Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 311: Which of the following is contained in the 'Today' contraceptive?

A. Prostaglandin F2
B. Norethisterol
C. Nonoxynol-9 (Correct Answer)
D. Copper releasing mesh

Explanation: **Explanation:** The correct answer is **C. Nonoxynol-9**. **Why it is correct:** 'Today' is a popular brand of **vaginal contraceptive sponge**. It is a small, polyurethane foam device that acts as a mechanical barrier over the cervix. However, its primary contraceptive efficacy comes from being impregnated with **1000 mg of Nonoxynol-9**, a chemical spermicide. Nonoxynol-9 is a surfactant that destroys the sperm cell membrane, effectively immobilizing or killing sperm before they can enter the cervical canal. **Analysis of Incorrect Options:** * **A. Prostaglandin F2:** These are used in obstetrics for induction of labor or management of postpartum hemorrhage (PPH), not as a primary contraceptive agent. * **B. Norethisterone:** This is a synthetic progestin used in oral contraceptive pills (OCPs) or injectable contraceptives (e.g., NET-EN). It works by suppressing ovulation and thickening cervical mucus, not as a local spermicide. * **D. Copper releasing mesh:** Copper is the active component in Intrauterine Devices (IUDs) like Cu-T 380A. It acts as a spermicide by causing a local inflammatory response in the endometrium. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** The sponge provides a triple action: mechanical barrier, chemical spermicide, and absorption of semen. * **Usage:** It must be moistened with water before insertion and should be left in place for at least **6 hours after intercourse**, but not longer than 30 hours total (to avoid Toxic Shock Syndrome). * **Failure Rate:** The failure rate is higher in multiparous women compared to nulliparous women (approx. 24% vs 12% with typical use). * **STI Warning:** Nonoxynol-9 does **not** protect against HIV/STIs; in fact, frequent use may increase the risk of HIV transmission due to vaginal mucosal irritation.

Question 312: What is the ideal contraceptive in the given scenario?

A. Intrauterine device (Cu-T)
B. Barrier method
C. Oral contraceptive pill (Correct Answer)
D. Depot medroxyprogesterone acetate (Depo-Provera)

Explanation: ***Oral contraceptive pill*** - Provides excellent **contraceptive efficacy** (>99%) while offering dual benefits of **cycle regulation** and **hormonal balance** in young women with irregular cycles or PCOS. - Contains **estrogen and progestin** that help regulate menstrual cycles, reduce **dysmenorrhea**, and improve **acne** in reproductive-age women. *Intrauterine device (Cu-T)* - **Cu-T** may cause increased **menstrual bleeding** and **dysmenorrhea**, worsening existing menstrual irregularities. - Not ideal for young women with **heavy or irregular periods** as it can exacerbate these symptoms. *Barrier method* - Provides **lower contraceptive efficacy** (85-95%) compared to hormonal methods, requiring consistent proper use. - Offers **no hormonal benefits** for cycle regulation, dysmenorrhea relief, or management of conditions like PCOS. *Depot medroxyprogesterone acetate (Depo-Provera)* - Can cause **irregular bleeding** or **amenorrhea**, potentially masking underlying menstrual disorders in young women. - Associated with **bone density loss** and **weight gain**, making it less suitable for young women who need long-term contraception.

Question 313: What is the absolute contraindication for prescribing oral contraceptive pills in a woman of reproductive age group?

A. Epilepsy
B. Diabetes mellitus
C. Congenital hyperlipidemia (Correct Answer)
D. Hypertension

Explanation: **Explanation:** The correct answer is **Congenital hyperlipidemia**. Combined Oral Contraceptive Pills (COCPs) contain estrogen, which significantly impacts lipid metabolism. Estrogen increases the synthesis of triglycerides and VLDL in the liver. In patients with congenital hyperlipidemia, COCPs can trigger severe hypertriglyceridemia, leading to a high risk of **acute pancreatitis** and accelerating atherosclerosis, thereby increasing the risk of cardiovascular events. According to the WHO Medical Eligibility Criteria (MEC), known dyslipidemias are classified as **MEC Category 4** (absolute contraindication). **Analysis of Incorrect Options:** * **Epilepsy:** This is a **relative contraindication**. The primary concern is not safety, but efficacy; enzyme-inducing anti-epileptic drugs (like Phenytoin or Carbamazepine) increase the metabolism of OCPs, leading to contraceptive failure. * **Diabetes Mellitus:** It is a relative contraindication (**MEC 2/3**). OCPs can be used in diabetics without vascular complications. It becomes an absolute contraindication only if there is associated nephropathy, retinopathy, neuropathy, or if the duration of diabetes is >20 years. * **Hypertension:** It is a relative contraindication (**MEC 3**) if blood pressure is well-controlled (140–159/90–99 mmHg). It becomes an absolute contraindication (**MEC 4**) only if BP is ≥160/100 mmHg or if there is associated vascular disease. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications (MEC 4):** Smoker >35 years (≥15 cigarettes/day), History of DVT/PE, Ischemic heart disease, Stroke, Breast cancer (current), Migraine with aura, and Decompensated Cirrhosis. * **Best OCP for Lactating Mothers:** Progestogen-only pills (POPs), as estrogen suppresses lactation. * **Non-contraceptive benefit:** OCPs reduce the risk of Ovarian and Endometrial cancers.

