Contraception and Family Planning Practice Questions

Q: Use of combined oral contraceptive pills is contraindicated in women with any of the following conditions except?

Tuberculosis. **Explanation:** The correct answer is **Tuberculosis**. Combined Oral Contraceptive Pills (COCPs) contain both estrogen and progestogen. Their contraindications are primarily based on the **WHO Medical Eligibility Criteria (MEC)**, focusing on cardiovascular risks and hormonal sensitivities. 1. **Why Tuberculosis is the correct answer:** Tuberculosis itself is not a contraindication to COCP use. However, it is a "high-yield" distractor because **Rifampicin** (a first-line anti-TB drug) is a potent hepatic enzyme inducer. It increases the metabolism of estrogen, potentially leading to contraceptive failure. While the *medication* requires caution (MEC Category 3), the *disease* itself does not prohibit use. 2. **Why other options are incorrect:** * **Lactation:** Estrogen suppresses prolactin's action on breast tissue, reducing milk quantity and quality. It is contraindicated in the first 6 months of breastfeeding (MEC 4 if 20 years (MEC 4) due to the increased risk of arterial thrombosis. **High-Yield Clinical Pearls for NEET-PG:** * **MEC Category 4 (Absolute Contraindication):** Smoker >35 years (≥15 cigarettes/day), Migraine with aura, Undiagnosed abnormal uterine bleeding, Breast cancer, and History of Stroke/IHD. * **Drug Interaction:** For patients on Rifampicin, the preferred method is an IUD or Injectable MPA, as these are not affected by liver enzyme induction. * **Benefit:** COCPs are protective against Ovarian and Endometrial cancers.

Q: The first dose of oral contraceptive pills for emergency contraception should be taken within how many hours?

72 hours. **Explanation:** The primary mechanism of hormonal emergency contraception (EC) is to delay or inhibit ovulation. For maximum efficacy, the first dose must be administered as soon as possible after unprotected intercourse, ideally within **72 hours (3 days)**. This timeframe corresponds to the window before the LH surge triggers ovulation and before fertilization/implantation can occur. **Analysis of Options:** * **72 hours (Correct):** Standard guidelines (WHO and MoHFW) recommend the use of Levonorgestrel (LNG) 1.5 mg or the Yuzpe regimen within 72 hours. While some efficacy remains up to 120 hours, the failure rate increases significantly after the 72-hour mark. * **24 & 48 hours (Incorrect):** While taking the pill within these windows is highly effective (the sooner, the better), they do not represent the maximum clinical "cutoff" window typically tested in exams. * **96 hours (Incorrect):** This exceeds the standard recommended window for traditional LNG-based emergency pills. **High-Yield Clinical Pearls for NEET-PG:** 1. **Drug of Choice:** Levonorgestrel (1.5 mg single dose) is the preferred hormonal EC due to better tolerability and higher efficacy than the Yuzpe regimen (Ethinylestradiol + Levonorgestrel). 2. **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) that is effective up to **120 hours (5 days)** and is more effective than LNG in obese women. 3. **Most Effective EC:** The **Copper-T (Cu-T 380A)** IUD is the most effective emergency contraceptive and can be inserted up to **5 days** after unprotected intercourse. 4. **Centchroman (Chhaya):** A non-steroidal SERM used for routine contraception (twice weekly for 3 months, then weekly), but **not** used for emergency contraception.

Q: Which of the following is NOT a mechanism by which an Intrauterine Contraceptive Device (IUCD) acts?

Inhibition of ovulation. **Explanation:** The primary mechanism of action for Intrauterine Contraceptive Devices (IUCDs) is to create a local environment that is hostile to sperm and prevents fertilization. **Why "Inhibition of Ovulation" is the correct answer:** IUCDs (both Copper and Hormonal) are **non-anovulatory** methods of contraception. They act locally within the uterus and do not suppress the Hypothalamic-Pituitary-Ovarian (HPO) axis. Therefore, patients using an IUCD continue to have regular ovulatory cycles. **Analysis of incorrect options:** * **Chronic endometrial inflammation:** Copper IUCDs (e.g., Cu-T 380A) act as a foreign body, inducing a sterile inflammatory response in the endometrium. This leads to the release of cytokines and macrophages which are spermicidal and prevent implantation. * **Increased motility of the fallopian tubes:** IUCDs alter the tubal and uterine motility, which interferes with the transport of the gametes (sperm and ovum), ensuring they do not meet at the right time for fertilization. * **Inducing endometrial atrophy:** This is the hallmark of **Hormonal IUCDs (LNG-IUD/Mirena)**. The continuous release of levonorgestrel leads to profound endometrial atrophy and thickening of cervical mucus, preventing sperm penetration. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect of Cu-T:** Menorrhagia (Bleeding). * **Most common reason for removal of Cu-T:** Pain followed by bleeding. * **Ideal time for insertion:** Within 10 days of the menstrual cycle (to ensure the patient is not pregnant). * **LNG-IUD (Mirena):** Is the **Drug of Choice (DOC)** for Menorrhagia (DUB) and provides protection against Endometrial Hyperplasia. * **Mechanism of Cu-T:** Primarily **spermicidal** (Copper ions inhibit sperm motility and viability).

