Contraception and Family Planning — MCQs
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Which of the following is NOT true about centchroman?
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?
Depot progestins are administered by which route?
What is the technique used for Cu-T insertion?
Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?
Oral Contraceptive Pills are protective from all of the following conditions except?
Which of the following cannot be used as post-coital contraception?
Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?
Multi load device refers to:
All of the following are complications of IUCD except:
Contraception and Family Planning Indian Medical PG Practice Questions and MCQs
Question 241: Which of the following is NOT true about centchroman?
- A. Anti-estrogenic
- B. Not a teratogen
- C. Long-acting pill
- D. Failure rate is 10 per 100 women-years (Correct Answer)
Explanation: **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.
Question 242: 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?
- A. Remove the IUD and evacuate the uterine contents.
- B. Remove the IUD and plan expectant pregnancy management. (Correct Answer)
- C. Leave the IUD in place and plan expectant pregnancy management.
- D. Leave the IUD in place and administer broad-spectrum antibiotics for the next 4 weeks.
Explanation: ### Explanation The management of pregnancy with an intrauterine device (IUD) in situ depends on the patient's desire to continue the pregnancy and the visibility of the IUD strings. **1. Why Option B is Correct:** When a patient wishes to continue an intrauterine pregnancy and the IUD strings are visible, the standard recommendation is to **remove the IUD as soon as possible** (ideally before 12 weeks). * **Medical Concept:** Leaving the IUD in situ significantly increases the risk of complications, including **spontaneous abortion** (up to 50% risk), **preterm labor**, and **chorioamnionitis** (septic abortion). Removing the IUD reduces these risks, although the risk of miscarriage remains slightly higher than in a normal pregnancy. **2. Why Other Options are Incorrect:** * **Option A:** Evacuation is only indicated if the patient wishes to terminate the pregnancy or if there is evidence of an inevitable/incomplete abortion. * **Option C:** Leaving the IUD in place is only considered if the strings are not visible and the IUD cannot be easily retrieved under ultrasound guidance. However, this carries a high risk of mid-trimester sepsis and preterm birth. * **Option D:** Prophylactic antibiotics do not mitigate the mechanical and inflammatory risks posed by a retained IUD; removal is the definitive management. **High-Yield Clinical Pearls for NEET-PG:** * **Ectopic Risk:** While IUDs are highly effective, if a pregnancy *does* occur, the **proportionate risk** of it being an ectopic pregnancy is higher (approx. 5-8%), though the absolute risk is lower than in non-contraceptive users. * **Congenital Anomalies:** There is **no increased risk** of fetal malformations or birth defects if the pregnancy continues with a Copper-T in situ. * **Strings not visible:** if strings are not seen, perform USG to locate the IUD. If it is intrauterine and cannot be removed easily, it is generally left in place.
Question 243: Depot progestins are administered by which route?
- A. Subcutaneous route
- B. Intravenous route
- C. Intramuscular route
- D. Both subcutaneous and intramuscular route (Correct Answer)
Explanation: **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.
Question 244: What is the technique used for Cu-T insertion?
- A. Surgery under local anesthesia
- B. Surgery under general anesthesia
- C. Pushing (Correct Answer)
- D. Laparotomy
Explanation: The correct technique for the insertion of a Copper-T (Cu-T) intrauterine device is the **"Push" technique** (also known as the withdrawal technique depending on the specific model, though "Pushing" is the standard descriptor for the insertion process into the uterine cavity). ### Explanation of the Correct Answer The Cu-T is inserted using a specialized plastic loading tube and a plunger. Once the device is loaded and the uterine sound has confirmed the length and direction of the uterus, the loaded inserter is **pushed** through the cervical canal until it reaches the fundus. For the Cu-T 380A, the "Withdrawal technique" is technically used to release the arms (holding the plunger steady while pulling the tube back), but the primary method of delivery into the uterus is the manual **pushing** of the inserter assembly. ### Why Other Options are Incorrect * **Options A & B (Surgery under Local/General Anesthesia):** Cu-T insertion is a minor OPD (Outpatient Department) procedure. It does not require surgery or systemic anesthesia. While a paracervical block (local) may be used in very anxious patients or those with cervical stenosis, it is not the standard "technique" for insertion. * **Option D (Laparotomy):** A laparotomy is a major abdominal surgery. Using this for a simple contraceptive insertion would be a gross medical error. Laparotomy (or laparoscopy) is only indicated if the Cu-T perforates the uterus and migrates into the abdominal cavity. ### High-Yield Clinical Pearls for NEET-PG * **Ideal Time for Insertion:** During menstruation or within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervical os is slightly dilated). * **Post-Partum Insertion:** Can be done within 48 hours (Post-Placental) or after 6 weeks (Post-Partum). * **Most Common Side Effect:** Excessive menstrual bleeding (Menorrhagia). * **Most Common Reason for Removal:** Pain and bleeding. * **Mechanism of Action:** Primarily a **spermicidal** effect due to local inflammatory response and copper ions.