Question 314: Which is the most likely complication of an IUD?

A. Hypofibrinogenemia
B. Sterility
C. Cervical tear
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above** because the most common complications of an Intrauterine Device (IUD) are **increased menstrual bleeding (menorrhagia)** and **pelvic pain**. Since these are not listed among the options, "None of the above" is the most appropriate choice. **Analysis of Options:** * **A. Hypofibrinogenemia:** This is not a complication of IUD use. It is typically associated with obstetric emergencies like Abruptio Placentae, Amniotic Fluid Embolism, or prolonged Intrauterine Fetal Death (IUFD). * **B. Sterility:** IUDs do not cause permanent sterility. Fertility returns immediately upon removal. While Pelvic Inflammatory Disease (PID) can lead to tubal factor infertility, the risk is primarily limited to the first 20 days post-insertion due to pre-existing infection or poor aseptic technique, not the device itself. * **C. Cervical tear:** This is an extremely rare mechanical injury that might occur during a difficult insertion but is not considered a standard or likely complication of the device. **High-Yield NEET-PG Pearls:** 1. **Most common side effect:** Excessive menstrual bleeding (especially with Cu-T). 2. **Most common reason for removal:** Excessive bleeding and pain. 3. **Most common cause of IUD failure:** Expulsion (most common in the first year, during menstruation). 4. **Ectopic Pregnancy:** An IUD does not *cause* ectopic pregnancy, but if a woman becomes pregnant with an IUD in situ, the *likelihood* that the pregnancy is ectopic is higher compared to the general population. 5. **Perforation:** Most common during the act of insertion (incidence 1 in 1000).

Question 315: Which of the following is a male contraceptive pill?

A. Quinesterol
B. Gossypol (Correct Answer)
C. Saheli
D. MALA-N

Explanation: **Explanation:** **Gossypol** is the correct answer. It is a polyphenolic compound derived from the seeds of the cotton plant (*Gossypium*). It acts as a male contraceptive by inhibiting sperm production (spermatogenesis) and reducing sperm motility. While effective, its clinical use has been limited due to two major side effects: **irreversible infertility** in approximately 10–20% of users and **hypokalemia**, which can lead to transient muscle paralysis. **Analysis of Incorrect Options:** * **Quinesterol (A):** This is a long-acting synthetic estrogen. It was historically used as a "once-a-month" female oral contraceptive pill, not for males. * **Saheli (C):** This is the brand name for **Centchroman** (Ormeloxifene). It is a non-steroidal Selective Estrogen Receptor Modulator (SERM) developed by CDRI, Lucknow. It is a female contraceptive taken twice weekly for the first three months, then once weekly. * **MALA-N (D):** This is a combined oral contraceptive pill (OCP) provided free of cost by the Government of India. It contains Levonorgestrel (0.15 mg) and Ethinylestradiol (0.03 mg) and is intended for female use. **High-Yield Clinical Pearls for NEET-PG:** * **Gossypol Mechanism:** It inhibits the enzyme lactate dehydrogenase-X in the testes. * **DMPA-G (Male Injectable):** Another male contraceptive under study is RISUG (Reversible Inhibition of Sperm Under Guidance), which is a non-hormonal injectable polymer. * **Centchroman (Saheli):** High-yield because it is non-hormonal and has a unique "Once-a-Week" dosage schedule, making it a favorite for exam questions.

Question 316: What is the primary mechanism of action of combined oral contraceptive pills?