Q: Which of the following is an adverse effect of combined oral contraceptive pills?

Liver disorders. **Explanation:** Combined Oral Contraceptive Pills (COCPs) contain both estrogen and progestogen. Their metabolic impact on the liver is a significant clinical consideration. **Why Liver Disorders is Correct:** The estrogen component (usually ethinylestradiol) in COCPs is metabolized in the liver. It can induce hepatic enzymes, alter bile composition, and decrease bile flow, leading to **cholestatic jaundice**. Long-term use is also strongly associated with **Hepatic Adenomas** (benign but vascular tumors). Therefore, COCPs are strictly contraindicated in patients with active liver disease, cirrhosis, or a history of cholestasis of pregnancy. **Analysis of Incorrect Options:** * **Pelvic Inflammatory Disease (PID):** COCPs actually **decrease** the risk of PID. The progestogen component thickens the cervical mucus, creating a physical barrier that prevents the upward migration of pathogens into the upper reproductive tract. * **Weight Loss:** Weight changes are a common concern, but COCPs are more frequently associated with minor **weight gain** due to fluid retention (estrogen) or increased appetite (progestogen), though large-scale studies show this effect is often negligible. * **Acne:** COCPs are a **treatment** for acne, not a cause. They increase Sex Hormone Binding Globulin (SHBG), which lowers free testosterone levels, thereby reducing sebum production. **High-Yield NEET-PG Pearls:** * **Cancer Risks:** COCPs **increase** the risk of Breast and Cervical cancer but are **protective** against Ovarian and Endometrial cancer (the "Rule of 2": 10 years of use reduces risk by 50% for 20 years). * **Cardiovascular:** The most serious acute side effect is **Venous Thromboembolism (VTE)** due to increased clotting factors (VII, X, and Fibrinogen). * **Absolute Contraindication:** Smokers >35 years of age (due to high risk of MI and stroke).

Q: The combined oral contraceptive pill is absolutely contraindicated in:

History of thromboembolism. **Explanation:** The **Combined Oral Contraceptive Pill (COCP)** contains estrogen, which increases the hepatic synthesis of clotting factors (II, VII, IX, and X) and decreases anticoagulant levels (Protein S and Antithrombin III). This induces a hypercoagulable state. **1. Why Option A is Correct:** A **history of thromboembolism** (DVT or Pulmonary Embolism) is a **WHO Medical Eligibility Criteria (MEC) Category 4** contraindication (absolute contraindication). Since the estrogen component significantly elevates the risk of recurrent thrombotic events, COCPs are strictly prohibited in these patients. **2. Why the other options are incorrect:** * **B. Pelvic Inflammatory Disease (PID):** COCPs are not contraindicated in PID. In fact, they may offer a protective effect by thickening cervical mucus, which prevents the upward migration of pathogens. * **C. Age above 40 years:** Age alone is not a contraindication. However, it becomes a contraindication if combined with smoking (≥15 cigarettes/day) or other cardiovascular risk factors. * **D. Leiomyoma:** COCPs are not contraindicated and are often used to manage the heavy menstrual bleeding associated with fibroids. **NEET-PG High-Yield Pearls:** * **Absolute Contraindications (MEC 4):** Undiagnosed vaginal bleeding, pregnancy, history of thromboembolism, stroke, ischemic heart disease, active liver disease/tumors, breast cancer, and smokers >35 years old (≥15 cigarettes/day). * **Best Contraceptive for a Lactating Mother:** Progesterone-only pills (POPs) or Centchroman (Saheli), as estrogen suppresses lactation. * **Non-contraceptive benefit:** COCPs reduce the risk of Ovarian and Endometrial cancers.

Q: What is the best index for measuring the efficacy of contraception?

