Contraception and Family Planning Practice Questions

Q: Which of the following is NOT true about centchroman?

Failure rate is 10 per 100 women-years. **Explanation:** Centchroman (Ormeloxifene) is a unique **Selective Estrogen Receptor Modulator (SERM)** developed by CDRI, Lucknow. It is marketed under the trade names **Saheli** or **Chhaya** and is part of India’s National Family Planning Programme. **Why Option D is the correct answer (The False Statement):** The failure rate of Centchroman is significantly lower than 10 per 100 women-years. With typical use, the Pearl Index is approximately **1.83 to 2.84 per 100 women-years**. A failure rate of 10 would be unacceptably high for a modern contraceptive method. **Analysis of Incorrect Options:** * **A. Anti-estrogenic:** Centchroman acts as an estrogen antagonist in the uterus (preventing implantation) and breast, while having weak estrogenic effects elsewhere. Its primary contraceptive mechanism is altering the endometrium to make it unreceptive to a fertilized ovum. * **B. Not a teratogen:** Unlike many hormonal contraceptives, Centchroman is non-steroidal and has no reported teratogenic effects. If a woman conceives while taking it, there is no risk of fetal malformation. * **C. Long-acting pill:** It has a long half-life (approx. 170 hours), allowing for infrequent dosing. The standard regimen is **twice weekly for the first 3 months**, followed by **once weekly** thereafter. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Ideal for lactating mothers as it does not affect the quantity or quality of breast milk. * **Non-Contraceptive Benefits:** Used in the management of Abnormal Uterine Bleeding (AUB) and mastalgia. * **Side Effects:** The most common side effect is **delayed periods** (prolonged cycles), which occurs in about 8-10% of users. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease.

Q: Depot progestins are administered by which route?

Both subcutaneous and intramuscular route. **Explanation:** Depot progestins, primarily **Depot Medroxyprogesterone Acetate (DMPA)**, are long-acting reversible contraceptives (LARCs) designed for slow release into the systemic circulation. Traditionally, DMPA was administered exclusively via the **intramuscular (IM)** route (150 mg every 3 months) [1]. However, a newer formulation, **DMPA-SC 104**, is specifically designed for **subcutaneous (SC)** administration (104 mg every 3 months). Therefore, both routes are clinically utilized [1]. * **Why Option D is Correct:** DMPA is available in two preparations: 1. **DMPA-IM:** Injected into the gluteal or deltoid muscle. 2. **DMPA-SC:** Injected into the anterior thigh or abdomen. The SC version allows for easier self-administration and carries a lower dose while maintaining efficacy for 13 weeks. * **Why Option B is Incorrect:** Progestins are never given intravenously for contraception. The "depot" effect relies on the formation of a drug reservoir in muscle or fat for slow absorption; an IV bolus would cause immediate metabolism and lack the required duration of action. * **Why Options A & C are Incorrect:** While both are used, selecting only one would be incomplete. In the context of modern medical practice and NEET-PG patterns, the inclusion of the SC route is a high-yield update. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge; it also thickens cervical mucus. * **The "Antara" Program:** Under India’s National Family Planning Program, DMPA is provided free of cost under the brand name **Antara**. * **Side Effects:** Menstrual irregularities (most common), weight gain, and a reversible decrease in **Bone Mineral Density (BMD)** [2]. * **Return to Fertility:** There is a characteristic delay in the return to fertility (average 7–10 months) after the last injection.

Q: Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?

Essure. **Explanation:** The question asks to identify the technique that is **not** an abdominal laparoscopic method for tubal ligation. **1. Why Essure is the correct answer:** Essure is a **hysteroscopic** (transcervical) sterilization technique, not an abdominal or laparoscopic one. It involves the insertion of micro-inserts (made of nickel-titanium and polyethylene fibers) into the fallopian tubes via the vagina and cervix. These inserts trigger a chronic inflammatory response, leading to fibrosis and complete tubal occlusion over 3 months. *Note: Essure was discontinued globally due to safety concerns, but remains a high-yield topic for identifying non-surgical routes.* **2. Analysis of incorrect options (Abdominal/Laparoscopic methods):** * **Pomeroy (Option A):** The most common method. A loop of the tube is ligated with absorbable suture and the knuckle is excised. * **Parkland (Option B):** Involves ligating the tube at two points and excising the intervening segment, ensuring the ends are separated to prevent recanalization. * **Irving (Option C):** The most effective method (lowest failure rate). The proximal end of the severed tube is buried into the posterior wall of the uterus. **Clinical Pearls for NEET-PG:** * **Most common method worldwide:** Pomeroy’s technique. * **Method with the lowest failure rate:** Irving’s technique. * **Madlener’s technique:** Ligation without excision (highest failure rate due to fistula formation). * **Uchida technique:** Involves subserosal injection and resection; very effective but complex. * **Timing:** Postpartum sterilization is ideally performed 24–48 hours after delivery.

