Contraception and Family Planning Practice Questions

Q: A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

Levonorgestrel. **Explanation:** **Levonorgestrel (LNG)** is the gold standard progesterone for emergency contraception (EC). The primary mechanism of action is the **inhibition or delay of ovulation** by suppressing the Luteinizing Hormone (LH) surge. It is most effective when taken as soon as possible, ideally within 72 hours of unprotected intercourse, though it may be used up to 120 hours. **Why Levonorgestrel is correct:** * It is the most widely studied and recommended progestogen-only EC pill (POEC). * The standard dose is a single **1.5 mg tablet** (or two 0.75 mg doses 12 hours apart). * It has a superior safety profile and higher efficacy compared to older methods like the Yuzpe regimen. **Analysis of Incorrect Options:** * **A. Norethisterone:** Primarily used for menstrual cycle regulation, dysfunctional uterine bleeding, and endometriosis. It is not used for emergency contraception. * **B. Medroxyprogesterone acetate (DMPA):** Used as an injectable contraceptive (Depo-Provera) for long-term protection (3 months), not for post-coital emergency use. * **D. Desogestrel:** A third-generation progestogen used in daily Combined Oral Contraceptive Pills (COCPs) or Progestogen-Only Pills (POPs), but not as a dedicated emergency contraceptive. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG is effective up to 72–120 hours, but **Ulipristal acetate** (a selective progesterone receptor modulator) is more effective between 72–120 hours. * **Most Effective EC:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Failure Rate:** LNG-EC has a failure rate of approximately 1–3%. It does not work if implantation has already occurred and is not an abortifacient. * **Vomiting:** If the patient vomits within 2 hours of taking the LNG pill, the dose must be repeated.

Q: Which of the following is NOT a mechanism of action of oral contraceptive pills?

Blocking the fimbrial ostia. **Explanation:** The mechanism of action of Combined Oral Contraceptive Pills (COCPs) is multi-factorial, primarily targeting the Hypothalamic-Pituitary-Ovarian (HPO) axis and the female reproductive tract environment. **Why Option D is Correct:** **Blocking the fimbrial ostia** is a mechanical/anatomical barrier. This occurs during surgical procedures like **Tubal Ligation** (e.g., Pomeroy’s technique) or due to pathological conditions like Salpingitis/PID. OCPs are pharmacological agents and do not physically obstruct the fallopian tubes. **Why the other options are incorrect (Mechanisms of OCPs):** * **Option B (Primary Mechanism):** The estrogen and progestogen components provide negative feedback to the hypothalamus and anterior pituitary. This suppresses **GnRH, FSH, and LH**, preventing the mid-cycle LH surge. Without the LH surge, ovulation does not occur, resulting in an **anovulatory cycle**. * **Option A:** Progestogen increases the viscosity and thickness of the **cervical mucus**, making it "hostile" and impenetrable to sperm. * **Option C:** OCPs cause the endometrium to become thin, atrophic, and out of sync with the menstrual cycle (decidualization), which **prevents the implantation** of a blastocyst should fertilization occur. **High-Yield Clinical Pearls for NEET-PG:** * **Most potent component for ovulation inhibition:** Progestogen (suppresses LH). * **Role of Estrogen:** Primarily inhibits FSH (preventing follicle selection) and provides cycle control (prevents breakthrough bleeding). * **Failure Rate:** The Pearl Index for perfect use of COCPs is **0.1 per 100 woman-years**. * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years after discontinuation).

Q: All of the following drugs have been used for medical abortion except?

Atosiban. **Explanation:** The correct answer is **Atosiban** because it is a **tocolytic agent**, not an abortifacient. Its primary clinical use is to delay imminent preterm birth by inhibiting uterine contractions. **Why Atosiban is the correct answer:** Atosiban is a competitive **Oxytocin receptor antagonist**. By blocking these receptors in the myometrium, it decreases the frequency of contractions and uterine tone. In the context of pregnancy management, it is used to "stop" labor (tocolysis), which is the functional opposite of medical abortion. **Why the other options are incorrect:** * **Mifepristone (RU-486):** An anti-progestational agent. It blocks progesterone receptors, leading to decidual necrosis, cervical softening, and increased uterine sensitivity to prostaglandins. It is the first step in the standard medical abortion regimen. * **Misoprostol:** A Prostaglandin E1 (PGE1) analogue. It causes cervical ripening and potent uterine contractions to expel the products of conception. It is typically administered 24–48 hours after Mifepristone. * **Methotrexate:** A folate antagonist that inhibits dihydrofolate reductase. It targets rapidly dividing cells (trophoblastic tissue) and is used medically for early unruptured ectopic pregnancies and occasionally in combination with misoprostol for early induced abortion. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen (WHO/GOI):** Mifepristone 200 mg orally followed by Misoprostol 800 mcg (vaginal/buccal/sublingual) for up to 9 weeks (63 days) of gestation. * **MTP Act 2021 Update:** Medical abortion is legal up to 24 weeks under specific conditions, but the "pills-only" method is most effective in the first trimester. * **Atosiban Side Effects:** Generally well-tolerated; most common are nausea, headache, and tachycardia (less than beta-mimetics).

