Hormonal Contraceptives — MCQs
Use of OCPs is known to protect against the following malignancies except:
What is the absolute contraindication of oral contraceptive pills (OCPs)?
The adverse effect of combined oral contraceptives among the following is:
A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful, with severe lower abdominal cramping and back pain, requiring pad changes every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she experiences uncharacteristic tearfulness, irritability, and depression, which are affecting her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?
Which of the following reduces the efficacy of oral contraceptives?
Which of the following is a side effect of Progestin Only Pills (POPs)?
The mechanism of action of emergency contraception includes the following except:
A woman comes after 96 hours post coitus. Best contraceptive of choice is?
What is the management for women with polycystic ovary syndrome (PCOS) and hirsutism?
Among the following intra-uterine contraceptive devices, which of the following are included in second generation IUDs? 1. Lippes Loop 2. Copper T-200 3. LNG-20 (Mirena) 4. Copper-T-380 A
Hormonal Contraceptives Indian Medical PG Practice Questions and MCQs
Question 1: Use of OCPs is known to protect against the following malignancies except:
- A. Colorectal carcinomas
- B. Carcinoma cervix (Correct Answer)
- C. Ovarian carcinoma
- D. Endometrial carcinoma
Explanation: ***Carcinoma cervix*** - While oral contraceptive pills (OCPs) offer protection against some cancers, they are **not protective against cervical cancer**. - In fact, long-term use of OCPs is considered a **risk factor for cervical cancer**, especially in conjunction with human papillomavirus (HPV) infection. *Colorectal carcinomas* - OCP use has been consistently associated with a **reduced risk of colorectal cancer**. - The protective effect is thought to be mediated by various hormonal mechanisms, including their impact on **bile acid metabolism** and **estrogen receptors in the colon**. *Ovarian carcinoma* - OCPs provide significant and **long-lasting protection against ovarian cancer**. - This protective effect is believed to be due to the **suppression of ovulation**, thereby reducing the continuous trauma and repair of the ovarian epithelium. *Endometrial carcinoma* - OCPs are known to offer substantial **protection against endometrial cancer**. - The progestin component in combined OCPs effectively **counteracts the proliferative effects of estrogen** on the endometrium, reducing the risk of hyperplasia and subsequent cancer.
Question 2: What is the absolute contraindication of oral contraceptive pills (OCPs)?
- A. Dysmenorrhoea
- B. Carcinoma of the breast (Correct Answer)
- C. Endometriosis
- D. Hypertension
Explanation: ***Carcinoma of the breast*** - OCPs contain **estrogen and progesterone**, which can stimulate the growth of **hormone-sensitive breast cancers**. - Therefore, a history of or current **breast cancer** is an absolute contraindication to OCP use. *Dysmenorrhoea* - **Dysmenorrhoea** (painful menstruation) is often effectively treated or alleviated by OCPs due to their ability to suppress ovulation and reduce prostaglandin production. - It is not a contraindication; rather, it is a common indication for OCP use. *Hypertension* - **Uncontrolled severe hypertension** (≥160/100 mmHg) is an absolute contraindication to OCP use. - However, the term "hypertension" alone typically refers to mild or well-controlled hypertension, which is a relative contraindication with careful monitoring. - OCPs can sometimes **increase blood pressure**, requiring careful risk-benefit assessment for individuals with existing hypertension. *Endometriosis* - **Endometriosis** is often managed and its symptoms improved by OCPs, as they help suppress endometrial growth and reduce menstrual flow. - OCPs are a common and effective treatment for endometriosis, not a contraindication.
