Contraception and Family Planning Practice Questions

Q: Which of the following is not related to the use of Levonorgestrel releasing intra-uterine contraceptive device ?

Inhibition of ovulation. ***Inhibition of ovulation*** - Levonorgestrel-releasing IUDs primarily act by thickening cervical mucus, thinning the **endometrium**, and creating a local inflammatory reaction that impairs sperm viability and fertilization. - While some systemic absorption of levonorgestrel occurs, it is generally **insufficient to consistently inhibit ovulation**, unlike higher-dose hormonal contraceptives. *Reduction of pain and dysmenorrhoea in endometriosis and adenomyosis* - The **local release of levonorgestrel** directly in the uterus helps to thin the endometrial lining, reducing prostaglandin production and mitigating pain associated with conditions like endometriosis and adenomyosis. - This local hormonal effect suppresses the growth of ectopic endometrial tissue and decreases uterine contractions, leading to a significant reduction in pain. *Amenorrhoea in 50% of cases* - The **endometrial thinning** caused by continuous levonorgestrel release often leads to a significant decrease in menstrual bleeding, and in about 50% of users, this results in complete amenorrhoea over time. - This effect is beneficial for women with heavy menstrual bleeding or dysmenorrhoea. *Reduction of blood loss* - Levonorgestrel-releasing IUDs are well-known for their efficacy in treating **heavy menstrual bleeding (menorrhagia)**. - The progestin causes significant atrophy and thinning of the endometrium, reducing the amount of tissue shed during menstruation and thus **decreasing blood loss**.

Q: Safe period is calculated by

Length of menstrual cycle. ***Length of menstrual cycle*** - The **"safe period"** or **rhythm method** of contraception relies on estimating the fertile window by tracking the length of the menstrual cycle. - Ovulation typically occurs around day 14 of a 28-day cycle, and the fertile window includes the days leading up to and immediately after ovulation, which is determined by the overall cycle length. *Length of luteal phase* - The **luteal phase** is relatively constant in most women, lasting about **14 days**, irrespective of the overall cycle length. - While it's part of the menstrual cycle, its length alone does not provide enough information to calculate the fertile window for overall "safe period" estimation. *Date of ovulation* - The **date of ovulation** is a crucial component in determining the fertile window but is a specific point within the cycle, not the overall calculation method for the "safe period." - Methods to predict ovulation (e.g., basal body temperature, ovulation predictor kits) help identify the fertile window but are not how the cyclic "safe period" is initially calculated for planning purposes. *Duration of menstrual flow* - The **duration of menstrual flow** (usually 3-7 days) is highly variable among individuals and has no direct correlation with the timing of ovulation or the fertile window. - It marks the beginning of a new cycle but does not help in identifying the fertile days for natural family planning.

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

Previous history of thrombo-embolism. ***Previous history of thrombo-embolism*** - A history of **thromboembolism** significantly increases the risk of recurrent events with combined oral contraceptive pills (COCs) due to their procoagulant effects [1, 2]. - COCs contain **estrogen**, which can enhance the synthesis of clotting factors and decrease natural anticoagulants, making them absolutely contraindicated in this setting [1]. *Migraine without aura* - **Migraine without aura** is generally considered a relative contraindication or a condition requiring careful consideration, not an absolute contraindication, for combined oral contraceptive pills. - The risk of **stroke** is slightly elevated in women with migraine without aura using COCs, but it is not as high as with migraine with aura. *Diabetes mellitus* - **Diabetes mellitus** itself is not an absolute contraindication for combined oral contraceptive pills, especially if it is well-controlled and there are no vascular complications. - However, in cases of diabetes with **vascular complications** (e.g., nephropathy, retinopathy, neuropathy) or of >20 years' duration, COCs are generally contraindicated. *Gall bladder disease* - While combined oral contraceptive pills can increase the risk of **gallstone formation**, especially in susceptible individuals, it is not considered an absolute contraindication. - The effect is linked to **estrogen-induced changes** in bile composition, but careful monitoring is usually sufficient rather than absolute avoidance.

Q: Success of tubal re-canalization is best with :

Laparoscopic ring application. ***Laparoscopic ring application (Falope ring/Tubal clips)*** - Mechanical occlusion methods (clips and rings) cause **minimal tissue destruction**, typically affecting only **2-3 cm** of the fallopian tube. - The tubal segments remain relatively **healthy and undamaged**, with minimal scarring and fibrosis. - Reversal success rates are **highest at 70-90%** due to the preservation of tubal architecture and length. - These methods are considered the **most reversible** form of tubal sterilization. *Pomeroy's technique* - Involves excision of a tubal loop (approximately 3-4 cm) with ligation, causing moderate tissue damage. - The cut ends heal by scarring, and some tubal length is permanently lost. - Reversal success rates are moderate at **60-70%**. - More tissue damage than clip/ring methods but still reasonably reversible. *Uchida's technique* - Involves separating the serosa from the muscularis, ligating and excising a **larger segment** of the tube (4-5 cm). - Creates more extensive tissue damage with greater tubal length loss. - Reversal success rates are lower at **40-50%** due to the complexity and extent of tissue disruption. *Fimbriectomy* - Involves complete removal of the **fimbrial end** of the fallopian tube, which is essential for ovum pickup. - Even if re-anastomosis is technically successful, the **absence of fimbriae** results in extremely poor functional outcomes. - Reversal success rates are very poor at **<20%**, making this the least reversible sterilization method.

