Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 191: Which of the following drugs is not used as emergency contraception?

A. Levonorgestrel
B. Mifepristone
C. Ulipristal acetate
D. Raloxifene (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Raloxifene**. **Why Raloxifene is the correct answer:** Raloxifene is a **Selective Estrogen Receptor Modulator (SERM)** primarily used for the prevention and treatment of osteoporosis in postmenopausal women and to reduce the risk of invasive breast cancer. Unlike emergency contraceptives, it does not inhibit ovulation or prevent implantation. It has an anti-estrogenic effect on the breast and uterus but an estrogenic effect on the bone. **Analysis of Incorrect Options:** * **A. Levonorgestrel (LNG):** The most commonly used emergency contraceptive pill (ECP). It is a progestogen that works primarily by delaying or inhibiting ovulation. It is most effective when taken within 72 hours of unprotected intercourse. * **B. Mifepristone:** An anti-progestogen. In low doses (10–25 mg), it is highly effective as an emergency contraceptive by delaying ovulation and altering the endometrium. (Note: Higher doses are used for medical abortion). * **C. Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM). It is currently considered the "gold standard" for hormonal emergency contraception because it is effective up to 120 hours (5 days) after intercourse and can inhibit ovulation even just before it occurs. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective Method:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Yuzpe Regimen:** An older method using combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel); it is less effective and causes more side effects (nausea/vomiting) than LNG alone. * **Dose of LNG:** 1.5 mg as a single dose (or two doses of 0.75 mg 12 hours apart). * **Mechanism:** Emergency contraceptives work by preventing fertilization; they are **not** abortifacients and do not work if implantation has already occurred.

Question 192: Which of the following statements is NOT true regarding progestin-only contraceptives?

A. Also known as mini-pills.
B. Have minimal effect on carbohydrate metabolism.
C. The pill is taken on alternate days. (Correct Answer)
D. Associated with a high incidence of irregular bleeding.

Explanation: ### Explanation **1. Why Option C is the Correct Answer (The False Statement):** Progestin-only pills (POPs) must be taken **daily at the same time** without any pill-free interval. Unlike combined oral contraceptives (COCs), which allow for a 7-day break or have a wider margin of error, POPs have a very short half-life. If a dose is delayed by more than **3 hours**, its contraceptive efficacy (specifically the cervical mucus thickening effect) significantly diminishes, requiring backup contraception for the next 48 hours. Taking them on alternate days would lead to immediate contraceptive failure. **2. Analysis of Incorrect Options:** * **Option A:** POPs are commonly referred to as **"mini-pills"** because they contain only a small dose of progestin and no estrogen. * **Option B:** Unlike estrogen-containing pills, POPs have **minimal to no effect on carbohydrate and lipid metabolism**. This makes them a safer choice for women with controlled diabetes or those at risk for cardiovascular complications. * **Option D:** The most common side effect and the primary reason for discontinuation of POPs is **irregular menstrual bleeding** (breakthrough bleeding or spotting). This occurs because the low dose of progestin is insufficient to maintain a stable, synchronized endometrium. **3. NEET-PG High-Yield Pearls:** * **Mechanism of Action:** The primary mechanism is **thickening of cervical mucus** (preventing sperm penetration). It also causes endometrial atrophy. Ovulation is inhibited in only about 40–60% of cycles. * **Ideal Candidates:** 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, smokers >35 years, or migraine with aura). * **Ectopic Pregnancy:** While the absolute risk is low, if a woman becomes pregnant while on POPs, there is a higher *proportionate* risk that the pregnancy will be ectopic.

Question 193: Which among the following is the ideal contraception for lactating mothers?

A. Barrier method
B. Combined oral contraceptive pill
C. Lactational amenorrhoea method (Correct Answer)
D. Progesterone-only pill

Explanation: **Explanation:** The **Lactational Amenorrhoea Method (LAM)** is considered the ideal and most natural first-line contraceptive for breastfeeding mothers in the early postpartum period. **Why LAM is the Correct Answer:** LAM relies on the physiological suppression of ovulation caused by high levels of **Prolactin**. Suckling inhibits the release of Gonadotropin-Releasing Hormone (GnRH) from the hypothalamus, which in turn suppresses LH and FSH, preventing follicular development and ovulation. It is highly effective (>98%) if three criteria are met: 1. The mother is in the first 6 months postpartum. 2. She is practicing **exclusive breastfeeding** (day and night, no supplements). 3. She remains **amenorrhoeic**. **Analysis of Incorrect Options:** * **Combined Oral Contraceptive Pills (COCPs):** These are **contraindicated** in the first 6 weeks of lactation because estrogen suppresses milk production (hypogalactia) and increases the risk of thromboembolism in the early postpartum period. * **Progesterone-only Pill (POP):** While POPs are the hormonal method of choice for lactating women (as they do not affect milk volume), they are usually started only after 6 weeks or if LAM criteria are no longer met. * **Barrier Method:** While safe, they have higher failure rates compared to LAM and are generally used as a backup rather than the primary "ideal" physiological method. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal time to start IUCD:** Postpartum IUCD (PPIUCD) can be inserted within 48 hours of delivery or after 6 weeks (involution). * **DMPA (Injectable):** Should be avoided before 6 weeks postpartum in lactating mothers. * **Centchroman (Saheli):** A non-steroidal SERM; it is safe during lactation and is part of the National Family Planning Program (Antara program focuses on DMPA, Chhaya focuses on Centchroman).

