Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 201: Which of the following are benefits of combined oral contraceptive pills use?

A. Pelvic inflammatory disease, Ovarian cysts, Fibrocystic disease of the breast
B. Hepatocellular adenoma, Pelvic inflammatory disease, Ovarian cysts
C. Pelvic inflammatory disease, Ovarian cysts, Ectopic pregnancy (Correct Answer)
D. Hepatocellular adenoma, Ovarian cysts, Ectopic pregnancy

Explanation: **Explanation:** Combined Oral Contraceptive Pills (COCPs) provide significant non-contraceptive health benefits by suppressing ovulation and altering the reproductive environment. **Why Option C is Correct:** * **Pelvic Inflammatory Disease (PID):** COCPs thicken cervical mucus, creating a physical barrier that prevents the ascending migration of pathogens (like *N. gonorrhoeae*) into the upper genital tract, thereby reducing the risk of symptomatic PID. * **Ovarian Cysts:** By suppressing the Hypothalamic-Pituitary-Ovarian (HPO) axis and inhibiting ovulation, COCPs prevent the formation of functional follicular and corpus luteum cysts. * **Ectopic Pregnancy:** Since COCPs are highly effective at preventing conception/ovulation, the absolute risk of any pregnancy, including ectopic pregnancy, is drastically reduced. **Analysis of Incorrect Options:** * **Hepatocellular Adenoma (Options B & D):** This is a known **risk/complication** of long-term COCP use, not a benefit. Estrogen can stimulate the growth of these benign but vascular liver tumors. * **Fibrocystic disease of the breast (Option A):** While COCPs do reduce the incidence of benign breast diseases (like fibroadenomas and fibrocystic changes), Option C is the more "classic" triad tested in exams regarding the reduction of acute gynecological pathologies. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** COCPs significantly reduce the risk of **Ovarian cancer** (by 40-50%) and **Endometrial cancer** (by 50%). This protection persists for years after discontinuation. * **Menstrual Benefits:** They are first-line for managing Menorrhagia, Dysmenorrhea, and PCOS. * **Absolute Contraindications:** History of Thromboembolism (DVT/PE), Smokers >35 years, Undiagnosed vaginal bleeding, and Estrogen-dependent tumors (Breast CA).

Question 202: Which contraceptive is supplied free of cost by the government?

A. Minipill
B. Norplant
C. Mala-N (Correct Answer)
D. Centchroman

Explanation: **Explanation:** The correct answer is **Mala-N**. Under the National Family Welfare Programme in India, oral contraceptive pills (OCPs) are distributed through two main channels: **Mala-N** is supplied **free of cost** at all government health centers and through ASHA workers, while **Mala-D** is available via "social marketing" at a highly subsidized nominal price. Both are combined oral contraceptives containing 0.03 mg Ethinyl Estradiol and 0.15 mg Levonorgestrel. **Analysis of Options:** * **Mala-N (Correct):** The "N" stands for "Nishulk" (Free). It is the standard OCP provided free by the government to ensure universal access to contraception. * **Minipill:** These are Progestogen-only pills (POPs). While available in the private sector, they are not the standard OCP supplied free under the national program (though the injectable 'Antara' is the government's free progestogen-only option). * **Norplant:** This is a sub-dermal implant. While implants are highly effective, Norplant is not currently part of the free basket of choices in the Indian public health system. * **Centchroman (Chhaya):** While Centchroman is indeed supplied free by the government under the brand name **Chhaya**, the question specifically points to Mala-N as the classic historical and primary answer in the context of traditional OCP distribution. In modern exams, if both are present, Mala-N remains the most established answer for "free OCP." **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Mala-N/D contains 21 hormonal tablets and 7 brown ferrous fumarate (60mg) tablets to prevent anemia and maintain the habit of pill-taking. * **Centchroman (Chhaya):** A Non-steroidal, Selective Estrogen Receptor Modulator (SERM). Dosage: Twice a week for the first 3 months, then once a week. * **Antara:** The brand name for the free injectable contraceptive (DMPA) provided by the government. * **Chhaya & Antara:** Both were introduced more recently under the "Mission Parivar Vikas."

Question 203: Tubal ligation is reported to have decreased the risk of?

