure the ovaries remain in a quiescent state. 2. **Why Other Options are Incorrect:** * **Option A:** Oocyte maturation is arrested in prophase I since fetal life; COCPs do not directly interfere with this cellular process but rather prevent the release of the egg. * **Option C:** COCPs do not produce "toxic" secretions. Instead, progestins cause the cervical mucus to become thick and viscous, creating a physical barrier to sperm penetration. * **Option D:** While COCPs do affect the endometrium, they cause **atrophic/hypoplastic** changes (making it thin and unreceptive), not hyperplastic changes. Hyperplasia is typically a result of unopposed estrogen. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Mechanism:** Inhibition of ovulation (LH surge suppression). * **Secondary Mechanisms:** Thickening of cervical mucus (hostile to sperm) and endometrial atrophy (prevents implantation). * **Pearl:** If a patient misses a pill, the risk of "escape ovulation" increases because FSH levels rise, leading to follicular development. * **Drug Interaction:** Rifampicin is a potent enzyme inducer that decreases the efficacy of COCPs, necessitating additional contraception.

Q: All of the following are beneficial effects of oral contraceptive pills, EXCEPT:

Decreased blood pressure. **Explanation:** **Why Option C is the Correct Answer:** Combined Oral Contraceptive Pills (COCPs) do **not** decrease blood pressure; in fact, they are known to cause a mild increase in blood pressure in some women. This occurs because the estrogen component (Ethinyl Estradiol) stimulates the hepatic production of **angiotensinogen**, which activates the Renin-Angiotensin-Aldosterone System (RAAS), leading to sodium and water retention. Hypertension is a known side effect and a relative contraindication for COCP use. **Analysis of Incorrect Options:** * **A. Decreased risk of ectopic pregnancies:** COCPs prevent ovulation. Since no ovum is released, the absolute risk of both intrauterine and ectopic pregnancies is significantly reduced compared to women not using contraception. * **B. Prevention of atherogenesis:** Estrogen in COCPs increases HDL (good cholesterol) and decreases LDL (bad cholesterol), which can have a protective effect against the formation of fatty plaques in the arteries. * **D. Increase in bone density:** The estrogen component inhibits osteoclast activity, thereby reducing bone resorption. Long-term use is associated with higher bone mineral density, offering protection against osteoporosis. **NEET-PG High-Yield Pearls:** * **Protective Effects (The "Big Three"):** COCPs significantly reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Colorectal cancer**. * **Benign Conditions:** They reduce the risk of Pelvic Inflammatory Disease (PID), Benign Breast Disease, and functional ovarian cysts. * **Menstrual Benefits:** They are used to treat menorrhagia, dysmenorrhea, and PCOS. * **Contraindications:** History of Thromboembolism (VTE), undiagnosed vaginal bleeding, breast cancer, and smokers >35 years old.

Question 1

Centchroman, a non-hormonal contraceptive pill, is taken orally:

Accepted Answer

Twice a week for the first three months, then once a week.

Answer

Daily for the first three months, then once a week.

Answer

Thrice a week for the first three months, then once a week.

Answer

Twice a week for the first five months, then once a week.

Question 2

What menstrual abnormality is typically seen in a woman using a subdermal progesterone implant for contraception?

Accepted Answer

Metrorrhagia

Answer

Menorrhagia

Answer

Polymenorrhea

Answer

Amenorrhea

Question 3

What is the preferred investigation to confirm the presence of an intrauterine device (IUD) when its strings are not visible?

Accepted Answer

Ultrasound (USG)

Answer

Pelvic X-ray

Answer

CT Abdomen

Answer

MRI Pelvis

Question 4

Which of the following mechanisms best explains the contraceptive effect of birth control pills that contain both synthetic estrogen and progestin?

Accepted Answer

Inhibition of ovulation

Answer

Direct inhibition of oocyte maturation

Answer

Production of uterine secretions that are toxic to developing embryos

Answer

Impairment of implantation by hyperplastic changes of the endometrium

Question 5

Which of the following is NOT a contraindication to the use of combined oral contraceptives?

Accepted Answer

Suspected Osteosarcoma

Answer

Migraine with focal neurological deficit

Answer

Coronary artery disease

Answer

Diabetes with vascular involvement

Question 6

All of the following are beneficial effects of oral contraceptive pills, EXCEPT:

Accepted Answer

Decreased blood pressure

Answer

Decreased risk of ectopic pregnancies

Answer

Prevention of atherogenesis

Answer

Increase in bone density

Question 7

All of the following are non-contraceptive benefits of oral contraceptive pills except?

Accepted Answer

Decreased risk for venous thrombosis

Answer

Reduces dysmenorrhea

Answer

Reduces fibroadenomas

Answer

Reduces ovarian cancer risk

Question 8

What is an absolute contraindication for Cu-T insertion?

Accepted Answer

Undiagnosed vaginal bleeding

Answer

Patient unmotivated for contraception

Answer

Previous ectopic pregnancy

Answer

Previous history of abortion

Question 9

What is the best mode of contraception for a newly married lady with rheumatic heart disease?

Accepted Answer

Condom

Answer

Oral pills

Answer

Norplant

Answer

IUCD

Question 10

Which of the following is the best contraceptive option in a 30-year-old woman with heart disease?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Sterilization

Answer

Steroid contraceptive

Answer

Barrier methods

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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