Question 194: Mirena is:

A. Used in abortions
B. Antiprogesterone
C. Progesterone IUCD (Correct Answer)
D. Hormonal implant

Explanation: **Explanation:** **Mirena** is a Levonorgestrel-releasing Intrauterine System (LNG-IUS). It is a T-shaped device that contains a reservoir of 52 mg of Levonorgestrel, which is released at an initial rate of 20 mcg/day. It is classified as a **third-generation, medicated, hormonal IUCD**. * **Why Option C is correct:** Mirena works primarily by releasing progesterone (Levonorgestrel) locally into the uterine cavity. This causes thickening of the cervical mucus (preventing sperm penetration), endometrial atrophy (preventing implantation), and inhibition of sperm motility. * **Why Option A is incorrect:** Mirena is a contraceptive device, not an abortifacient. While it prevents pregnancy, it is not used to terminate an existing pregnancy. * **Why Option B is incorrect:** Mirena is a progestogen agonist, not an antagonist. Antiprogesterones (like Mifepristone) are used for medical abortion or emergency contraception. * **Why Option D is incorrect:** Hormonal implants (e.g., Norplant or Implanon/Nexplanon) are rods placed sub-dermally in the arm, whereas Mirena is an intrauterine device. **High-Yield Clinical Pearls for NEET-PG:** * **Lifespan:** Mirena is FDA-approved for up to **8 years** for contraception (previously 5 years). * **Non-contraceptive uses:** It is the **Gold Standard/Medical treatment of choice** for Menorrhagia (DUB) and is also used in Endometriosis and Adenomyosis. * **Side Effect Profile:** The most common side effect in the first few months is irregular spotting, eventually leading to **amenorrhea** in many users (which is often a therapeutic goal). * **Pearl:** Unlike Copper-T, Mirena reduces the risk of Pelvic Inflammatory Disease (PID) due to the thickening of cervical mucus.

Question 195: Which progesterone is used in emergency contraception?

A. Norethisterone
B. Medroxyprogesterone
C. Desogestrel
D. Levonorgestrel (Correct Answer)

Explanation: **Explanation:** **Levonorgestrel (LNG)** is the gold-standard progesterone used for emergency contraception (EC). It is a second-generation synthetic progestin that primarily works by **delaying or inhibiting ovulation** through the suppression of the Luteinizing Hormone (LH) surge. For maximum efficacy, it must be administered as soon as possible, ideally within 72 hours of unprotected intercourse, though it remains effective up to 120 hours. The standard dose is a single tablet of **1.5 mg** (or two doses of 0.75 mg taken 12 hours apart). **Analysis of Incorrect Options:** * **A. Norethisterone:** Primarily used for cycle regulation, management of abnormal uterine bleeding (AUB), and endometriosis. It is not used in emergency protocols. * **B. Medroxyprogesterone (DMPA):** An injectable contraceptive administered every 3 months. It is used for long-term depot contraception, not emergency use. * **C. Desogestrel:** A third-generation progestin commonly used in "mini-pills" (POP) or combined oral contraceptives. While it has high bioavailability, it is not the agent of choice for EC. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** LNG does **not** work if fertilization or implantation has already occurred; it is not an abortifacient. * **Efficacy:** The most effective oral EC is actually **Ulipristal acetate** (a Selective Progesterone Receptor Modulator), but LNG remains the most widely used and available. * **The "Gold Standard":** The **Copper-T 380A** is the most effective overall method of emergency contraception if inserted within 5 days of intercourse. * **Yuzpe Regimen:** An older EC method using high doses of combined oral contraceptives (Ethinylestradiol + Levonorgestrel), now largely replaced by LNG-only pills due to lower side effects (less nausea/vomiting).

Question 196: Which method of contraception has a Pearl Index of 0?

