Emergency Contraception — MCQs
The contraceptive which is contraindicated in DVT is?
A female patient missed her oral contraceptive pill (OCP) on four different days during the first two weeks of her menstrual cycle. What is the most appropriate advice for her?
What is the most common gastrointestinal side effect of oral contraceptives?
What is the best contraceptive option for managing menorrhagia?
For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?
Which of the following statements about intra-uterine devices (IUDs) is incorrect?
The mechanism of action of emergency contraception includes the following except:
Which of the following is NOT used as an emergency contraceptive?
A woman comes after 96 hours post coitus. Best contraceptive of choice is?
Which of the following is not used for postcoital contraception?
Emergency Contraception Indian Medical PG Practice Questions and MCQs
Question 1: The contraceptive which is contraindicated in DVT is?
- A. Barrier method
- B. Non hormonal IUCD
- C. Billing's method
- D. OCP (Correct Answer)
Explanation: ***OCP*** - **Oral contraceptive pills (OCPs)**, especially those containing estrogen, increase the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis (DVT). - Estrogen promotes a **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants. *Barrier method* - **Barrier methods** like condoms or diaphragms are non-hormonal and act physically to prevent sperm from reaching the egg. - They have **no systemic effects** on coagulation and are safe for individuals with DVT. *Non hormonal IUCD* - **Non-hormonal intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs, prevent conception primarily by causing a local inflammatory reaction in the uterus. - They do not release hormones and therefore **do not affect coagulation** or increase DVT risk. *Billing's method* - The **Billing's ovulation method** (cervical mucus method) is a natural family planning technique based on observing changes in cervical mucus. - It involves no medications or devices and thus has **no impact on DVT risk**.
Question 2: A female patient missed her oral contraceptive pill (OCP) on four different days during the first two weeks of her menstrual cycle. What is the most appropriate advice for her?
- A. Adopt another method of contraception
- B. Continue taking the pill
- C. Continue current pack, consider additional contraceptive method for remaining days (Correct Answer)
- D. Take all 4 pills at once and continue taking pills
Explanation: **Continue current pack, consider additional contraceptive method for remaining days** - Missing four pills in the first two weeks significantly compromises contraceptive efficacy, necessitating the use of **backup contraception** (like condoms) for the remainder of the cycle. - Continuing the current pack is important to maintain hormonal rhythm and prevent unscheduled bleeding, but it won't immediately restore full protection. *Adopt another method of contraception* - While a backup method is needed, she doesn't necessarily need to **completely abandon** OCPs, especially if she has previously tolerated them well. - The immediate concern is the current cycle's protection; a long-term change in method might be considered if adherence is a persistent issue. *Continue taking the pill* - Simply continuing the pill without additional measures is **insufficient** as the contraceptive effectiveness has been significantly compromised by missing multiple doses. - This approach would leave her at a **high risk of pregnancy** during the current cycle. *Take all 4 pills at once and continue taking pills* - Taking multiple missed pills at once is **not recommended** and can lead to **nausea, vomiting**, or irregular bleeding due to a sudden high dose of hormones. - This strategy would not restore contraceptive efficacy effectively and would increase side effects without providing better protection.
Question 3: What is the most common gastrointestinal side effect of oral contraceptives?
- A. Decreased appetite
- B. Weight loss
- C. Nausea (Correct Answer)
- D. Constipation
Explanation: ***Nausea*** - **Nausea** is a very common gastrointestinal side effect of oral contraceptives, especially during the initial weeks of use, due to the **estrogen component**. - This side effect often **improves over time** as the body adjusts, or can be managed by taking the pill with food or at bedtime. *Weight loss* - Oral contraceptives are **not typically associated with weight loss**; in fact, some users may experience slight weight gain, although studies show no consistent significant effect. - Changes in weight are more often due to **fluid retention** rather than true fat loss. *Decreased appetite* - **Decreased appetite** is not a common side effect of oral contraceptives; rather, some individuals might experience an increased appetite due to hormonal fluctuations. - The hormonal effects on metabolism and appetite are **varied and not consistently demonstrated** to lead to decreased appetite. *Constipation* - **Constipation** is not a frequent gastrointestinal side effect of oral contraceptives; rather, some users may experience changes in bowel habits, but **diarrhea is more commonly reported** than constipation when GI issues occur. - Hormonal contraceptives primarily affect the gut through **estrogen and progestin**, leading to various effects, but constipation is not a predominant one.
Question 4: What is the best contraceptive option for managing menorrhagia?
