Contraception and Family Planning Practice Questions

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.

Q: Which of the following statements regarding DMPA is FALSE?

It protects against ovarian cancer.. **Explanation:** **1. Why Option D is the Correct (False) Statement:** While Depot Medroxyprogesterone Acetate (DMPA) provides significant protection against **Endometrial Cancer** (due to its progestogenic effect opposing estrogenic stimulation), its role in protecting against **Ovarian Cancer** is not as well-established or significant as that of Combined Oral Contraceptive Pills (COCPs). In the context of standard medical examinations like NEET-PG, the "protective effect against ovarian cancer" is a classic hallmark of COCPs, not primarily DMPA. **2. Analysis of Other Options:** * **Option A (Failure Rate):** The typical use failure rate of DMPA is approximately **3%** (though perfect use is 0.2%). In competitive exams, 3% is the standard figure cited for typical use. * **Option B (Menorrhagia):** DMPA causes endometrial atrophy, leading to amenorrhea in about 50-70% of users after one year. This makes it an excellent therapeutic choice for managing **menorrhagia** and endometriosis. * **Option C (Seizures):** DMPA is the **contraceptive of choice for women with epilepsy**. It has an inherent anticonvulsant effect (raises the seizure threshold) and its metabolism is not significantly affected by enzyme-inducing anti-epileptic drugs, unlike COCPs. **High-Yield Clinical Pearls for NEET-PG:** * **Dose:** 150 mg intramuscularly every 3 months (12 weeks). * **Mechanism:** Primarily inhibits ovulation by suppressing the LH surge. * **Side Effects:** Most common is **irregular bleeding/spotting**; most concerning is a reversible decrease in **Bone Mineral Density (BMD)**. * **Return to Fertility:** There is a characteristic delay in return to fertility (average 7–10 months after the last dose).

Q: What is the iron content of the MALA-D contraceptive?

19.5 mg. **Explanation:** Mala-D is a Combined Oral Contraceptive Pill (COCP) provided under the National Family Welfare Programme in India. Each cycle pack contains **28 tablets**: 21 hormonal (active) tablets and 7 non-hormonal (placebo) tablets. **1. Why 19.5 mg is correct:** The 7 brown-colored placebo tablets in the Mala-D pack are not empty; they contain **Ferrous Fumarate**. Each of these 7 tablets contains **60 mg of Ferrous Fumarate**, which provides exactly **19.5 mg of elemental iron**. This is included to maintain the habit of daily pill-taking and to supplement iron stores, as many women in the reproductive age group in India suffer from iron-deficiency anemia due to menstrual blood loss. **2. Analysis of Incorrect Options:** * **10 mg:** This is a distracter and does not correspond to standard iron formulations in OCPs. * **29.5 mg:** This is often confused with the elemental iron content of other supplements. * **40 mg:** While some therapeutic iron doses are higher, the standard prophylactic dose in Mala-D remains 19.5 mg elemental iron. **3. High-Yield Clinical Pearls for NEET-PG:** * **Composition of Active Pill:** 0.15 mg Levonorgestrel + 0.03 mg Ethinyl Estradiol. * **Mala-N vs. Mala-D:** Both have the same composition. The only difference is that **Mala-N is free** of cost at government centers, while **Mala-D is subsidized** (social marketing). * **Centchroman (Chhaya):** A non-steroidal, once-a-week pill (Selective Estrogen Receptor Modulator). * **Failure Rate:** The Pearl Index of COCPs with perfect use is 0.1 per 100 woman-years.

Q: What is the recommended dose of levonorgestrel for emergency contraception?