Q: Oral Contraceptive Pills are protective from all of the following conditions except?

Deep Venous Thrombosis. **Explanation:** The correct answer is **Deep Venous Thrombosis (DVT)**. Combined Oral Contraceptive Pills (COCPs) are a well-known **risk factor** for venous thromboembolism, rather than a protective factor. **1. Why DVT is the correct answer:** The estrogen component (Ethinyl Estradiol) in COCPs increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases anticoagulant levels (Protein S and Antithrombin III). This induces a hypercoagulable state, significantly increasing the risk of DVT and pulmonary embolism. **2. Why other options are incorrect (Protective effects of COCPs):** * **Endometriosis:** COCPs cause decidualization and subsequent atrophy of the endometrial tissue. By suppressing ovulation and reducing menstrual flow (retrograde menstruation), they alleviate symptoms and limit the progression of endometriosis. * **Ovarian Carcinoma:** COCPs suppress ovulation ("incessant ovulation" theory). By preventing the repeated trauma and repair of the ovarian epithelium, they reduce the risk of epithelial ovarian cancer by approximately 50%. This protection persists for years after discontinuation. * **Benign Breast Disease:** COCPs reduce the incidence of fibrocystic disease and fibroadenomas, likely due to the stabilization of hormonal fluctuations. (Note: They do *not* protect against breast cancer). **High-Yield Clinical Pearls for NEET-PG:** * **Protective against:** Endometrial cancer (most significant protection), Ovarian cancer, Ectopic pregnancy, Pelvic Inflammatory Disease (PID), and Iron deficiency anemia. * **Increased risk of:** Venous Thromboembolism (VTE), Cervical cancer (with long-term use >5 years), and Hepatic adenoma. * **Absolute Contraindications:** Smokers >35 years, history of VTE/Stroke, Migraine with aura, and undiagnosed abnormal uterine bleeding.

Q: Which of the following cannot be used as post-coital contraception?

Danazol. **Explanation:** The correct answer is **Danazol**. While historically explored, Danazol (an ethisterone derivative) has been proven ineffective as emergency contraception. It acts as a weak androgen and inhibits gonadotropin release, but it does not reliably prevent pregnancy after unprotected intercourse. **Analysis of Options:** * **CuT 200 (Copper IUD):** This is the **most effective** method of emergency contraception (failure rate <0.1%) [1], [2]. It must be inserted within 5 days (120 hours) of unprotected intercourse [1]. It works primarily by causing a sterile inflammatory reaction in the endometrium that is toxic to sperm and prevents implantation [3]. * **RU 486 (Mifepristone):** A potent anti-progestin [1]. In low doses (10 mg or 25 mg), it is highly effective as emergency contraception by delaying or inhibiting ovulation [2]. It is often preferred due to fewer side effects compared to hormonal methods. * **High-dose Estrogens:** Historically used as the "morning-after pill" (e.g., Ethinylestradiol 5mg for 5 days) [1], [2]. They work by altering the endometrium and interfering with luteal function. However, they are rarely used today due to severe side effects like nausea and vomiting. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Copper IUD is the most effective post-coital contraceptive [1]. * **Yuzpe Regimen:** Consists of high-dose Ethinylestradiol (100 mcg) + Levonorgestrel (0.5 mg), taken in two doses 12 hours apart [1]. * **Levonorgestrel (LNG):** The most common hormonal method (1.5 mg single dose) [1]. It is effective only **before** the LH surge. * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) effective up to 120 hours [2]; it is more effective than LNG as it can inhibit ovulation even after the LH surge has started [2].

Q: Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?

Breast cancer. **Explanation:** Combined Oral Contraceptive Pills (COCPs) offer several non-contraceptive benefits due to their ability to suppress ovulation and regulate the hormonal milieu. However, their relationship with breast cancer is a notable exception. **Why Breast Cancer is the Correct Answer:** COCPs do **not** provide a protective effect against breast cancer. In fact, most epidemiological studies suggest a **slight increase in the relative risk** of breast cancer among current and recent users. This risk is generally considered to return to baseline 10 years after discontinuing the pill. Therefore, it is not a "benefit." **Analysis of Other Options:** * **Endometrial Cancer:** COCPs provide a significant protective effect (approx. 50% reduction in risk) by preventing estrogen-driven endometrial hyperplasia through the progestogen component. This protection persists for years after stopping the pill. * **Rheumatoid Arthritis:** High-yield evidence suggests that COCPs may reduce the risk of developing severe rheumatoid arthritis and can ameliorate the progression of the disease. * **Endometriosis:** COCPs are a first-line medical management for endometriosis. They induce decidualization and subsequent atrophy of endometrial tissue, thereby reducing dysmenorrhea and pelvic pain. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** COCPs significantly reduce the risk of **Ovarian cancer** (by 40-80%) and **Endometrial cancer**. They also reduce the risk of **Colorectal cancer**. * **Increased Risk:** COCPs are associated with an increased risk of **Cervical cancer** (especially with >5 years of use) and **Hepatocellular adenoma**. * **Benign Conditions:** They reduce the incidence of Benign Breast Disease (e.g., fibroadenoma), Pelvic Inflammatory Disease (PID), and Iron Deficiency Anemia (due to reduced menstrual flow).