- A. Hormonal IUD (Correct Answer)
- B. Oral progestin
- C. Non-hormonal IUD
- D. Barrier contraceptives
Explanation: ***Hormonal IUD*** - The **levonorgestrel-releasing intrauterine device (LNG-IUD)** is highly effective for menorrhagia due to its localized release of progesterone, which thins the endometrial lining, significantly **reducing menstrual blood loss**. - It also provides highly effective, **long-acting contraception** while offering non-contraceptive benefits like menorrhagia management. *Non-hormonal IUD* - The **copper IUD** can actually **increase menstrual bleeding** and dysmenorrhea, which would worsen menorrhagia. - It works by inducing a local inflammatory reaction in the uterus to prevent fertilization and implantation, without hormonal effects on the endometrium. *Oral progestin* - While oral progestins can sometimes be used to manage menorrhagia, they are generally **less effective** than the hormonal IUD for long-term reduction in menstrual blood loss. - They require **daily adherence** and do not offer the same extended period of efficacy as the hormonal IUD. *Barrier contraceptives* - Barrier methods like **condoms or diaphragms** provide contraception by physically blocking sperm, but they have **no effect on menstrual bleeding** or menorrhagia. - They offer no therapeutic benefit for heavy menstrual bleeding and are solely contraceptive in function.
Question 5: For a woman who has had unprotected intercourse two days ago, which one of the following emergency contraceptive methods is LEAST preferred as first-line emergency contraception?
- A. Levonorgestrel 1.5 mg
- B. LNG IUD
- C. Yuzpe regimen (Correct Answer)
- D. Ulipristal acetate
Explanation: ***Yuzpe regimen*** - The **Yuzpe regimen** uses higher doses of combined oral contraceptive pills, leading to more side effects like nausea and vomiting and generally lower efficacy compared to newer methods. - It involves taking two doses of estrogen and progestin, making it less convenient and less effective, especially after **48 hours**, compared to progestin-only or ulipristal acetate pills. *Levonorgestrel 1.5 mg* - **Levonorgestrel (LNG)** 1.5 mg, taken as a single dose, is a highly effective and widely recommended first-line emergency contraceptive within **72 hours** of unprotected intercourse. - It primarily works by **inhibiting or delaying ovulation**, without causing significant side effects in most women. *LNG IUD* - While an **LNG IUD** can be used as emergency contraception, it is not typically considered a first-line *oral* method; it is placed by a healthcare provider and can provide long-term contraception. - It is effective if inserted within **5 days** of unprotected intercourse, making it a highly effective option that also offers ongoing contraception. *Ulipristal acetate* - **Ulipristal acetate (UPA)** is a highly effective emergency contraceptive, even up to **120 hours (5 days)** after unprotected intercourse. - It works by delaying or inhibiting ovulation and is generally more effective than levonorgestrel, especially when taken more than **72 hours** post-coitally.
Question 6: Which of the following statements about intra-uterine devices (IUDs) is incorrect?
- A. Copper devices are effective as post-coital contraceptives
- B. Pregnancy rates of Lippes Loop and T Cu-200 are similar
- C. LNG-20 (Mirena) has an effective life of 5 years
- D. Multiload Cu-375 is a third generation intra-uterine device (IUD) (Correct Answer)
Explanation: ***Multiload Cu-375 is a third generation intra-uterine device (IUD)*** - This statement is **incorrect** - Multiload Cu-375 is a **second-generation IUD** - It features a modified T-shape or flexible frame with copper wire and higher copper surface area (375 mm²) - **Third-generation IUDs** refer to **hormonal levonorgestrel-releasing systems** (LNG-IUS like Mirena) or advanced copper IUDs with added features - First generation: inert devices (Lippes Loop); Second generation: copper-bearing devices (T Cu-200, Multiload Cu-375); Third generation: hormone-releasing systems *Copper devices are effective as post-coital contraceptives* - This statement is **correct** - Copper IUDs can be inserted up to **5 days after unprotected intercourse** as highly effective emergency contraception - Mechanism: creates a **sterile inflammatory reaction** toxic to sperm and ova, prevents fertilization and implantation *LNG-20 (Mirena) has an effective life of 5 years* - This statement is **correct** - Mirena (levonorgestrel 52 mg) was originally approved for **5 years** of use - FDA has now extended approval to **8 years** based on clinical data, but 5 years remains a valid duration *Pregnancy rates of Lippes Loop and T Cu-200 are similar* - This statement is **correct** - While T Cu-200 added copper (200 mm² surface area), pregnancy rates were comparable between both devices - Later copper IUDs with higher copper content (Cu-380A) showed significantly improved efficacy
Question 7: The mechanism of action of emergency contraception includes the following except:
- A. Degeneration of corpus luteum (Correct Answer)
- B. Prevention of implantation of fertilized egg.