Question 245: Which of the following is NOT an abdominal laparoscopic technique for tubal ligation?
- A. Pomeroy
- B. Parkland
- C. Essure (Correct Answer)
- D. Irving
Explanation: **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.
Question 246: Oral Contraceptive Pills are protective from all of the following conditions except?
- A. Endometriosis
- B. Ovarian Carcinoma
- C. Benign Breast Disease
- D. Deep Venous Thrombosis (Correct Answer)
Explanation: **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.
Question 247: Which of the following cannot be used as post-coital contraception?
- A. Danazol (Correct Answer)
- B. CuT 200
- C. RU 486
- D. High dose estrogens
Explanation: **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].
Question 248: Non-contraceptive benefits of oral contraceptive pills may be seen in all of the following conditions except?
- A. Endometrial cancer
- B. Breast cancer (Correct Answer)
- C. Rheumatoid arthritis
- D. Endometriosis
Explanation: **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).
Question 249: Multi load device refers to:
- A. First generation IUCD
- B. Oral contraceptive pills
- C. Barrier contraceptives
- D. Second generation IUCD (Correct Answer)
Explanation: ### 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 250: All of the following are complications of IUCD except:
- A. Genital malignancy (Correct Answer)
- B. Bleeding
- C. Actinomycosis
- D. Vaginal discharge
Explanation: **Explanation:** The Intrauterine Contraceptive Device (IUCD) is a highly effective reversible contraceptive, but it is associated with specific side effects and complications. **Why Genital Malignancy is the Correct Answer:** Genital malignancy is **not** a complication of IUCD use. In fact, the Levonorgestrel-releasing intrauterine system (LNG-IUS) is known to have a **protective effect** against endometrial hyperplasia and endometrial cancer by inducing endometrial atrophy. While IUCDs do not cause cervical or ovarian cancer, they are generally contraindicated in patients with known or suspected pelvic malignancies. **Analysis of Incorrect Options:** * **Bleeding:** This is the **most common complication** and the leading cause of IUCD removal. It typically manifests as menorrhagia (heavy menstrual bleeding) or intermenstrual spotting, particularly with copper-bearing devices. * **Actinomycosis:** *Actinomyces israelii* is a Gram-positive bacterium that can colonize the female genital tract in long-term IUCD users. While often asymptomatic, it can lead to pelvic inflammatory disease (PID) or pelvic abscesses. * **Vaginal Discharge:** This is a common complaint among IUCD users. It may be due to secondary pelvic infection or, more commonly, a non-specific inflammatory response of the endometrium and cervix to the foreign body. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Bleeding. * **Most common cause of removal:** Bleeding and pain. * **Most common complication:** Expulsion (most likely to occur in the first 3 months and during menstruation). * **Risk of PID:** Highest in the first 20 days following insertion (related to the insertion technique rather than the device itself). * **Ectopic Pregnancy:** While an IUCD reduces the absolute risk of ectopic pregnancy by preventing pregnancy overall, if a woman *does* conceive with an IUCD in situ, the **relative risk** of that pregnancy being ectopic is increased.
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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