Contraception and Family Planning Practice Questions

Q: Which contraceptive is contraindicated during lactation?

Combined Oral Contraceptive Pill (OCP). **Explanation:** The primary reason **Combined Oral Contraceptive Pills (COCPs)** are contraindicated during lactation (specifically within the first 6 months) is the **Estrogen** component. Estrogen suppresses the production of prolactin, leading to a significant reduction in both the quantity and quality of breast milk. Furthermore, there is a theoretical risk of estrogen being excreted in milk, potentially affecting the infant. According to WHO Medical Eligibility Criteria (MEC), COCPs are categorized as **MEC 4** (unacceptable health risk) if used <3 weeks postpartum and **MEC 3** between 3 weeks to 6 months if breastfeeding. **Analysis of Incorrect Options:** * **B. Intrauterine Device (IUD):** Both Cu-T and LNG-IUS are safe during lactation. They do not interfere with milk production. While the risk of perforation is slightly higher in lactating women due to a soft uterus, they remain a first-line postpartum contraceptive (PPIUCD). * **C. Progesterone-only pill (POP):** Also known as the "Minipill," this is the **contraceptive of choice** for lactating mothers. Progesterone does not suppress lactation; in some studies, it has been shown to slightly increase milk volume. **NEET-PG High-Yield Pearls:** * **Ideal time to start POPs:** 6 weeks postpartum (though can be started earlier as per recent guidelines). * **Lactational Amenorrhea Method (LAM):** Effective only if the mother is exclusively breastfeeding, is amenorrheic, and the baby is <6 months old. * **DMPA (Injectable):** Safe during lactation; usually administered after 6 weeks postpartum to ensure lactation is well-established. * **Centchroman (Saheli):** A non-steroidal SERM; it is safe during lactation and does not affect milk yield.

Q: A single tablet of levonorgestrel 0.75 mg has been taken for effective post-coital contraception. When should the second tablet be taken?

24 hours after the first tablet. **Explanation:** The correct answer is **B. 24 hours after the first tablet.** **Understanding the Concept:** Levonorgestrel (LNG) is a progestogen-only emergency contraceptive pill (ECP). The standard regimen for emergency contraception using 0.75 mg tablets involves a total dose of 1.5 mg. According to the **World Health Organization (WHO)** and standard clinical guidelines, if the 0.75 mg formulation is used, the two doses should be taken **24 hours apart**. While earlier protocols suggested a 12-hour interval, current evidence and updated guidelines (including those often cited in NEET-PG) emphasize the 24-hour interval for optimal efficacy and convenience. Alternatively, both tablets (1.5 mg total) can be taken as a single stat dose. **Analysis of Options:** * **Option A (12 hours):** This was the traditional Yuzpe regimen timing, but it is no longer the preferred interval for LNG-only pills as per updated guidelines. * **Options C & D (36 and 48 hours):** These intervals are too long. Delaying the second dose significantly reduces the efficacy of the hormonal surge required to inhibit or delay ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG-ECP should ideally be taken within 72 hours of unprotected intercourse, though it has some efficacy up to 120 hours. * **Mechanism of Action:** Primarily acts by **inhibiting or delaying ovulation**. It does not disrupt an established pregnancy (not an abortifacient). * **Single Dose Trend:** The most common current practice is a single dose of **1.5 mg LNG** (e.g., i-Pill or 72-H) as it improves compliance without increasing side effects. * **Most Effective EC:** The **Copper-T 380A** is the most effective emergency contraceptive if inserted within 5 days. * **Drug of Choice:** **Ulipristal acetate (30 mg)** is now considered more effective than LNG, especially between 72–120 hours.

Q: What is the best hormonal contraceptive for a patient with sickle cell anemia?

Progestogen-Only Pill (POP). ### Explanation **Correct Answer: B. Progestogen-Only Pill (POP)** **Why it is correct:** In patients with Sickle Cell Anemia (SCA), the primary goal of contraception is to avoid triggers for vaso-occlusive crises (VOC). **Progestogens** (specifically POPs, DMPA, or implants) are the preferred hormonal choice because they have been shown to **reduce the frequency and intensity of painful crises**. The underlying mechanism involves the stabilization of the red blood cell membrane, which inhibits the sickling process. Additionally, progestogens reduce menstrual blood loss, helping to manage the chronic anemia often seen in these patients. **Why the other options are incorrect:** * **A. Oral Contraceptive Pill (OCP):** Combined OCPs contain estrogen. Estrogen is generally avoided or used with caution in SCA because it is pro-thrombotic. Since SCA is already a hypercoagulable state with a high risk of stroke and thromboembolism, adding estrogen increases the risk of vascular complications. * **C. Copper T (Cu-T):** While not hormonal, the Copper T often causes increased menstrual bleeding (menorrhagia) and dysmenorrhea. In a patient with baseline hemolytic anemia, any increase in blood loss can worsen their clinical status. * **D. None of the above:** Incorrect, as POPs are a recognized and recommended option. **High-Yield Clinical Pearls for NEET-PG:** * **DMPA (Depot Medroxyprogesterone Acetate)** is often cited in literature as the "gold standard" for SCA because it significantly reduces VOC, but among the options provided, POP is the best hormonal choice. * **WHO Eligibility Criteria (MEC):** Progestogen-only methods are **MEC Category 1** (no restriction) for Sickle Cell Disease. * **Levonorgestrel Intrauterine System (LNG-IUS)** is also an excellent choice as it reduces menstrual blood loss significantly. * **Avoid Estrogen:** Always remember that Estrogen + Sickle Cell = Increased Risk of Thrombosis.

Q: Which of the following is NOT included in emergency contraception?