A. Functional ovarian cysts
B. Ovarian cancer (Correct Answer)
C. Breast cancer
D. Salpingitis

Explanation: **Explanation:** **Correct Answer: B. Ovarian Cancer** Tubal ligation is a significant protective factor against ovarian cancer, reducing the risk by approximately **30–50%**. The underlying medical concept involves two main theories: 1. **Prevention of Ascending Carcinogens:** It blocks the passage of potential carcinogens (like talc or asbestos) and inflammatory mediators from the lower genital tract to the ovaries. 2. **Origin of Serous Cancer:** Modern research suggests that many "ovarian" cancers (specifically High-Grade Serous Carcinomas) actually originate in the fimbrial end of the fallopian tube (STIC lesions). Tubal ligation disrupts this pathway and often involves partial salpingectomy, removing the tissue of origin. **Analysis of Incorrect Options:** * **A. Functional ovarian cysts:** Tubal ligation does not affect ovulation or the hormonal feedback loop; therefore, the incidence of functional cysts remains unchanged. * **C. Breast cancer:** There is no established physiological link between tubal sterilization and a decreased risk of breast cancer. * **D. Salpingitis:** While tubal ligation prevents ascending infection from reaching the peritoneal cavity (reducing the risk of Pelvic Inflammatory Disease/PID), it does not necessarily prevent infection of the proximal tubal stump itself (salpingitis). The reduction in **ovarian cancer** is the more classically tested and significant epidemiological association. **High-Yield Clinical Pearls for NEET-PG:** * **OCPs** also decrease the risk of ovarian cancer (by ~50% if used for >5 years). * **Hysterectomy** also provides a protective effect against ovarian cancer. * The most common site of ectopic pregnancy after failed tubal ligation is the **isthmus**. * **Failure rate (Pearl Index):** For Pomeroy’s technique, it is approximately 0.1–0.5%. The most common cause of failure is **recanalization**.

Question 204: Which of the following is NOT used as emergency contraception?

A. Danazol (Correct Answer)
B. Copper T 200B
C. RU486
D. High dose Estrogen

Explanation: **Explanation:** The correct answer is **Danazol**. While Danazol (an attenuated androgen) was historically investigated for various gynecological conditions like endometriosis, it has **no proven efficacy** as an emergency contraceptive (EC) and is not part of any standard EC protocol. **Analysis of Options:** * **Copper T 200B:** This is the **most effective** method of emergency contraception. If inserted within 5 days (120 hours) of unprotected intercourse, it prevents implantation by causing a sterile inflammatory reaction in the endometrium. * **RU486 (Mifepristone):** This is a potent anti-progestin. In low doses (10 mg or 25 mg), it acts as a highly effective EC by delaying or inhibiting ovulation. (Note: 600 mg is used for medical abortion). * **High-dose Estrogen:** Historically, high doses of estrogens (e.g., Ethinylestradiol 5mg for 5 days) were used as EC. While effective, they are no longer preferred due to severe side effects like nausea and vomiting. They have been largely replaced by the **Yuzpe Regimen** (Combined Pills) or Levonorgestrel (LNG). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard/Most Effective EC:** Copper-T (Failure rate <0.1%). * **Drug of Choice (DOC):** Levonorgestrel (LNG) 1.5 mg single dose (effective up to 72 hours). * **Ulipristal Acetate (30 mg):** A selective progesterone receptor modulator (SPRM) effective up to **120 hours** (5 days) and is more effective than LNG in obese women. * **Yuzpe Regimen:** Consists of 100 mcg Ethinylestradiol + 0.5 mg Norgestrel, repeated after 12 hours.

Question 205: An Intrauterine Device (IUD) is not inserted during which of the following conditions?

A. During menstruation
B. Within 10 days of the beginning of menstruation
C. Immediately after delivery (within 48 hours) (Correct Answer)
D. 6-8 weeks after delivery

Explanation: ### Explanation The timing of IUD insertion is critical to minimize risks of expulsion, perforation, and infection. **Why Option C is the Correct Answer:** While IUDs *can* be inserted immediately postpartum (PPIUD), the question asks when it is **not** typically inserted based on standard clinical guidelines regarding safety and efficacy. In the context of traditional teaching and many standard protocols, the period between **48 hours and 6 weeks postpartum** is considered a contraindication for insertion. This is because the uterus is undergoing rapid involution, significantly increasing the risk of **spontaneous expulsion** and **uterine perforation**. Therefore, if not inserted within the first 48 hours, one must wait until the involution is complete (6 weeks). **Analysis of Other Options:** * **A & B (During/Within 10 days of menstruation):** This is the **ideal time** for interval insertion. It ensures the patient is not pregnant, and the cervical os is slightly dilated, making insertion easier and less painful. * **D (6-8 weeks after delivery):** This is known as **Postpartum Interval Insertion**. By this time, the uterus has returned to its non-pregnant size (involution complete), making it a safe and standard time for insertion. **High-Yield NEET-PG Pearls:** * **Ideal Time for Interval IUD:** Within 10 days of the LMP. * **Post-Abortal Insertion:** Can be done immediately after first-trimester abortion (if no infection). * **PPIUD (Postpartum IUD):** Must be done within **48 hours** (ideally within 10 minutes of placental delivery) or delayed until **6 weeks**. * **Most Common Side Effect:** Bleeding (Menorrhagia). * **Most Common Reason for Removal:** Bleeding and Pain. * **Mechanism of Action (Cu-T):** Primarily spermicidal (causes a sterile inflammatory response).

