Contraception and Family Planning Practice Questions

Q: Progestin-only pills should not be taken by women with which of the following conditions?

Migraine headache without aura. **Explanation:** The question asks for the condition where Progestin-Only Pills (POPs) are **NOT** contraindicated. According to the WHO Medical Eligibility Criteria (MEC), **Migraine without aura** is classified as **MEC Category 2** (advantages generally outweigh risks) for POPs. Therefore, it is safe for these women to use them. **Why the correct answer is right:** Unlike combined oral contraceptives (COCs), which contain estrogen and are contraindicated in migraine patients due to an increased risk of ischemic stroke, POPs do not contain estrogen. They do not significantly alter coagulation factors or blood pressure, making them a safe alternative for women with migraines (without aura). **Why the other options are wrong:** * **Unexplained uterine bleeding (MEC 4):** This is a contraindication because the bleeding may be due to an undiagnosed malignancy (e.g., endometrial cancer) which must be ruled out before starting hormonal therapy. * **Breast Cancer (MEC 4):** Current breast cancer is a strict contraindication for all hormonal contraceptives, as progestins can stimulate the growth of hormone-sensitive tumor cells. * **Severe active liver disease (MEC 3/4):** Steroid hormones are metabolized in the liver. In cases of acute hepatitis, decompensated cirrhosis, or liver tumors (adenomas/hepatomas), POPs are contraindicated as they may worsen the condition or fail to be metabolized correctly. **High-Yield Clinical Pearls for NEET-PG:** * **MEC 4 (Absolute Contraindication):** Current Breast Cancer is the most high-yield MEC 4 for POPs. * **Migraine with Aura:** While COCs are MEC 4, POPs are generally considered MEC 2. * **Lactation:** POPs are the hormonal contraceptive of choice for breastfeeding mothers (MEC 1) as they do not suppress milk production, unlike COCs. * **Efficacy:** POPs must be taken at the same time every day; a delay of >3 hours is considered a "missed pill."

Q: A 30-year-old woman is on warfarin for deep vein thrombosis. Which contraceptive should be advised to her?

Intrauterine contraceptive device (IUCD). **Explanation:** The primary concern for a patient on **Warfarin** for Deep Vein Thrombosis (DVT) is the high risk of recurrent thromboembolism. In such cases, the selection of contraception is guided by the **WHO Medical Eligibility Criteria (MEC)**. **1. Why IUCD is the Correct Choice:** The **Intrauterine Contraceptive Device (IUCD)**, specifically the Copper-T (Cu-T), is categorized as **WHO MEC 1** (no restriction) for women with a history of DVT or those on anticoagulant therapy. It is a non-hormonal method that does not increase the risk of thrombosis. While anticoagulants can increase menstrual bleeding, the Cu-T remains the safest long-term option. Note: The Levonorgestrel-IUS (Mirena) is also an excellent choice as it reduces the heavy menstrual bleeding often caused by Warfarin. **2. Why Other Options are Incorrect:** * **Progesterone-only pills (POPs), Levonorgestrel implants, and Implanon:** These are generally categorized as **WHO MEC 2** for patients with current DVT or those on anticoagulants. While they do not contain estrogen (the primary culprit in thrombosis), they are considered secondary to IUCDs in this specific clinical scenario. * **Combined Oral Contraceptive Pills (COCPs):** (Though not an option here) These are strictly **Contraindicated (WHO MEC 4)** because estrogen increases clotting factors and the risk of recurrent DVT. **Clinical Pearls for NEET-PG:** * **Gold Standard:** For any patient with a history of thromboembolism, **Non-hormonal methods (Cu-T)** or **Progestogen-only methods** are preferred. * **MEC 4 (Absolute Contraindication) for COCPs:** History of DVT/PE, Migraine with aura, Smoking >15 cigarettes/day in women >35 years, and Breast Cancer. * **Warfarin & Pregnancy:** Warfarin is **teratogenic** (causes fetal warfarin syndrome/chondrodysplasia punctata); hence, highly effective contraception like an IUCD is mandatory.

Q: All of the following are used for contraception in patients with sickle cell anemia except?