Q: Which of the following is the principle disadvantage of depot progestin?

Irregular menstrual bleeding and prolonged anovulation. **Explanation:** Depot Medroxyprogesterone Acetate (DMPA), commonly known as the "Antara" program injection in India, is a long-acting injectable contraceptive. **Why Option D is Correct:** The most significant clinical disadvantage and the leading cause of discontinuation for DMPA is **menstrual irregularity**. Initially, users experience unpredictable spotting or breakthrough bleeding. With prolonged use, the endometrium becomes atrophic, leading to **amenorrhea** (seen in 50-70% of users at one year). Furthermore, DMPA causes **prolonged anovulation**; there is a significant delay in the return of fertility, averaging **7 to 9 months** after the last injection, as the drug takes time to clear from the systemic circulation. **Analysis of Incorrect Options:** * **A. Weight gain:** While a common side effect (average 1.5–2 kg in the first year), it is often manageable and less likely to cause immediate discontinuation compared to unpredictable bleeding. * **B. Breast tenderness:** This is a minor progestogenic side effect that usually subsides after the first few months. * **C. Depression:** Though reported by some users, large-scale studies have not conclusively proven a direct causal link between DMPA and clinical depression. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge. It also increases cervical mucus viscosity. * **Dosage:** 150 mg intramuscularly (IM) every 3 months (12 weeks). * **Black Box Warning:** Long-term use is associated with a reversible decrease in **Bone Mineral Density (BMD)**. It is generally advised not to use it for more than 2 years if other options are available. * **Non-contraceptive benefit:** Reduces the risk of endometrial cancer and iron-deficiency anemia (due to amenorrhea).

Q: Which of the following is an absolute contraindication for combined oral contraceptive pills?

Previous history of thromboembolism. **Explanation:** The correct answer is **Previous history of thromboembolism**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which increases the hepatic synthesis of clotting factors (II, VII, IX, and X) and decreases anticoagulant levels (Antithrombin III). This creates a hypercoagulable state. Therefore, any condition involving active or past venous thromboembolism (VTE), pulmonary embolism, or major surgery with prolonged immobilization is an **absolute contraindication** (WHO Medical Eligibility Criteria Category 4). **Analysis of Incorrect Options:** * **Diabetes Mellitus:** It is generally a relative contraindication. It only becomes an absolute contraindication if there are vascular complications (nephropathy, retinopathy, neuropathy) or if the duration of diabetes is >20 years. * **Migraine:** Migraine *without* aura is a relative contraindication (Category 3). However, Migraine *with* aura at any age is an absolute contraindication due to the significantly increased risk of ischemic stroke. * **Heart Disease:** This is a broad term. While ischemic heart disease or complicated valvular disease are absolute contraindications, mild forms of heart disease are not. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (WHO Category 4):** Smoker >35 years (≥15 cigarettes/day), Hypertension (≥160/100 mmHg), Current Breast Cancer, and Acute Hepatitis/Cirrhosis. * **Cancer Risk:** COCPs *decrease* the risk of Ovarian and Endometrial cancers (protective effect) but slightly *increase* the risk of Breast and Cervical cancers. * **Drug Interaction:** Rifampicin and Antiepileptics (enzyme inducers) decrease the efficacy of COCPs.

Q: Progesterone-only pills act by which of the following mechanisms?