Life Table Analysis. ### Explanation The efficacy of a contraceptive method is measured by its failure rate. While multiple indices exist, **Life Table Analysis** is considered the superior and most accurate method. **1. Why Life Table Analysis is the Correct Answer:** Unlike other methods, Life Table Analysis calculates the **cumulative failure rate** at specific intervals (e.g., 12, 24, or 36 months). It accounts for "loss to follow-up" and varying durations of use among participants. By calculating the probability of pregnancy for each month of use, it provides a more scientifically rigorous and longitudinal view of contraceptive effectiveness compared to a simple ratio. **2. Analysis of Incorrect Options:** * **Pearl Index (Option A):** This is the most *commonly* used index, but not the *best*. It is defined as the number of unintended pregnancies per 100 woman-years of exposure. Its main drawback is that it assumes a constant failure rate over time, whereas, in reality, the risk of failure is highest in the first few months of use and decreases over time. * **Couple Protection Rate (Option C):** This is a **process indicator** used by national family planning programs to monitor the proportion of eligible couples protected by any modern contraceptive method. It measures program coverage and prevalence, not the clinical efficacy of a specific contraceptive. **3. NEET-PG High-Yield Pearls:** * **Pearl Index Formula:** (Total Accidental Pregnancies × 1200) / (Total months of exposure). * **Most Effective Contraceptive:** Implants (Etonogestrel) have the lowest Pearl Index (~0.05). * **Hierarchy of Efficacy:** Life Table Analysis > Pearl Index. * **Contraceptive Prevalence Rate (CPR):** The percentage of currently married women (15-49 years) who are using any method of contraception. In India (NFHS-5), the CPR is approximately 67%.

Question 1

A woman on combined oral contraceptive pills forgot to take them for two successive doses. What is the next best course of action?

Accepted Answer

Take the missed pills as soon as remembered, continue the remaining pills at the usual time, and use backup contraception for the next seven days.

Answer

Continue the next pill on the following day as scheduled.

Answer

Take three pills on the next day, then resume one pill daily.

Answer

Take two pills each day for the remainder of the cycle.

Question 2

Use of combined oral contraceptive pills is contraindicated in women with any of the following conditions except?

Accepted Answer

Tuberculosis

Answer

Lactation

Answer

Diabetes

Answer

Thromboembolism

Question 3

Which of the following is NOT true about spermicidal agents?

Accepted Answer

'Immediate douching' is a must after intercourse to avoid irritant action.

Answer

Contain non-ionic surfactants causing osmotic changes resulting in the killing of sperms.

Answer

They act as a physical barrier to sperm transport.

Answer

Do not have STD/HIV protection action.

Question 4

The first dose of oral contraceptive pills for emergency contraception should be taken within how many hours?

Accepted Answer

72 hours

Answer

24 hours

Answer

48 hours

Answer

96 hours

Question 5

Which of the following is NOT a mechanism by which an Intrauterine Contraceptive Device (IUCD) acts?

Accepted Answer

Inhibition of ovulation

Answer

Chronic endometrial inflammation

Answer

Increased motility of the fallopian tubes

Answer

Inducing endometrial atrophy

Question 6

Which of the following is an adverse effect of combined oral contraceptive pills?

Accepted Answer

Liver disorders

Answer

Pelvic inflammatory disease (PID)

Answer

Weight loss

Answer

Acne

Question 7

The Yuzpe method is used for which of the following contraceptive techniques?

Accepted Answer

Emergency contraception with oral contraceptive pills (OCPs)

Answer

Sterilization using the 'No scalpel technique'

Answer

Emergency contraception with intrauterine devices (IUDs)

Answer

Evaluation of newer contraceptive methods

Question 8

A 23-year-old woman desires a combined oral contraceptive for pregnancy protection. Which of the following factors would lead a health professional to recommend an alternative form of contraception?

Accepted Answer

History of migraine headache that is well controlled by sumatriptan

Answer

Evidence of hirsutism

Answer

Presence of fibroids

Answer

History of pelvic inflammatory disease

Question 9

The combined oral contraceptive pill is absolutely contraindicated in:

Accepted Answer

History of thromboembolism

Answer

Pelvic inflammatory disease

Answer

Age above 40 years

Answer

Leiomyoma

Question 10

What is the best index for measuring the efficacy of contraception?

Accepted Answer

Life Table Analysis

Answer

Pearl Index

Answer

Couple protection rate

Answer

None of the above

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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