DMPA. **Explanation:** Emergency contraception (EC) refers to methods used to prevent pregnancy after unprotected intercourse, typically within a specific window (up to 5 days). **Why DMPA is the correct answer:** **DMPA (Depot Medroxyprogesterone Acetate)** is a long-acting injectable contraceptive administered every 3 months. It is used for **routine, long-term contraception**, not emergency use. It works primarily by inhibiting ovulation over a sustained period and does not provide the rapid hormonal surge or local effect required to prevent implantation or ovulation immediately after a single act of intercourse. **Analysis of other options:** * **Oral Contraceptives (Yuzpe Regimen):** Combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel) can be used in specific high doses as EC. Though less commonly used now due to side effects like nausea, it remains a recognized method. * **Copper T (Cu-IUCD):** This is the **most effective** method of emergency contraception. If inserted within 5 days (120 hours) of unprotected intercourse, it prevents pregnancy by causing a local inflammatory response toxic to sperm and ova and preventing implantation. * **Levonorgestrel (LNG) tablets:** Often called the "morning-after pill" (e.g., 1.5 mg single dose), this is the most common hormonal EC. It works by delaying or inhibiting ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper T (Failure rate <0.1%). * **Drug of Choice (Hormonal):** Levonorgestrel 1.5mg (effective up to 72 hours, though can be used up to 120 hours). * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM); it is more effective than LNG and is the hormonal EC of choice between 72–120 hours. * **Mifepristone:** Can also be used as an EC in low doses (10–25 mg).

Q: Which is the progesterone of choice for emergency contraception?

Levonorgestrel. **Explanation:** **Levonorgestrel (LNG)** is the progesterone of choice for emergency contraception (EC) due to its high efficacy and safety profile. The primary mechanism of action is the **prevention or delay of ovulation** by inhibiting the LH surge. It is most effective when taken as soon as possible after unprotected intercourse (ideally within 72 hours), though it may be used up to 120 hours. The standard regimen is a single dose of **1.5 mg** (or two doses of 0.75 mg taken 12 hours apart). **Analysis of Options:** * **Levonorgestrel (C):** It is a second-generation synthetic progestogen. It is preferred over the older Yuzpe regimen (Estrogen + Progesterone) because it causes significantly less nausea and vomiting. * **Norgesterone (A):** This is an older progestogen not typically used in modern emergency contraception protocols. * **Micronized Progesterone (B):** This is a natural form of progesterone used primarily for luteal phase support in infertility or for hormone replacement therapy; it lacks the potency required for emergency contraceptive action. * **DMPA (D):** Depot Medroxyprogesterone Acetate is an injectable contraceptive used for long-term protection (3 months), not for emergency use. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** Most effective within 72 hours; efficacy decreases with increased Body Mass Index (BMI >26 kg/m²). * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) that is now considered more effective than LNG, especially between 72–120 hours. * **Gold Standard:** The **Copper-T (IUCD)** remains the most effective method of emergency contraception overall (failure rate <0.1%) and can be inserted up to 5 days after the earliest predicted day of ovulation. * **Failure:** If a patient conceives after LNG failure, there is no evidence of teratogenicity.

Question 1

Which contraceptive is contraindicated during lactation?

Accepted Answer

Combined Oral Contraceptive Pill (OCP)

Answer

Intrauterine Device (IUD)

Answer

Progesterone-only pill

Answer

None of the above

Question 2

A single tablet of levonorgestrel 0.75 mg has been taken for effective post-coital contraception. When should the second tablet be taken?

Accepted Answer

24 hours after the first tablet

Answer

12 hours after the first tablet

Answer

36 hours after the first tablet

Answer

48 hours after the first tablet

Question 3

Incidence of ectopic pregnancy is highest with which of the following contraceptive methods?

Accepted Answer

Progestogen-only contraceptives

Answer

Oral contraceptive pills

Answer

Copper T Intrauterine Contraceptive Device (IUCD)

Answer

Multiload Intrauterine Contraceptive Device (IUCD)

Question 4

Which of the following is the best explanation for the mechanism of action of the intrauterine device (IUD)?

Accepted Answer

A sterile inflammatory response of the endometrium prevents implantation.

Answer

Hyperperistalsis of the fallopian tubes accelerates oocyte transport and prevents fertilization.

Answer

A subacute or chronic bacterial endometritis interferes with implantation.

Answer

Premature endometrial sloughing associated with menorrhagia causes early abortion.

Question 5

The 'banana sign' and 'lemon sign' are associated with which fetal anomaly?

Accepted Answer

Neural tube defect

Answer

Hydrops fetalis

Answer

Multiple gestation (twins)

Answer

Intrauterine demise (IUD)

Question 6

Which of the following is NOT a contraindication for progestasert?

Accepted Answer

Previous history of abortion

Answer

Pelvic inflammatory disease

Answer

Uterine fibroids

Answer

Previous history of ectopic pregnancy

Question 7

What is the best hormonal contraceptive for a patient with sickle cell anemia?

Accepted Answer

Progestogen-Only Pill (POP)

Answer

Oral Contraceptive Pill (OCP)

Answer

Copper T Intrauterine Device (Cu-T)

Answer

None of the above

Question 8

Which of the following is NOT included in emergency contraception?

Accepted Answer

DMPA

Answer

Oral contraceptive

Answer

Copper T

Answer

Levonorgestrel tablets

Question 9

What is the most effective mode of contraception for a woman with heart disease?

Accepted Answer

Intrauterine Contraceptive Devices (IUCD)

Answer

Oral pills

Answer

Norplant

Answer

Condom

Question 10

Which is the progesterone of choice for emergency contraception?

Accepted Answer

Levonorgestrel

Answer

Norgesterone

Answer

Micronized progesterone

Answer

DMPA

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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