1.5 mg single dose. **Explanation:** The standard of care for emergency contraception using **Levonorgestrel (LNG)**, a synthetic progestogen, is a total dose of **1.5 mg**. **Why Option B is correct:** Current WHO and national guidelines recommend a **single dose of 1.5 mg** taken as soon as possible (ideally within 72 hours, but effective up to 120 hours) after unprotected intercourse. This single-dose regimen is preferred because it ensures better patient compliance and has been proven to be as effective as the split-dose regimen without increasing the incidence of side effects like nausea or vomiting. **Analysis of incorrect options:** * **Option A (0.75 mg single dose):** This is a sub-therapeutic dose and is insufficient to reliably prevent ovulation. * **Option C (Two 0.75 mg doses 12 hours apart):** This was the traditional "Yuzpe-like" progestin-only regimen. While effective, it is no longer the first-line recommendation due to the risk of the patient forgetting the second dose. * **Option D (7.5 mg single dose):** This is an excessively high dose and is not used in clinical practice for contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily acts by **delaying or inhibiting ovulation** (LH surge suppression). It does *not* disrupt an established pregnancy (not an abortifacient). * **Efficacy:** Effectiveness decreases with time; "the sooner, the better." It also has reduced efficacy in women with a BMI >30 kg/m². * **Failure:** If the patient vomits within **2 hours** of intake, the dose must be repeated. * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) given as a **30 mg single dose**; it is more effective than LNG, especially between 72–120 hours.

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

Inhibits ovulation. **Explanation:** The primary mechanism of action of an Intrauterine Contraceptive Device (IUCD) is to create a **sterile inflammatory response** within the uterine cavity. This environment is toxic to both sperm and the blastocyst. **Why "Inhibits Ovulation" is the correct answer:** IUCDs (both Copper-T and Levonorgestrel-releasing systems like Mirena) act locally within the uterus. They **do not** suppress the Hypothalamic-Pituitary-Ovarian (HPO) axis. Therefore, patients using an IUCD continue to have regular ovulatory cycles. Ovulation inhibition is the primary mechanism of Combined Oral Contraceptive Pills (OCPs) and DMPA injections, not IUCDs. **Analysis of other options:** * **A. Impairs implantation:** The foreign body reaction causes biochemical and histological changes in the endometrium, making it hostile for a blastocyst to implant. * **B. Increases tubal motility:** IUCDs alter the inflammatory milieu and prostaglandin levels, which can increase tubal peristalsis, potentially leading to the premature arrival of the ovum in the uterus before it is ready for fertilization or implantation. * **D. Releases prostaglandins:** The presence of the device stimulates the endometrium to release prostaglandins, which contribute to the spermicidal effect and alter uterine/tubal motility. **High-Yield Clinical Pearls for NEET-PG:** * **Copper-T (Cu-T):** Primarily **spermicidal** (copper ions inhibit sperm motility and viability). It is the most effective **emergency contraceptive** if inserted within 5 days of unprotected intercourse. * **LNG-IUD (Mirena):** Primarily acts by **thickening cervical mucus** (preventing sperm penetration) and causing endometrial atrophy. * **Ideal Candidate:** Multiparous women in a stable monogamous relationship (to minimize PID risk). * **Most common side effect:** Cu-T (Bleeding/Menorrhagia); LNG-IUD (Amenorrhea).

Question 1

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 2

Which of the following surgical sterilization procedures, if performed in a woman, leaves no potential for reversal?

Accepted Answer

Fimbriectomy

Answer

Pomroy method

Answer

Aldridge's method

Answer

Madlener operation

Question 3

What is the amount of estrogen in Mala D?

Accepted Answer

30 μg

Answer

50 μg

Answer

10 μg

Answer

80 μg

Question 4

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 5

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 6

Which of the following statements regarding DMPA is FALSE?

Accepted Answer

It protects against ovarian cancer.

Answer

It has a 3% failure rate.

Answer

It is useful in the treatment of menorrhagia.

Answer

It can be given to women with seizures.

Question 7

What is the iron content of the MALA-D contraceptive?

Accepted Answer

19.5 mg

Answer

10 mg

Answer

29.5 mg

Answer

40 mg

Question 8

What is the recommended dose of levonorgestrel for emergency contraception?

Accepted Answer

1.5 mg single dose

Answer

0.75 mg single dose

Answer

1.5 mg given as two 0.75 mg doses 12 hours apart

Answer

7.5 mg single dose

Question 9

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 10

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

Accepted Answer

Inhibits ovulation

Answer

Impairs implantation of the blastocyst

Answer

Increases tubal motility

Answer

Releases prostaglandins

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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