A. Male condom
B. Rhythm method
C. Coitus interruptus
D. Abstinence (Correct Answer)

Explanation: **Explanation:** The **Pearl Index** is the standard measure used to report the effectiveness of a contraceptive method. It is defined as the number of unintended pregnancies per 100 woman-years of exposure. A Pearl Index of 0 signifies absolute contraceptive efficacy with zero risk of pregnancy. **Why Abstinence is Correct:** **Abstinence** (complete avoidance of sexual intercourse) is the only method with a **Pearl Index of 0**. Since there is no deposition of sperm in the female reproductive tract, the probability of fertilization is zero. It is the only 100% effective method of contraception and prevention of STIs. **Analysis of Incorrect Options:** * **Male Condom:** Has a Pearl Index of approximately **2 (perfect use)** to **18 (typical use)**. Failure usually occurs due to breakage, slippage, or inconsistent use. * **Rhythm Method (Calendar Method):** This is a natural family planning method with a high failure rate (Pearl Index of **~24**). It relies on predicting ovulation, which can be irregular due to stress, illness, or hormonal fluctuations. * **Coitus Interruptus (Withdrawal):** Has a Pearl Index of approximately **4 (perfect use)** to **22 (typical use)**. Failure occurs because pre-ejaculatory fluid (pre-cum) can contain viable sperm, or due to lack of self-control. **High-Yield NEET-PG Pearls:** * **Most Effective Reversible Method:** Implant (e.g., Nexplanon) with a Pearl Index of **0.05**. * **Vasectomy vs. Tubectomy:** Vasectomy is more effective and safer than tubal ligation. * **Lactational Amenorrhea Method (LAM):** Only reliable for the first 6 months postpartum, provided the mother is exclusively breastfeeding and remains amenorrheic. * **Formula:** Pearl Index = (Number of pregnancies × 1200) / (Total number of months of exposure).

Question 197: What is the dose of centchroman?

A. 30 mg (Correct Answer)
B. 60 mg
C. 120 mg
D. 240 mg

Explanation: **Explanation:** **Centchroman (Ormeloxifene)** is a non-steroidal, non-hormonal Selective Estrogen Receptor Modulator (SERM) developed by CDRI, Lucknow. It is marketed under the brand names **Saheli** and **Chhaya** in the National Family Planning Programme of India. **Why 30 mg is correct:** The standard contraceptive dose of Centchroman is **30 mg**. The dosage schedule follows a unique "loading phase" to achieve steady-state plasma levels: * **First 3 months:** 30 mg twice weekly (e.g., Sunday and Wednesday). * **From the 4th month onwards:** 30 mg once weekly, regardless of the menstrual cycle. **Analysis of incorrect options:** * **60 mg:** While 60 mg doses are sometimes used in the treatment of Abnormal Uterine Bleeding (AUB) or mastalgia, it is not the standard dose for contraception. * **120 mg & 240 mg:** These are supratherapeutic doses for contraception and are not used in clinical practice for this indication. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** It acts as an estrogen antagonist in the uterus (preventing implantation by altering the endometrium) and an agonist in the bones/CVS. It does not suppress ovulation. * **Side Effects:** The most common side effect is **delayed menstruation** (prolonged cycles), occurring in about 8% of users. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease. * **Pearl:** It is the only contraceptive that does not interfere with the hypothalamic-pituitary-ovarian axis, making it safe for breastfeeding mothers (Category: L1/Safe).

Question 198: Scope of family planning services include all of the following except?

A. Screening for cervical cancer
B. Providing services for unmarried mothers
C. Screening for HIV infection (Correct Answer)
D. Providing adoption services

Explanation: **Explanation:** The scope of Family Planning services, as defined by the World Health Organization (WHO), extends beyond mere contraception. It encompasses a holistic approach to reproductive health. **Why "Screening for HIV infection" is the correct answer:** While family planning clinics often provide counseling on STIs and promote condom use (dual protection), **routine screening for HIV infection** is technically classified under **STI/HIV Control Programs** rather than the core scope of Family Planning services. Family planning focuses on the timing, spacing, and limitation of births, and the management of factors directly affecting fertility and maternal-child health. **Analysis of other options (Included in Scope):** * **Providing services for unmarried mothers:** Family planning services are inclusive and aim to prevent social and health complications associated with out-of-wedlock pregnancies. * **Screening for cervical cancer:** This is a vital component of reproductive health maintenance within family planning clinics, as it ensures the long-term health of women of reproductive age. * **Providing adoption services:** Helping couples with irreversible infertility or those who cannot conceive through medical intervention to build a family via adoption is a recognized component of comprehensive family planning. **High-Yield NEET-PG Pearls:** * **Scope of Family Planning includes:** Proper spacing and limitation of births, advice on sterility (infertility), education for parenthood, marriage counseling, screening for pathological conditions (e.g., cervical cancer), and providing adoption services. * **The "Eligible Couple":** Currently married couples where the wife is in the reproductive age group (15–49 years). * **Target:** The primary goal of family planning in India is to achieve a **Net Reproduction Rate (NRR) of 1**, which corresponds to a Total Fertility Rate (TFR) of 2.1.