Question 206: Replacement of a progestin-releasing intrauterine device should be done after how many years?

A. 1 year
B. 3 years
C. 5 years (Correct Answer)
D. 10 years

Explanation: **Explanation:** The correct answer is **5 years**. **1. Why 5 years is correct:** The most common progestin-releasing intrauterine device (IUCD) is the **Levonorgestrel-releasing Intrauterine System (LNG-IUS)**, commercially known as Mirena. It contains 52 mg of Levonorgestrel, which is released at an initial rate of 20 µg/day. While the hormone levels gradually decline over time, the device maintains high contraceptive efficacy and therapeutic benefits (such as reducing menstrual blood loss) for a period of **5 years**. After this duration, the reservoir of progestin is depleted to a level where its reliability decreases, necessitating replacement. **2. Why the other options are incorrect:** * **1 year:** Progestasert (an older progesterone-only IUD) required annual replacement, but it is largely obsolete. Modern LNG-IUS devices are designed for long-term use. * **3 years:** This is the typical duration for the **progestin subdermal implant (Nexplanon)** or the lower-dose LNG-IUS (Skyla/Jaydess), but not the standard LNG-IUS. * **10 years:** This is the replacement interval for the **Copper T 380A**, which is a non-hormonal IUCD. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily works by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy (preventing implantation). * **Non-contraceptive uses:** It is the **Gold Standard (Medical management)** for Menorrhagia and Adenomyosis. * **Failure Rate:** It has a Pearl Index of approximately 0.2, making it as effective as sterilization. * **Recent Update:** While the FDA has recently approved Mirena for up to 8 years for contraception, for the purpose of NEET-PG and standard textbooks (Dutta/Williams), **5 years** remains the standard answer for replacement.

Question 207: Which of the following drugs is not helpful in the treatment of ectopic pregnancy?

A. Methotrexate
B. Misoprostol (Correct Answer)
C. Actinomycin-D
D. RU486

Explanation: **Explanation:** The primary goal of medical management in ectopic pregnancy is to inhibit the rapidly dividing trophoblastic cells, leading to the involution of the pregnancy. **Why Misoprostol is the Correct Answer:** **Misoprostol** is a synthetic Prostaglandin E1 (PGE1) analogue. Its primary action is to induce uterine contractions and cervical ripening. While it is highly effective for medical abortion in **intrauterine pregnancies**, it has no effect on the fallopian tubes or extrauterine tissues. Therefore, it cannot terminate an ectopic pregnancy and is not used in its management. **Analysis of Incorrect Options:** * **Methotrexate (Option A):** The drug of choice for medical management. It is a folic acid antagonist that inhibits Dihydrofolate Reductase, stopping DNA synthesis in actively dividing trophoblastic cells. * **Actinomycin-D (Option C):** An antitumor antibiotic that inhibits RNA synthesis. While rarely used today due to toxicity, it was historically used as a second-line agent for ectopic pregnancy and remains a treatment for gestational trophoblastic neoplasia. * **RU486 / Mifepristone (Option D):** An anti-progestational agent. Since progesterone is essential for maintaining any pregnancy (including ectopic), RU486 can be used as an adjunct to Methotrexate to increase success rates. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Candidate for Methotrexate:** Hemodynamically stable, tubal mass <3.5 cm, no fetal cardiac activity, and baseline β-hCG <5000 mIU/mL. * **Dosing:** Most common regimen is a single dose of **50 mg/m²** IM. * **Contraindication:** Ruptured ectopic pregnancy (requires immediate surgery). * **Follow-up:** Monitor β-hCG on days 4 and 7; a drop of <15% between these days requires a second dose.

Question 208: Third generation oral contraceptive pills containing norgestrel and gestodene along with estrogens:

A. Are more lipid friendly (Correct Answer)
B. Decrease the risk of venous thromboembolism
C. Increase the risk of breakthrough bleeding
D. Are not used for emergency contraception