Thickening of cervical mucus. **Explanation:** Progesterone-only pills (POPs), often referred to as the "Mini-pill," primarily function by altering the female reproductive tract's environment rather than consistently suppressing the hypothalamic-pituitary-ovarian axis. **1. Why Option A is Correct:** The **primary mechanism of action** of POPs is the **thickening and hypertrophy of cervical mucus**. Under the influence of continuous low-dose progesterone, the mucus becomes scanty, thick, and viscous (hostile). This creates a physical barrier that prevents sperm penetration into the upper reproductive tract. **2. Analysis of Incorrect Options:** * **Option B (Inhibiting ovulation):** While this is the primary mechanism for Combined Oral Contraceptive Pills (COCPs) and injectable progesterones (DMPA), POPs only inhibit ovulation in approximately 40–60% of cycles. Therefore, it is not their *primary* or most reliable mechanism. * **Option C (Aseptic inflammation):** This is the mechanism of action for **Intrauterine Devices (IUDs)**, particularly non-medicated ones like Lippes Loop or Copper-T, which trigger a foreign body reaction in the endometrium. * **Option D (Destruction of the embryo):** This is incorrect as contraceptives act to prevent fertilization or implantation; they are not abortifacients. **High-Yield NEET-PG Pearls:** * **Endometrial Changes:** POPs also cause endometrial atrophy, making the lining unfavorable for implantation (secondary mechanism). * **Half-life:** POPs have a very short half-life; they must be taken at the **same time every day**. A delay of more than **3 hours** is considered a "missed pill." * **Ideal Candidate:** POPs are the contraceptive of choice for **lactating mothers** (as they do not suppress milk production) and women in whom estrogen is contraindicated (e.g., history of DVT or smokers >35 years).

Q: What is the mechanism of action of spermicides?

Disrupting cell membrane and motility. **Explanation:** Spermicides are chemical barrier methods of contraception. The most commonly used active ingredient is **Nonoxynol-9**, a surfactant. **1. Why the correct answer is right:** The primary mechanism of action involves the **disruption of the sperm cell membrane (lipoprotein surface)**. As a surfactant, Nonoxynol-9 reduces surface tension, causing the cell membrane to break down. This leads to the loss of sperm motility and eventual cell death (spermicidal effect). By immobilizing the sperm, it prevents them from ascending the female genital tract to reach the ovum. **2. Why the incorrect options are wrong:** * **Option A:** Activating acrosomal enzymes would actually facilitate fertilization (the acrosome reaction is necessary for sperm to penetrate the egg). Spermicides aim to inhibit, not promote, this process. * **Option B:** While some metabolic interference may occur, the primary and definitive action is physical membrane disruption, not specific inhibition of glucose transport enzymes. * **Option C:** Spermicides do not function by altering vaginal enzymes; however, they may temporarily alter vaginal pH or microflora, which is a side effect rather than the primary contraceptive mechanism. **3. NEET-PG High-Yield Pearls:** * **Active Ingredient:** Nonoxynol-9 is the most common; others include Octoxynol-9 and Menfegol. * **Failure Rate:** High when used alone (Typical failure rate ~28%). It is best used in combination with barriers like condoms or diaphragms. * **Clinical Caution:** Frequent use of Nonoxynol-9 can cause vaginal/cervical irritation and epithelial disruption, which may **increase the risk of HIV and STI transmission**. * **Application:** Must be placed high in the vagina near the cervix at least 10–15 minutes before intercourse.

Q: Which contraceptive method can prevent cervical cancer?

Condom. **Explanation:** **1. Why Condom is the Correct Answer:** Cervical cancer is primarily caused by persistent infection with high-risk strains of **Human Papillomavirus (HPV)**, a sexually transmitted infection (STI). Condoms act as a mechanical barrier that reduces the skin-to-skin and mucosal transmission of HPV during intercourse. By preventing the primary cause (HPV infection), condoms serve as a protective factor against the development of cervical intraepithelial neoplasia (CIN) and subsequent cervical cancer. **2. Analysis of Incorrect Options:** * **Oral Contraceptive Pills (OCPs):** Combined OCPs are actually associated with a **slight increase** in the risk of cervical cancer if used for more than 5 years. This is likely due to hormonal influences on the transformation zone and the fact that users are less likely to use barrier protection. (Note: OCPs are *protective* against Ovarian and Endometrial cancers). * **Mini Pills (Progestogen-Only Pills):** These do not provide protection against STIs/HPV and have no documented protective effect against cervical cancer. * **Tubectomy:** This is a permanent surgical sterilization method. While some studies suggest it may slightly reduce the risk of *ovarian* cancer (by preventing the migration of precursors from the fallopian tubes), it has no effect on the pathogenesis of cervical cancer. **3. NEET-PG High-Yield Pearls:** * **Dual Protection:** Condoms are the only contraceptive method that provides "dual protection" (prevention of both pregnancy and STIs/HIV). * **OCP Cancer Profile:** * *Decreases risk of:* Ovarian, Endometrial, and Colorectal cancers. * *Increases risk of:* Cervical and Breast cancers. * **Primary Prevention of Cervical Cancer:** The most effective primary prevention is the **HPV Vaccine** (e.g., Gardasil), while condoms are a significant secondary behavioral intervention.