Question 199: According to the WHO Medical Eligibility Criteria for Contraceptive Use, what does Category 4 signify?

A. No restriction to use
B. Absolute contraindications (Correct Answer)
C. Relative contraindications
D. Contraception in special conditions, such as HIV

Explanation: The WHO Medical Eligibility Criteria (MEC) is a standardized framework used to guide clinicians on the safety of various contraceptive methods for individuals with specific medical conditions. ### **Explanation of the Correct Answer** **Category 4** signifies an **absolute contraindication**. In this category, the use of the contraceptive method represents an **unacceptable health risk** to the patient. The risks far outweigh any potential benefits, and the method must not be used under any circumstances (e.g., using Combined Oral Contraceptives in a woman with a history of breast cancer or current deep vein thrombosis). ### **Analysis of Incorrect Options** * **Option A (No restriction):** This describes **Category 1**, where the method can be used without any limitations for the specific condition. * **Option C (Relative contraindications):** This encompasses **Category 2** (Advantages generally outweigh risks; method can be used) and **Category 3** (Risks generally outweigh advantages; method should not be used unless other safer methods are unavailable or unacceptable). * **Option D (Special conditions):** While the WHO MEC covers conditions like HIV, it classifies them into Categories 1-4 based on the specific contraceptive method and clinical status (e.g., drug interactions with ART). ### **NEET-PG High-Yield Pearls** * **Category 1:** Use the method in any circumstances. * **Category 2:** Generally use the method. * **Category 3:** Use of method not usually recommended unless other more appropriate methods are not available or not acceptable. * **Category 4:** Method not to be used. * **Common Category 4 Examples for COCs:** Age ≥35 and smoking ≥15 cigarettes/day, Migraine with aura, Hypertension (≥160/100), and Ischemic heart disease.

Question 200: What is a contraindication for the use of an intrauterine contraceptive device (IUCD)?

A. Previous cesarean section
B. Pelvic inflammatory disease (PID)
C. Uterine malformation
D. All of the above (Correct Answer)

Explanation: The correct answer is **D. All of the above**. ### **Explanation of the Medical Concept** The insertion of an Intrauterine Contraceptive Device (IUCD) requires a healthy, normally shaped uterine cavity and a pelvic environment free of active infection. Contraindications are generally categorized into conditions that increase the risk of **perforation**, **expulsion**, or **exacerbation of infection**. 1. **Pelvic Inflammatory Disease (PID):** This is an **absolute contraindication**. Inserting an IUCD in the presence of an active or recent (within 3 months) pelvic infection can introduce vaginal flora into the upper genital tract, potentially leading to life-threatening sepsis or chronic infertility. 2. **Uterine Malformation:** Structural anomalies (e.g., bicornuate or septate uterus) or large fibroids that distort the cavity are contraindications because they significantly increase the risk of **accidental perforation** during insertion and lead to high **expulsion rates** or contraceptive failure. 3. **Previous Cesarean Section:** While not an absolute contraindication for all, a recent C-section (especially within 6 weeks) or a history of multiple surgeries increases the risk of uterine scarring and thinning. This elevates the risk of **iatrogenic uterine perforation** during the procedure. ### **High-Yield Clinical Pearls for NEET-PG** * **Most Common Side Effect:** Menorrhagia (heavy menstrual bleeding) is the most common reason for IUCD removal. * **Ideal Time for Insertion:** During menstruation or within 10 days of the cycle (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Post-Partum Timing:** Can be inserted within 48 hours (PPIUCD) or after 6 weeks (involution complete). * **Absolute Contraindications (WHO Category 4):** Pregnancy, unexplained vaginal bleeding, current PID, and copper allergy (for Cu-T). * **Protective Effect:** IUCDs (especially LNG-IUD) are known to be protective against endometrial cancer.

Practice by Chapter

Natural Family Planning Methods

Practice Questions

Barrier Methods

Practice Questions

Hormonal Contraceptives

Practice Questions

Intrauterine Devices

Practice Questions

Emergency Contraception

Practice Questions

Permanent Contraception Methods

Practice Questions

Contraception in Special Populations

Practice Questions

Contraceptive Counseling

Practice Questions

Side Effects and Complications of Contraceptives

Practice Questions

Future Contraceptive Technologies

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free