Q: Contraindications for medical abortions are all except :

Age more than 35 years. ***Age more than 35 years*** - Age alone, including being over 35 years old, is **not a contraindication** for a medical abortion. - The decision for medical abortion is based on health status, gestational age, and patient choice, not primarily on age. *Uncontrolled seizure disorder* - An **uncontrolled seizure disorder** can be a relative contraindication due to the stress and potential risks associated with the abortion process, which could trigger seizures. - Prostaglandins used in medical abortion can sometimes **increase uterine contractions and pain**, which may exacerbate a seizure disorder. *Hemoglobin less than 8 gm%* - A **hemoglobin level less than 8 gm%** indicates significant anemia, which increases the risk of complications from blood loss during a medical abortion. - Patients with severe anemia may require **blood transfusion** if significant bleeding occurs, making medical abortion less safe. *Undiagnosed adnexal mass* - An **undiagnosed adnexal mass** can be a contraindication because it might mask an **ectopic pregnancy**, for which medical abortion drugs are not effective and could be dangerous. - It also raises concerns about potential **complications or rupture** of the mass during the abortion process.

Q: Oral contraceptives may provide protection against the following malignancies except :

Cervical cancer. ***Cervical cancer*** - Oral contraceptives (OCPs) are associated with an **increased risk of cervical cancer**, particularly with prolonged use, due to their potential influence on the immune response to **HPV infection**. - OCPs do not provide protection against cervical cancer; instead, they are considered a **risk factor** in its development. *Endometrial cancer* - OCPs, especially with their progestin component, offer significant **protection against endometrial cancer** by counteracting unopposed estrogen effects on the endometrium. - This protective effect is evident after just a few years of use and can persist for decades after discontinuation. *Ovarian cancer* - Oral contraceptive use is well-established to **reduce the risk of ovarian cancer**, with the protective effect increasing with longer duration of use. - This protection is thought to be mediated by the **suppression of ovulation**, thereby reducing the continuous trauma to the ovarian surface epithelium. *None of the options* - This option is incorrect because OCPs do provide protection against several malignancies, specifically endometrial and ovarian cancers, but actually increase the risk of cervical cancer.

Q: During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Combined oral contraceptive pills. ***Combined oral contraceptive pills*** - **Combined oral contraceptive pills (COCs)** contain both **estrogen** and **progestin**, and the synthetic estrogen component can potentially reduce breast milk supply, which is critical during the initial 6 months of breastfeeding. - Estrogen may also alter the composition of breast milk, and there's a theoretical concern about **estrogen excretion into breast milk** affecting the newborn during this vulnerable period. *Norplant* - **Norplant** (levonorgestrel implants) contains only **progestin**, which is generally considered safe for use during breastfeeding from 6 weeks postpartum. - Progestin-only contraceptives do not significantly affect milk supply or infant health. *DMPA* - **DMPA (depot medroxyprogesterone acetate)** is an injectable contraceptive containing only **progestin**. It is considered safe and effective during breastfeeding, typically from 6 weeks postpartum. - It does not negatively impact milk production or infant growth and development. *Progestin only pills* - **Progestin-only pills (POPs)** are safe for use during breastfeeding, usually initiated immediately postpartum or from 6 weeks. - They do not contain estrogen, thereby avoiding the concerns associated with combined oral contraceptives regarding milk supply and infant exposure.

Question 1

Which of the following is not related to the use of Levonorgestrel releasing intra-uterine contraceptive device ?

Accepted Answer

Inhibition of ovulation

Answer

Reduction of pain and dysmenorrhoea in endometriosis and adenomyosis

Answer

Amenorrhoea in 50% of cases

Answer

Reduction of blood loss

Question 2

Safe period is calculated by

Accepted Answer

Length of menstrual cycle

Answer

Length of luteal phase

Answer

Date of ovulation

Answer

Duration of menstrual flow

Question 3

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

Accepted Answer

Previous history of thrombo-embolism

Answer

Migraine without aura

Answer

Diabetes mellitus

Answer

Gall bladder disease

Question 4

Success of tubal re-canalization is best with :

Accepted Answer

Laparoscopic ring application

Answer

Uchida's technique

Answer

Fimbriectomy

Answer

Pomeroy's technique

Question 5

In a woman using an intrauterine contraceptive device (IUCD) an unexpected pregnancy occurs and the IUCD threads are visible. What is the reason to recommend removal of the device ?

Accepted Answer

To prevent the risk of subsequent septic abortion and preterm labour

Answer

To prevent post partum haemorrhage

Answer

To prevent congenital abnormality of the newborn

Answer

To prevent perforation

Question 6

Contraindications for medical abortions are all except :

Accepted Answer

Age more than 35 years

Answer

Uncontrolled seizure disorder

Answer

Hemoglobin less than 8 gm%

Answer

Undiagnosed adnexal mass

Question 7

Oral contraceptives may provide protection against the following malignancies except :

Accepted Answer

Cervical cancer

Answer

Endometrial cancer

Answer

Ovarian cancer

Answer

None of the options

Question 8

During the first 6 months of lactation, which amongst the following contraceptives is not advisable?

Accepted Answer

Combined oral contraceptive pills

Answer

Norplant

Answer

DMPA

Answer

Progestin only pills

Question 9

A man underwent vasectomy, but 6 months later his wife was 16 week pregnant. What is the most likely cause ?

Accepted Answer

Failure to use additional contraception in postoperative period

Answer

Recanalisation of vas

Answer

Pregnancy antedating vasectomy

Answer

Failure of operative procedure

Question 10

Following are the contraindications for laparoscopic female sterilization except :

Accepted Answer

Hiatus hernia

Answer

Respiratory dysfunction

Answer

Heart disease

Answer

Obesity

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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