Q: Multi load device refers to:

Second generation IUCD. ### Explanation **Correct Answer: D. Second generation IUCD** **Medical Concept:** Intrauterine Contraceptive Devices (IUCDs) are categorized into generations based on their composition and mechanism. **Second-generation IUCDs** are characterized by the addition of **copper** to a polyethylene frame. The **Multiload (MLCu-250 or MLCu-375)** is a classic example of this category. It features a unique design with flexible side arms (serrated fins) that help anchor the device in the uterine cavity, reducing the risk of expulsion compared to the traditional T-shaped devices. **Analysis of Options:** * **Option A (First generation IUCD):** These are non-medicated or inert devices, typically made of polyethylene or stainless steel. The most famous example is the **Lippes Loop**. * **Option B (Oral contraceptive pills):** These are hormonal methods of contraception (combined or progestogen-only) administered systemically, not intrauterine devices. * **Option C (Barrier contraceptives):** These include physical or chemical barriers (condoms, diaphragms, spermicides) that prevent sperm from entering the cervix. **High-Yield Clinical Pearls for NEET-PG:** * **Generations Recap:** * **1st Gen:** Inert (Lippes Loop). * **2nd Gen:** Medicated with Copper (CuT-200, CuT-380A, Multiload). * **3rd Gen:** Hormone-releasing (Mirena/LNG-20, Progestasert). * **CuT-380A:** Currently the "Gold Standard" IUCD; effective for **10 years**. * **Multiload-375:** Effective for **5 years**. * **Mechanism of Action:** Copper IUCDs primarily act as a **spermicide** by causing a sterile inflammatory response in the endometrium and altering cervical mucus. * **Ideal Candidate:** A multiparous woman in a stable monogamous relationship (low risk of PID).

Question 1

Which of the following is NOT true about centchroman?

Accepted Answer

Failure rate is 10 per 100 women-years

Answer

Anti-estrogenic

Answer

Not a teratogen

Answer

Long-acting pill

Question 2

A 32-year-old multipara with an intrauterine contraceptive device (Cu-T) in place presents for a regular checkup. Her urine pregnancy test is positive, and a 10-week intrauterine gestation is confirmed on ultrasonography. She wishes to continue the pregnancy. Which of the following management strategies is recommended in this patient?

Accepted Answer

Remove the IUD and plan expectant pregnancy management.

Answer

Remove the IUD and evacuate the uterine contents.

Answer

Leave the IUD in place and plan expectant pregnancy management.

Answer

Leave the IUD in place and administer broad-spectrum antibiotics for the next 4 weeks.

Question 3

Depot progestins are administered by which route?

Accepted Answer

Both subcutaneous and intramuscular route

Answer

Subcutaneous route

Answer

Intravenous route

Answer

Intramuscular route

Question 4

What is the technique used for Cu-T insertion?

Accepted Answer

Pushing

Answer

Surgery under local anesthesia

Answer

Surgery under general anesthesia

Answer

Laparotomy

Question 5

Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?

Accepted Answer

Essure

Answer

Pomeroy

Answer

Parkland

Answer

Irving

Question 6

Oral Contraceptive Pills are protective from all of the following conditions except?

Accepted Answer

Deep Venous Thrombosis

Answer

Endometriosis

Answer

Ovarian Carcinoma

Answer

Benign Breast Disease

Question 7

Which of the following cannot be used as post-coital contraception?

Accepted Answer

Danazol

Answer

CuT 200

Answer

RU 486

Answer

High dose estrogens

Question 8

Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?

Accepted Answer

Breast cancer

Answer

Endometrial cancer

Answer

Rheumatoid arthritis

Answer

Endometriosis

Question 9

Multi load device refers to:

Accepted Answer

Second generation IUCD

Answer

First generation IUCD

Answer

Oral contraceptive pills

Answer

Barrier contraceptives

Question 10

All of the following are complications of IUCD except:

Accepted Answer

Genital malignancy

Answer

Bleeding

Answer

Actinomycosis

Answer

Vaginal discharge

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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