A. Prevent fertilization
B. Prevent release of ovum from the ovary (Correct Answer)
C. Prevent implantation of a fertilized ovum
D. Reduce sperm motility

Explanation: **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is the **inhibition of ovulation** (prevention of the release of the ovum). COCPs contain both estrogen and progestogen, which exert negative feedback on the hypothalamo-pituitary-ovarian axis. Estrogen primarily suppresses **FSH** (Follicle Stimulating Hormone), preventing follicular development, while progestogen suppresses the **LH** (Luteinizing Hormone) surge, which is essential for ovulation. **Analysis of Options:** * **Option A (Incorrect):** While COCPs do prevent fertilization as a secondary result of there being no egg, the *primary* physiological action occurs earlier in the cycle by halting ovulation. * **Option B (Correct):** As explained, the suppression of the LH surge prevents the ovary from releasing an egg. * **Option C (Incorrect):** This is a secondary mechanism. Progestogens cause endometrial atrophy, making the lining unreceptive, but this only occurs if ovulation and fertilization were to bypass the primary mechanism. * **Option D (Incorrect):** While progestogens thicken the cervical mucus to create a barrier for sperm penetration, they do not directly reduce the intrinsic motility of the sperm itself. **NEET-PG High-Yield Pearls:** 1. **Triple Action of COCPs:** 1) Inhibition of ovulation (Primary), 2) Thickening of cervical mucus (Hostile mucus), and 3) Endometrial atrophy (Prevents implantation). 2. **The "Mini-pill" (POPs):** Unlike COCPs, Progestogen-Only Pills primarily act by thickening cervical mucus; they do not consistently inhibit ovulation. 3. **Non-contraceptive benefits:** COCPs reduce the risk of ovarian and endometrial cancers, ectopic pregnancy, and benign breast disease. 4. **Failure Rate:** The Pearl Index for COCPs with perfect use is 0.1 per 100 woman-years.

Question 317: Which method of contraception is contraindicated in a patient with AIDS?

A. Oral contraceptive pill
B. Sterilization
C. Intrauterine contraceptive device (IUCD)
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above** because, according to the WHO Medical Eligibility Criteria (MEC) for Contraceptive Use, HIV/AIDS is not an absolute contraindication for any of the listed methods. **1. Why "None of the above" is correct:** The management of contraception in HIV/AIDS patients depends on the clinical stage of the disease rather than the diagnosis alone. Most methods are safe (MEC Category 1 or 2). Even for IUCDs, which were previously feared due to pelvic inflammatory disease (PID) risk, current guidelines state they can be safely used in HIV-positive individuals. **2. Analysis of Options:** * **Oral Contraceptive Pills (OCPs):** These are safe (MEC 1). However, clinicians must be aware of drug interactions with certain Antiretroviral Therapy (ART) drugs (like Efavirenz or Ritonavir-boosted Protease Inhibitors) which may decrease the efficacy of hormonal contraceptives. * **Sterilization:** This is a permanent surgical method and is not contraindicated. It is often recommended for patients who have completed their family, provided they are medically stable for surgery. * **IUCD:** According to WHO MEC, IUCDs are **Category 1** (no restriction) for women with HIV who are clinically well. If a patient has **AIDS (WHO Stage 3 or 4)** and is not on ART, *initiation* of an IUCD is MEC Category 3 (risks outweigh benefits), but *continuation* in a woman who already has one is MEC Category 2. **Clinical Pearls for NEET-PG:** * **Dual Protection:** Regardless of the contraceptive method chosen, the use of **condoms** is mandatory in HIV patients to prevent the transmission of the virus and other STIs. * **IUCD & HIV:** The risk of PID in HIV-positive women using an IUCD is not significantly higher than in HIV-negative women. * **Drug Interaction:** Progestogen-only injectables (DMPA) are generally preferred over OCPs if the patient is on enzyme-inducing ART drugs.

Question 318: Which of the following is an absolute contraindication for combined oral contraceptive pills?

A. Diabetes mellitus
B. Hypertension
C. Past history of thromboembolism (Correct Answer)
D. Heart disease

Explanation: **Explanation:** The correct answer is **C. Past 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 Antithrombin III. This induces a hypercoagulable state. According to the **WHO Medical Eligibility Criteria (MEC) Category 4**, a history of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) is an **absolute contraindication** because the risk of recurrent life-threatening thromboembolic events far outweighs any benefits. **Analysis of Incorrect Options:** * **A. Diabetes Mellitus:** It is generally a relative contraindication (MEC 2). It only becomes an absolute contraindication (MEC 4) if there are associated vascular complications (nephropathy, retinopathy, neuropathy) or if the duration is >20 years. * **B. Hypertension:** Mildly elevated blood pressure (140–159/90–99 mmHg) is MEC 3 (relative contraindication). It becomes MEC 4 only if BP is ≥160/100 mmHg or if there is associated vascular disease. * **C. Heart Disease:** Not all heart diseases are absolute contraindications. While ischemic heart disease and valvular disease with complications (like atrial fibrillation) are MEC 4, simple valvular diseases are often MEC 2. **High-Yield Clinical Pearls for NEET-PG:** * **MEC 4 (Absolute Contraindications) Mnemonic:** "My Cords" — **M**igraine with aura, **Y**ears >35 + Smoking (>15 cigarettes), **C**ancer (Breast), **O**bstruction (Thromboembolism/Stroke), **R**iver (Liver disease/Tumors), **D**iabetes with vascular complications, **S**ystolic BP >160 or Diastolic >100. * COCPs are **protective** against Ovarian and Endometrial cancers but increase the risk of Cervical and Breast cancers. * The most common side effect of COCPs is **breakthrough bleeding**, but the most serious is **venous thromboembolism**.