Q: Which of the following medications is used as a post-coital pill?

0.75 mg Levonorgestrel. **Explanation:** **1. Why Levonorgestrel (LNG) is correct:** Levonorgestrel is a synthetic progestogen and is the most widely used emergency contraceptive (EC) pill. The standard regimen involves either a single dose of **1.5 mg** or two doses of **0.75 mg** taken 12 hours apart. To be effective, it must be administered within **72 hours** of unprotected intercourse. Its primary mechanism of action is the **inhibition or delay of ovulation** by suppressing the LH surge; it does not disrupt an established pregnancy. **2. Analysis of Incorrect Options:** * **A. 25 mg Mifepristone:** While Mifepristone (an anti-progestin) is highly effective as an EC, the standard low-dose used for this purpose is **10 mg**. A 25 mg dose is not the conventional EC strength; higher doses (200 mg) are used for medical abortion in combination with Misoprostol. * **B. Misoprostol:** This is a Prostaglandin E1 analogue used for cervical ripening, induction of labor, and medical abortion. It has no role as a primary post-coital contraceptive. * **C. 10 mg Ethinylestradiol:** High-dose estrogens alone are no longer used due to severe side effects like nausea and vomiting. In the older **Yuzpe Regimen**, 100 mcg of Ethinylestradiol was combined with 0.5 mg of LNG. **3. High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The most effective emergency contraceptive is the **Copper-T (IUCD)**, which can be inserted up to 5 days after intercourse. * **Ulipristal Acetate (30 mg):** A selective progesterone receptor modulator (SPRM) that is effective up to **120 hours (5 days)** and is superior to LNG in efficacy. * **Failure Rate:** LNG has a failure rate of approximately 1–3%. It is less effective in women with a BMI >30 kg/m². * **Centchroman (Saheli):** A non-steroidal SERM used as a weekly oral contraceptive, not as a standard post-coital pill.

Question 1

A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

Accepted Answer

Levonorgestrel

Answer

Norethisterone

Answer

Medroxyprogesterone acetate

Answer

Desogestrel

Question 2

Which of the following is NOT a mechanism of action of oral contraceptive pills?

Accepted Answer

Blocking the fimbrial ostia

Answer

Inhibiting sperm penetration into the cervical mucus

Answer

Inducing an anovulatory cycle

Answer

Preventing blastocyst implantation

Question 3

All of the following drugs have been used for medical abortion except?

Accepted Answer

Atosiban

Answer

Mifepristone

Answer

Misoprostol

Answer

Methotrexate

Question 4

In a non-breastfeeding woman, what is the use of combined oral contraceptive pills during the first three weeks following delivery?

Accepted Answer

Relative contraindication

Answer

Absolute contraindication

Answer

Indicated

Answer

Not required

Question 5

Which of the following is the principle disadvantage of depot progestin?

Accepted Answer

Irregular menstrual bleeding and prolonged anovulation

Answer

Weight gain

Answer

Breast tenderness

Answer

Depression

Question 6

Which of the following is an absolute contraindication for combined oral contraceptive pills?

Accepted Answer

Previous history of thromboembolism

Answer

Diabetes mellitus

Answer

Migraine

Answer

Heart disease

Question 7

Progesterone-only pills act by which of the following mechanisms?

Accepted Answer

Thickening of cervical mucus

Answer

Inhibiting ovulation

Answer

Causing aseptic inflammation in the endometrium

Answer

Destruction of the embryo

Question 8

What is the mechanism of action of spermicides?

Accepted Answer

Disrupting cell membrane and motility

Answer

Activating acrosomal enzymes

Answer

Inhibiting glucose transport enzymes

Answer

Altering vaginal enzymes

Question 9

Which contraceptive method can prevent cervical cancer?

Accepted Answer

Condom

Answer

Oral Contraceptive Pill (OCP)

Answer

Mini Pills

Answer

Tubectomy

Question 10

Which of the following medications is used as a post-coital pill?

Accepted Answer

0.75 mg Levonorgestrel

Answer

25 mg Mifepristone

Answer

Misoprostol

Answer

10 mg Ethinylestradiol

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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