Question 3: The adverse effect of combined oral contraceptives among the following is:
- A. Pelvic inflammatory disease (PID)
- B. Weight changes
- C. Acne based on formulation
- D. Liver disorders (Correct Answer)
Explanation: ***Liver disorders*** - Combined oral contraceptives (COCs) can cause adverse effects on the liver, including **cholestasis**, adenomas, and, rarely, **hepatocellular carcinoma**. - This is primarily due to the **estrogen component** which can affect liver metabolism and function. *Pelvic inflammatory disease (PID)* - COCs have been shown to **reduce the risk of PID** by thickening cervical mucus, which acts as a barrier to ascending infections. - PID is typically caused by sexually transmitted infections, not directly by COC use. *Weight changes* - While some women report weight changes, large-scale studies have not found a significant or consistent **causal link between COCs and weight gain**. - Any perceived weight changes are often transient or related to other factors, such as fluid retention. *Acne based on formulation* - Many COCs are actually prescribed to **treat acne** due to their anti-androgenic effects, particularly formulations with newer progestins. - While some specific older formulations might worsen acne in susceptible individuals, it is not a general adverse effect of COCs.
Question 4: A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful, with severe lower abdominal cramping and back pain, requiring pad changes every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she experiences uncharacteristic tearfulness, irritability, and depression, which are affecting her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?
- A. Progesterone intrauterine device (IUD)
- B. Depo-Provera (medroxyprogesterone acetate) shots every 3 months
- C. Combination oral contraceptive pill with drospirenone and ethinyl estradiol (Correct Answer)
- D. Tubal ligation (permanent sterilization)
Explanation: ***Combination oral contraceptive pill with drospirenone and ethinyl estradiol*** - This combination addresses **contraception**, **dysmenorrhea**, **heavy menstrual bleeding**, **premenstrual dysphoric disorder (PMDD)**, and **acne**. Drospirenone has anti-androgenic effects, improving acne and potentially reducing fluid retention. - The patient's symptoms of irregular mood and irritability before her period are consistent with **PMDD**, which is effectively treated by **combination oral contraceptives** (COCs). *Progesterone intrauterine device (IUD)* - While effective for **contraception** and reducing **heavy menstrual bleeding** and **dysmenorrhea**, it does not typically improve acne or PMDD symptoms. - It works primarily locally in the uterus and does not have the systemic anti-androgenic or mood-stabilizing effects of COCs. *Depo-Provera (medroxyprogesterone acetate) shots every 3 months* - This method is effective for contraception and can reduce menstrual bleeding and dysmenorrhea, but it is often associated with **weight gain**, which the patient wants to avoid. - It can also cause **worsening of mood symptoms** and **acne** in some individuals, conflicting with her specific concerns. *Tubal ligation (permanent sterilization)* - This method provides permanent **contraception** but does not address her heavy, painful periods, PMDD, or acne. - The patient only desires to avoid pregnancy for a few years, making a permanent method like tubal ligation inappropriate at this time.
Question 5: Which of the following reduces the efficacy of oral contraceptives?
- A. Griseofulvin (Correct Answer)
- B. Disulfiram
- C. Erythromycin
- D. Cimetidine
Explanation: ***Griseofulvin*** - **Griseofulvin** is an antifungal agent known to induce liver enzymes, specifically the **cytochrome P450 system**. - Enzyme induction accelerates the metabolism and clearance of **oral contraceptives**, leading to lower plasma concentrations and reduced efficacy. *Erythromycin* - **Erythromycin** is a macrolide antibiotic that typically inhibits liver enzymes rather than inducing them. - While it can interfere with the metabolism of some drugs, it usually **increases** rather than decreases the plasma levels of co-administered medications, and is not known to reduce oral contraceptive efficacy. *Disulfiram* - **Disulfiram** is used to treat chronic alcoholism and inhibits aldehyde dehydrogenase. - It does not significantly interact with the metabolism of **oral contraceptives** via the cytochrome P450 system or other mechanisms that would reduce their efficacy. *Cimetidine* - **Cimetidine** is an H2 receptor antagonist that is known to inhibit cytochrome P450 enzymes. - This inhibition would likely **increase** the plasma concentration of drugs metabolized by these enzymes, such as oral contraceptives, rather than reducing their efficacy.
Question 6: Which of the following is a side effect of Progestin Only Pills (POPs)?