Oral contraceptive pills. **Explanation:** The primary concern in managing contraception for patients with **Sickle Cell Anemia (SCA)** is the risk of triggering a vaso-occlusive crisis or thromboembolic events. **1. Why Oral Contraceptive Pills (OCPs) are the Correct Answer:** Combined Oral Contraceptive Pills contain **Estrogen**, which is known to increase the synthesis of clotting factors and enhance platelet aggregation. In patients with SCA, who are already at a baseline hypercoagulable state and prone to vascular stasis, the addition of estrogen significantly increases the risk of **thromboembolism and stroke**. Therefore, estrogen-containing methods are generally avoided (WHO MEC Category 4 or 3 depending on severity). **2. Analysis of Other Options:** * **IUCD (Option B):** Copper IUCDs are safe as they are non-hormonal. However, Levonorgestrel-IUS (Mirena) is often preferred as it reduces menstrual blood loss, helping with the anemia common in SCA. * **Progestin-only Pills (Option C) & Progesterone Implants (Option D):** Progesterone-only methods do not carry the same thromboembolic risks as estrogen. In fact, **Depot Medroxyprogesterone Acetate (DMPA)** is often considered a "gold standard" for SCA because it has been shown to stabilize red cell membranes and reduce the frequency of painful crises. **Clinical Pearls for NEET-PG:** * **Best Choice:** DMPA (Injectable) is highly recommended for SCA as it reduces sickling and crises. * **Avoid:** Any combined hormonal contraceptive (Pills, Patch, Ring) due to the estrogen component. * **WHO MEC:** For Sickle Cell Disease, Combined Hormonal Contraceptives are Category 4 (Unacceptable health risk).

Q: Which method of sterilization is least suited for recanalisation?

Bipolar cauterization. **Explanation:** The success of tubal recanalization (reversal of sterilization) depends primarily on the **length of the healthy fallopian tube remaining** and the **degree of tissue destruction** caused during the initial procedure. **Why Bipolar Cauterization is the correct answer:** Bipolar cauterization involves passing an electric current through a segment of the fallopian tube. This causes extensive **thermal damage** and lateral heat spread, leading to significant necrosis and scarring of the tubal tissue. Typically, 2–3 cm of the tube is destroyed. Because the damage is widespread and the blood supply is often compromised, there is insufficient healthy tissue left for a successful end-to-end anastomosis, making it the least suited for recanalization. **Analysis of Incorrect Options:** * **Clips (e.g., Hulka-Clemens, Filshie):** These cause the **least amount of damage** (approx. 4 mm of the tube). They have the highest success rates for recanalization. * **Fallopian Rings (Silastic bands):** These cause intermediate damage (approx. 2 cm) by causing ischemic necrosis of a small loop. Recanalization success is better than cauterization but lower than clips. * **Pomeroy’s Technique:** This is a surgical method involving ligation and excision of a mid-segment loop. While it removes a segment of the tube, the remaining ends are usually healthy and not thermally damaged, allowing for relatively successful surgical reversal. **High-Yield Clinical Pearls for NEET-PG:** * **Best method for recanalization:** Clips (Minimal tissue destruction). * **Most common method used in India:** Minilap with Pomeroy’s technique. * **Most common method used globally (Laparoscopic):** Falope rings. * **Ideal length of tube for successful reversal:** At least 4 cm of healthy tube must remain. * **Site of reversal:** The **isthmus-isthmus** anastomosis yields the highest pregnancy rates.

Q: What is the Pearl Index?

Accidental pregnancies per 100 women-years of exposure. The **Pearl Index** is the most common method used in clinical trials and epidemiological studies to measure the **effectiveness of a contraceptive method**. ### **Explanation of the Correct Answer** The Pearl Index is defined as the number of unintended pregnancies per **100 woman-years** of exposure. It represents the failure rate of a contraceptive method. A lower Pearl Index indicates a more effective contraceptive method. The formula used is: $$\text{Pearl Index} = \frac{\text{Total number of accidental pregnancies} \times 1200}{\text{Total months of exposure}}$$ *(Note: 1200 is used to convert the denominator into 100 woman-years, as $100 \text{ women} \times 12 \text{ months} = 1200$).* ### **Analysis of Incorrect Options** * **Option A (1000 women-years):** This is a common distractor. Standard epidemiological reporting for contraception uses a base of 100 to express results as a percentage-like failure rate. * **Options C & D (10 or 1 women-years):** These values are too small to provide a statistically significant or standardized representation of contraceptive failure across a population. ### **NEET-PG High-Yield Pearls** * **Perfect Use vs. Typical Use:** The Pearl Index varies based on whether the method is used correctly every time (perfect) or how it is used in real-world conditions (typical). * **Lowest Pearl Index (Most Effective):** Implants (e.g., Nexplanon) have the lowest Pearl Index (~0.05), followed by Vasectomy and IUCDs. * **Highest Pearl Index (Least Effective):** Barrier methods (Condoms) and behavioral methods (Withdrawal/Rhythm method) have higher Pearl Indices. * **Alternative Measure:** The **Life Table Analysis** is considered superior to the Pearl Index because it calculates failure rates at specific intervals (e.g., at 6 months vs. 24 months), accounting for the fact that failure rates usually decrease over time as users become more proficient.