Explanation: **Explanation:** Third-generation oral contraceptive pills (OCPs) were developed to minimize the androgenic side effects associated with earlier generations. They contain progestogens like **Desogestrel, Gestodene, and Norgestimate**. **1. Why Option A is Correct:** Third-generation progestogens are highly selective and possess **minimal androgenic activity**. Unlike older progestins (like Levonorgestrel), they do not antagonize the beneficial effects of estrogen on the lipid profile. Consequently, they are **"lipid-friendly"** because they tend to increase HDL (good cholesterol) and decrease LDL (bad cholesterol), reducing the overall metabolic impact on the liver. **2. Analysis of Incorrect Options:** * **Option B:** Third-generation OCPs actually **increase the risk of Venous Thromboembolism (VTE)** compared to second-generation pills. This is a classic high-yield fact; the risk of VTE is roughly double that of second-generation formulations. * **Option C:** Because these progestogens have high endometrial potency, they generally provide **better cycle control** and *decrease* the risk of breakthrough bleeding compared to older, low-dose formulations. * **Option D:** Desogestrel and other third-generation progestins *can* be used in various contraceptive formats, though Levonorgestrel remains the gold standard for progestin-only emergency contraception. **3. NEET-PG High-Yield Pearls:** * **1st Generation:** Norethynodrel (Historical). * **2nd Generation:** Levonorgestrel (Most common, lowest VTE risk, but most androgenic—causes acne/hirsutism). * **3rd Generation:** Desogestrel, Gestodene (Lipid-friendly, less acne, but **highest VTE risk**). * **4th Generation:** Drospirenone (Anti-mineralocorticoid and anti-androgenic; excellent for PCOS and PMDD). * **Drug of choice for PCOS with hirsutism:** OCPs containing Cyproterone acetate or Drospirenone.

Question 209: Mestranol acts as a contraceptive by:

A. Inhibiting FSH secretion (Correct Answer)
B. Inhibiting LH secretion
C. Inhibiting tubal motility
D. Inhibiting nidation

Explanation: **Explanation:** **Mestranol** is a synthetic estrogen and a prodrug of ethinyl estradiol, commonly used in combined oral contraceptive pills (COCPs). **1. Why Option A is Correct:** The primary mechanism of the **estrogen component** (like Mestranol) in COCPs is the **suppression of Follicle Stimulating Hormone (FSH)** via negative feedback on the anterior pituitary. By inhibiting FSH, the recruitment and maturation of ovarian follicles are prevented, ensuring there is no dominant follicle to release an egg. **2. Why Other Options are Incorrect:** * **Option B (Inhibiting LH secretion):** This is the primary mechanism of the **Progestogen component**. Progesterone suppresses Luteinizing Hormone (LH) surge, thereby preventing ovulation. While estrogen contributes to this, its hallmark action is FSH suppression. * **Option C (Inhibiting tubal motility):** This is a secondary effect of **Progesterone**, which alters the contractility of the fallopian tubes to slow down ovum/zygote transport. * **Option D (Inhibiting nidation):** This refers to making the endometrium unfavorable for implantation, another secondary effect primarily mediated by **Progesterone** (causing early secretory changes and subsequent atrophy). **Clinical Pearls for NEET-PG:** * **Mestranol vs. Ethinyl Estradiol:** Mestranol is less potent because it must be converted to ethinyl estradiol in the liver. * **The "Double Lock" Mechanism:** COCPs are highly effective because they inhibit ovulation through two pathways: Estrogen (FSH suppression) + Progesterone (LH surge suppression). * **Hostile Cervical Mucus:** The most important contraceptive effect of progestogen-only pills (Mini-pills) is thickening the cervical mucus to prevent sperm penetration.

Question 210: Which contraceptive method is medically contraindicated for a patient with a known latex allergy?

A. Oral contraceptives
B. Intrauterine device (IUD)
C. Condoms (Correct Answer)
D. Laparoscopic tubal ligation

Explanation: **Explanation:** **Correct Option: C. Condoms** The primary material used in the manufacturing of most standard male and female condoms is **natural rubber latex**. In patients with a known latex allergy, exposure can trigger hypersensitivity reactions ranging from localized contact dermatitis and pruritus to life-threatening systemic anaphylaxis. For these patients, non-latex alternatives such as polyurethane, polyisoprene, or nitrile condoms must be used. **Analysis of Incorrect Options:** * **A. Oral Contraceptives:** These are hormonal medications (estrogen and/or progestogen) administered systemically. They do not contain latex and have no cross-reactivity with latex proteins. * **B. Intrauterine Device (IUD):** Copper T (Cu-T) and Levonorgestrel-releasing IUDs (Mirena) are composed of plastic (polyethylene), barium sulfate, and copper or hormones. They are latex-free and safe for these patients. * **C. Laparoscopic Tubal Ligation:** This is a surgical procedure. While surgical gloves were historically latex-based, the procedure itself (and the clips/rings used for occlusion) does not inherently involve latex. In modern practice, latex-free gloves are used for allergic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Latex-Fruit Syndrome:** Patients allergic to latex often show cross-reactivity with certain fruits, most commonly **Avocado, Banana, Kiwi, and Chestnut**. * **Diaphragms and Cervical Caps:** Like condoms, these are often made of latex and are also contraindicated. * **Non-Latex Condoms:** Polyurethane condoms are thinner and provide good sensitivity but have a higher breakage and slippage rate compared to latex. * **Spermicides:** Nonoxynol-9 is the most common spermicide used with barrier methods; it does not contain latex but can cause vaginal irritation.

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

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