Question 319: Which one of the following statements regarding the female contraceptive "Today" is true?

A. It is a polyurethane foam saturated with nonoxynol. (Correct Answer)
B. It is an oral pill containing norethisterine acetate 1.0mg and ethinyl oestradiol 0.03 mg.
C. It is an oral pill containing D-norgesterel 0.50 mg and ethinyl oestradiol 0.3 mg.
D. It is made of gossypol, a derivative obtained from cottonseed oil.

Explanation: **Explanation:** **1. Why Option A is Correct:** "Today" is the brand name for a **vaginal contraceptive sponge**. It is a small, circular device made of **polyurethane foam** that is saturated with 1000 mg of **Nonoxynol-9**, a potent spermicide. It works through a triple mechanism: * **Chemical:** It releases the spermicide to kill sperm. * **Mechanical:** It acts as a physical barrier over the cervix. * **Absorption:** The foam absorbs the semen, preventing sperm from entering the cervical canal. It provides protection for up to 24 hours. **2. Why the Other Options are Incorrect:** * **Option B:** This describes a **Low-Dose Combined Oral Contraceptive Pill (COCP)**. While these are common, "Today" is a barrier method, not a hormonal pill. * **Option C:** This describes a **Standard-Dose COCP** (specifically a formulation like Ovral). The dosage of Ethinyl Oestradiol (0.3 mg) mentioned here is actually quite high/toxic; standard pills usually contain 0.03 mg (30 mcg). * **Option D:** **Gossypol** is a polyphenolic compound derived from cottonseed oil investigated as a **male contraceptive** (it inhibits sperm production). It is not used in "Today" and has been largely abandoned due to side effects like permanent infertility and hypokalemia. **3. NEET-PG High-Yield Pearls:** * **Nonoxynol-9:** It is a surfactant that destroys the sperm cell membrane. Note: It does **not** protect against HIV/STIs and may actually increase transmission risk by causing vaginal irritation. * **Toxic Shock Syndrome (TSS):** Users should be warned not to leave the sponge in for more than 30 hours due to the risk of TSS. * **Failure Rate:** The Pearl Index for the sponge is higher (approx. 12–24 per 100 woman-years) compared to OCPs or IUCDs, especially in parous women.

Question 320: Use of oral contraceptives decreases the incidence of all of the following except?

A. Ectopic pregnancy
B. Epithelial ovarian malignancy
C. Hepatic adenoma (Correct Answer)
D. Pelvic inflammatory disease

Explanation: **Explanation:** The correct answer is **C. Hepatic adenoma**. Combined Oral Contraceptive Pills (COCPs) are associated with several non-contraceptive benefits, but they also carry specific metabolic and neoplastic risks. **Hepatic adenoma** is a rare, benign liver tumor that is actually **increased** by the use of COCPs. The risk is dose-dependent and duration-dependent, linked primarily to the estrogen component which can stimulate hepatocyte proliferation. **Why other options are incorrect:** * **Ectopic pregnancy:** COCPs decrease the overall risk of ectopic pregnancy because they are highly effective at preventing ovulation and conception. If there is no pregnancy, there is no risk of an ectopic one. * **Epithelial ovarian malignancy:** COCPs provide a significant protective effect against ovarian cancer (approx. 40-50% reduction). This is due to the suppression of "incessant ovulation," which reduces trauma to the ovarian epithelium. This protection persists for years after discontinuation. * **Pelvic Inflammatory Disease (PID):** Progestogens in COCPs thicken the cervical mucus, creating a physical barrier that prevents the upward migration of pathogens (like *N. gonorrhoeae*) into the upper reproductive tract. **High-Yield NEET-PG Pearls:** * **Protective Effects of COCPs:** Decreased risk of Endometrial cancer, Ovarian cancer (Epithelial), Benign breast disease, PID, and Iron deficiency anemia (due to reduced menstrual flow). * **Increased Risks of COCPs:** Hepatic adenoma, Venous Thromboembolism (VTE), Hypertension, and a slight increase in the risk of Cervical cancer (linked to HPV persistence) and Breast cancer. * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of VTE, smokers >35 years (>15 cigarettes/day), and estrogen-dependent tumors.

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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