- C. Inhibition of fertilization
- D. By preventing or delaying ovulation
Explanation: ***Degeneration of corpus luteum*** - Emergency contraception primarily works by interfering with ovulation and fertilization. It does **not directly cause degeneration of the corpus luteum**. - The **corpus luteum** forms after ovulation, and its degradation is a natural process (luteolysis) if pregnancy does not occur. Emergency contraception acts earlier in the reproductive process and does not target the corpus luteum. - This is the **correct answer** as it is NOT a mechanism of emergency contraception. *By preventing or delaying ovulation* - This is the **primary mechanism** of action for most forms of emergency contraception, particularly those containing **levonorgestrel (LNG)** and **ulipristal acetate (UPA)**. - By delaying the release of an egg from the ovary, it prevents the possibility of fertilization. - This is the most established and clinically significant mechanism. *Inhibition of fertilization* - Emergency contraception may affect fertilization by altering **cervical mucus** thickness, making it less penetrable to sperm. - Some evidence suggests effects on **sperm motility** or function, though this mechanism is less well-established than ovulation inhibition. - This represents a possible secondary mechanism. *Prevention of implantation of fertilized egg* - **Current evidence does NOT support this as a mechanism** for levonorgestrel or ulipristal acetate emergency contraception. - Studies by **WHO, ACOG, FIGO, and ICMR** have shown that LNG-EC is ineffective once fertilization has occurred. - The **copper IUD** used for emergency contraception may have some anti-implantation effects due to its inflammatory action on the endometrium. - However, for hormonal EC (the most common form), prevention of implantation is **not an established mechanism** based on current medical evidence.
Question 8: Which of the following is NOT used as an emergency contraceptive?
- A. RU 486
- B. Danazol (Correct Answer)
- C. Copper T
- D. OCpill
Explanation: ***Danazol*** - **Danazol** is an **androgen derivative** primarily used to treat **endometriosis** and **fibrocystic breast disease**, not for emergency contraception. - Its mechanism involves suppressing **ovarian function** and creating an anovulatory state, which is not suitable for immediate post-coital intervention. *RU 486* - **RU 486 (Mifepristone)** is a **progesterone receptor modulator** that can be used as an emergency contraceptive, especially at higher doses. - It acts by **blocking progesterone receptors**, preventing implantation or inducing abortion if pregnancy has already occurred. *Copper T* - The **Copper T (intrauterine device - IUD)** is a highly effective method of emergency contraception if inserted within 5 days of unprotected intercourse. - It works by causing a **spermicidal effect** and preventing fertilization or implantation by inducing an inflammatory reaction in the uterus. *OCpill* - **OCPills (oral contraceptive pills)**, usually a combination of estrogen and progestin, can be used as emergency contraception when taken in higher doses. - This method, known as the **Yuzpe regimen**, involves taking two doses of combined oral contraceptives within 72 hours of unprotected intercourse to inhibit ovulation or fertilization.
Question 9: A woman comes after 96 hours post coitus. Best contraceptive of choice is?
- A. Progesterone only pills
- B. OCP
- C. IUCD (Correct Answer)
- D. Mifepristone
Explanation: ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.
Question 10: Which of the following is not used for postcoital contraception?
- A. CuT
- B. Ru 486
- C. High dose estrogen
- D. Danazol (Correct Answer)
Explanation: ***Danazol*** - **Danazol** is an androgen derivative primarily used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its ability to suppress gonadotropin secretion. - It is **not effective** as a postcoital contraceptive as it does not reliably prevent ovulation, fertilization, or implantation when taken after unprotected intercourse. *CuT* - The **copper-T intrauterine device (CuT IUD)** can be inserted within **5 days** of unprotected intercourse as an effective form of emergency contraception. - Its mechanism involves releasing **copper ions** that are toxic to sperm and eggs, inhibiting fertilization and implantation. *Ru 486* - **Mifepristone (RU 486)** is an **anti-progestin** that can be used for emergency contraception (often referred to as the morning-after pill). - It works by delaying or inhibiting ovulation and preventing implantation by altering the **endometrium**. *High dose estrogen* - High doses of **estrogen**, often in combination with progestin (**Yuzpe regimen**), can be used as emergency contraception. - This method primarily works by **disrupting ovulation** and altering the endometrium to prevent implantation.
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