Q: Which of the following agents cannot be used for postcoital contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While historically explored as a potential emergency contraceptive, Danazol (an ethinyl testosterone derivative) has been proven **ineffective** for postcoital contraception and is no longer recommended or used for this purpose. Its primary roles in gynecology are the treatment of endometriosis and hereditary angioedema. **Analysis of Options:** * **Copper T (Option B):** This is the **most effective** method of emergency contraception (failure rate <0.1%). It can be inserted up to 5 days (120 hours) after unprotected intercourse and provides the added benefit of long-term reversible contraception. * **Mifepristone (Option C):** A selective progesterone receptor modulator (SPRM). In low doses (10 mg or 25 mg), it is highly effective for emergency contraception by delaying ovulation. It is often preferred over the Yuzpe regimen due to fewer side effects. * **High-dose Estrogen (Option D):** Historically used as the "morning-after pill" (e.g., Ethinyl estradiol 5mg for 5 days). While effective, it is rarely used today due to severe nausea and vomiting. It has been largely replaced by the **Yuzpe Regimen** (combined E+P) or Levonorgestrel-only pills. **NEET-PG High-Yield Pearls:** 1. **Gold Standard:** The most effective emergency contraceptive is the **Copper-T 380A**. 2. **Drug of Choice (DOC):** The current hormonal DOC is **Levonorgestrel (1.5 mg single dose)**, effective up to 72 hours. 3. **Ulipristal Acetate:** A newer SPRM effective up to **120 hours (5 days)**; it is more effective than LNG in obese women. 4. **Mechanism:** Most hormonal emergency contraceptives work primarily by **delaying or inhibiting ovulation**; they are not abortifacients.

Question 1

Progestin-only pills should not be taken by women with which of the following conditions?

Accepted Answer

Migraine headache without aura

Answer

Unexplained uterine bleeding

Answer

Breast cancer

Answer

Severe active liver disease

Question 2

A 25-year-old woman with an IUD inserted 2 years ago presents with fever. On examination, actinomyces is positive in cervical cytology. What would you advise regarding the IUD?

Accepted Answer

Remove the IUD and give intensive antibiotic therapy.

Answer

Continue some contraception; no need for treatment.

Answer

Hysterectomy

Answer

Leave the IUD in place and start an antibiotic course.

Question 3

A 30-year-old woman is on warfarin for deep vein thrombosis. Which contraceptive should be advised to her?

Accepted Answer

Intrauterine contraceptive device (IUCD)

Answer

Progesterone-only pills

Answer

Levonorgestrel implant

Answer

Implanon

Question 4

All of the following are used for contraception in patients with sickle cell anemia except?

Accepted Answer

Oral contraceptive pills

Answer

Intrauterine contraceptive device (IUCD)

Answer

Progestin-only pills

Answer

Progesterone implants

Question 5

A 26-year-old female on a progestin-only pill contraceptive attends the gynecology OPD concerned about not taking her pill at the same time every day. She took her pill daily at 10 a.m. except for one day when she took it at 5 p.m. What is your advice?

Accepted Answer

Use an additional form of contraceptive for the next 48 hours.

Answer

No need to worry, continue the same contraceptive.

Answer

Change over to combined oral contraceptive pills.

Answer

Take a double dose of the pill the next morning.

Question 6

Which method of sterilization is least suited for recanalisation?

Accepted Answer

Bipolar cauterization

Answer

Clips

Answer

Fallopian rings

Answer

Pomeroys technique

Question 7

What is the Pearl Index?

Accepted Answer

Accidental pregnancies per 100 women-years of exposure

Answer

Accidental pregnancies per 1000 women-years of exposure

Answer

Accidental pregnancies per 10 women-years of exposure

Answer

Accidental pregnancies per women-years of exposure

Question 8

Which of the following is NOT a characteristic of an ideal candidate for copper-T insertion?

Accepted Answer

Has a history of ectopic pregnancy

Answer

Has borne at least one child

Answer

Is willing to check the IUD tail

Answer

Has normal menstrual periods

Question 9

Which of the following agents cannot be used for postcoital contraception?

Accepted Answer

Danazol

Answer

Copper T

Answer

Mifepristone

Answer

High dose estrogen

Question 10

Which of the following contraceptive methods has the least risk of ectopic pregnancy?

Accepted Answer

Condoms

Answer

Tubectomy

Answer

Oral contraceptive pills

Answer

Intrauterine device (Copper T)

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?