- A. Ovarian cysts (Correct Answer)
- B. Venous thromboembolism
- C. Increased risk of diabetes mellitus
- D. Ectopic pregnancy
Explanation: ***Ovarian cysts*** - **Functional ovarian cysts** are a known side effect of Progestin Only Pills (**POPs**), as POPs can alter the normal ovulatory cycle but usually do not completely suppress follicular development. - While generally benign and self-resolving, they can cause pain and discomfort. *Venous thromboembolism* - **POPs** are not significantly associated with an increased risk of **venous thromboembolism** due to the absence of estrogen, unlike combined hormonal contraceptives. - This is a key advantage of POPs, making them suitable for individuals at risk for thromboembolic events. *Increased risk of diabetes mellitus* - There is generally **no significant increased risk** of **diabetes mellitus** associated with POPs. - While some hormonal contraceptives *may* have minor effects on glucose metabolism, this is not a prominent or clinically significant side effect of POPs. *Ectopic pregnancy* - POPs **do not increase the risk of ectopic pregnancy**. In fact, they **reduce the overall pregnancy rate**, including ectopic pregnancies, by preventing ovulation. - However, if a pregnancy does occur while on POPs, there is a *slightly higher proportion* of those pregnancies that may be ectopic compared to unaided conceptions, but the *absolute risk* remains low.
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: 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 9: What is the management for women with polycystic ovary syndrome (PCOS) and hirsutism?
- A. Ethinyl estradiol + Cyproterone Acetate (Correct Answer)
- B. Ethinyl estradiol
- C. Levonorgestrel
- D. Ethinyl estradiol + Levonorgestrel
Explanation: ***Ethinyl estradiol + Cyproterone Acetate*** - This combination is effective for managing **hirsutism** in PCOS because ethinyl estradiol suppresses **gonadotropins** and ovarian androgen production, while **cyproterone acetate** is a potent **anti-androgen** that blocks androgen effects at the receptor level. - The anti-androgenic properties of cyproterone acetate directly address the excess androgen activity responsible for hirsutism. *Ethinyl estradiol* - While ethinyl estradiol (an estrogen) can suppress **gonadotropins** and thus reduce ovarian androgen production, it alone is not primarily effective in directly addressing and reversing existing hirsutism. - It would not sufficiently counteract the effects of high androgens on hair follicles without an additional anti-androgen. *Levonorgestrel* - Levonorgestrel is a **progestin** with **androgenic properties**, particularly at higher doses. - This would potentially worsen hirsutism rather than improve it, as it contributes to androgenic effects. *Ethinyl estradiol + Levonorgestrel* - This combination is a common component of oral contraceptive pills, but **levonorgestrel** has some **androgenic activity**, which means it could worsen or fail to improve hirsutism. - While ethinyl estradiol lowers androgens, the mild androgenic effect of levonorgestrel might counteract the desired anti-androgenic effect needed to treat hirsutism effectively.
Question 10: Among the following intra-uterine contraceptive devices, which of the following are included in second generation IUDs? 1. Lippes Loop 2. Copper T-200 3. LNG-20 (Mirena) 4. Copper-T-380 A
- A. 1 and 2 only
- B. 1, 3 and 4
- C. 2 and 4 only (Correct Answer)
- D. 2 and 3 only
Explanation: ***2 and 4 only*** - Second-generation IUDs are primarily **copper-releasing devices** with more effective copper surface areas, such as **Copper T-200** and **Copper T-380A**, designed for improved efficacy and longer duration of action [1]. - These devices leverage **copper's spermicidal and inflammatory properties** to prevent fertilization and implantation [1]. *1 and 2 only* - The **Lippes Loop** is a first-generation IUD, a non-medicated plastic device, while the **Copper T-200** is indeed a second-generation device [1]. - This option incorrectly groups a first-generation device with a second-generation one, making it incomplete for identifying all second-generation IUDs mentioned. *2 and 3 only* - While **Copper T-200** is correctly identified as a second-generation device, **LNG-20 (Mirena)** is a third-generation hormone-releasing IUD [1]. - This option incorrectly groups a second-generation copper device with a third-generation levonorgestrel-releasing device [2]. *1, 3 and 4* - The **Lippes Loop** is a first-generation IUD, making its inclusion incorrect for second-generation devices [1]. - **LNG-20 (Mirena)** is a third-generation, hormone-releasing IUD, distinct from the copper-based second-generation devices [2].
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