Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 341: The IUCD Copper T 200 is named "Copper 200" because it:

A. Contains 200 mg of copper
B. Has 200 sq mm of surface area covered with copper (Correct Answer)
C. Has 200 copper turns
D. Can be retained for 200 days

Explanation: **Explanation:** The nomenclature of Intrauterine Contraceptive Devices (IUCDs) like the Copper T 200 is based on the **surface area of the copper wire** wrapped around the stem. In "Copper T 200," the number **200** represents **200 square millimeters (sq mm)** of copper surface area. This surface area is critical because the contraceptive efficacy of an IUCD is directly proportional to the amount of copper exposed to the uterine environment. Copper ions act as a spermicide by causing a local inflammatory response and altering the uterine milieu. **Analysis of Options:** * **Option A (200 mg):** While the device contains a specific weight of copper, the naming convention is strictly based on surface area, not mass. * **Option B (Correct):** This is the standard medical definition for the numbering of IUCDs. * **Option C (200 turns):** The number of turns is a manufacturing detail and does not define the clinical name. * **Option D (200 days):** The Copper T 200 is a long-acting reversible contraceptive (LARC) with an effective lifespan of **3 years**, far exceeding 200 days. **High-Yield Clinical Pearls for NEET-PG:** * **CuT 200:** Effective for **3 years**. * **CuT 380A:** The current "Gold Standard" in India; effective for **10 years**. (380 sq mm surface area). * **Multiload 375:** Effective for **5 years**. * **Mechanism:** Primarily prevents fertilization by reducing sperm motility and viability (spermicidal). * **Ideal Insertion Time:** Within 10 days of the start of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Most Common Side Effect:** Excessive menstrual bleeding (menorrhagia). * **Most Common Reason for Removal:** Pain and bleeding.

Question 342: The progestogenic emergency contraceptive pills act by:

A. Altered cervical secretion
B. Inhibition of ovulation
C. Anti-implantation effect (Correct Answer)
D. Inhibition of LH secretion

Explanation: **Explanation:** The primary mechanism of action for **Progestogen-only Emergency Contraceptive Pills (ECPs)**, such as Levonorgestrel (1.5 mg), depends on the timing of administration during the menstrual cycle. However, for the purpose of standard examinations like NEET-PG, the **anti-implantation effect** is often highlighted as a definitive mechanism when fertilization might have already occurred. 1. **Why "Anti-implantation effect" is correct:** Progestogens in high doses cause rapid histological changes in the endometrium, making it "out of phase" and unreceptive to a fertilized ovum. It alters the endometrial lining, preventing the blastocyst from successfully implanting. 2. **Why other options are incorrect:** * **Inhibition of ovulation (Option B & D):** While high-dose progestogens can delay or inhibit the LH surge (Option D) and thus prevent ovulation (Option B) if taken in the pre-ovulatory phase, they are ineffective if ovulation has already occurred. The "anti-implantation" effect is what provides protection later in the fertile window. * **Altered cervical secretion (Option A):** While this is the primary mechanism for *daily* Progestogen-Only Pills (POPs/Mini-pills) by thickening cervical mucus to prevent sperm penetration, it is not the definitive mechanism for a one-time emergency dose intended to prevent pregnancy after intercourse has already happened. **High-Yield Clinical Pearls for NEET-PG:** * **Levonorgestrel (LNG):** Must be taken within **72 hours** (3 days) of unprotected intercourse. Dose: 1.5 mg single dose or 0.75 mg two doses 12 hours apart. * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM); effective up to **120 hours** (5 days). It is currently considered more effective than LNG. * **Most Effective ECP:** The **Copper-T (IUCD)** inserted within 5 days is the most effective emergency contraceptive and provides the best anti-implantation effect. * **Yuzpe Regimen:** Uses combined oral contraceptive pills (Ethinylestradiol + Levonorgestrel). It has more side effects (nausea/vomiting) compared to LNG-only pills.

Question 343: A 25-year-old woman with an IUD inserted 2 years ago presents with fever. On examination, actinomyces is positive in cervical cytology. What would you advise regarding the IUD?

A. Continue some contraception; no need for treatment.
B. Hysterectomy
C. Leave the IUD in place and start an antibiotic course.
D. Remove the IUD and give intensive antibiotic therapy. (Correct Answer)

Explanation: ### Explanation The presence of **Actinomyces israelii** on cervical cytology in a woman using an Intrauterine Device (IUD) is a significant clinical finding. While Actinomyces can be a commensal organism, its association with IUDs can lead to serious **Pelvic Inflammatory Disease (PID)** or Pelvic Actinomycosis, characterized by "woody" pelvic induration and abscess formation. **1. Why Option D is Correct:** The patient is **symptomatic** (presenting with fever). In a symptomatic patient with IUD-associated Actinomyces, the standard management protocol is the **removal of the IUD** followed by **intensive antibiotic therapy** (typically high-dose Penicillin). The IUD acts as a foreign body nidus for the bacteria; therefore, it must be removed to ensure effective eradication of the infection. **2. Why Other Options are Incorrect:** * **Option A:** Ignoring the finding is only considered in *asymptomatic* patients (though even then, many experts suggest counseling or removal). Since this patient has a fever, conservative management is contraindicated. * **Option B:** Hysterectomy is an extreme surgical intervention reserved only for severe, refractory cases with extensive tubo-ovarian abscesses that do not respond to medical management. * **Option C:** Leaving the IUD in place while giving antibiotics is ineffective because the biofilm on the device protects the bacteria from the host immune system and antibiotic penetration. **3. High-Yield Clinical Pearls for NEET-PG:** * **Organism:** *Actinomyces israelii* is a Gram-positive, anaerobic, filamentous bacterium (often described as "sulfur granules" on histology). * **Asymptomatic vs. Symptomatic:** If the patient is asymptomatic, the IUD can often be left in place (per CDC guidelines), but for NEET-PG purposes, if symptoms like fever or pelvic pain are present, **Removal + Antibiotics** is the gold standard. * **Drug of Choice:** Penicillin G is the treatment of choice for Actinomycosis. * **Duration:** Treatment for pelvic actinomycosis often requires a prolonged course (weeks to months) depending on the severity.

Question 344: A 30-year-old woman is on warfarin for deep vein thrombosis. Which contraceptive should be advised to her?

A. Progesterone-only pills
B. Levonorgestrel implant
C. Intrauterine contraceptive device (IUCD) (Correct Answer)
D. Implanon

Explanation: **Explanation:** The primary concern for a patient on **Warfarin** for Deep Vein Thrombosis (DVT) is the high risk of recurrent thromboembolism. In such cases, the selection of contraception is guided by the **WHO Medical Eligibility Criteria (MEC)**. **1. Why IUCD is the Correct Choice:** The **Intrauterine Contraceptive Device (IUCD)**, specifically the Copper-T (Cu-T), is categorized as **WHO MEC 1** (no restriction) for women with a history of DVT or those on anticoagulant therapy. It is a non-hormonal method that does not increase the risk of thrombosis. While anticoagulants can increase menstrual bleeding, the Cu-T remains the safest long-term option. Note: The Levonorgestrel-IUS (Mirena) is also an excellent choice as it reduces the heavy menstrual bleeding often caused by Warfarin. **2. Why Other Options are Incorrect:** * **Progesterone-only pills (POPs), Levonorgestrel implants, and Implanon:** These are generally categorized as **WHO MEC 2** for patients with current DVT or those on anticoagulants. While they do not contain estrogen (the primary culprit in thrombosis), they are considered secondary to IUCDs in this specific clinical scenario. * **Combined Oral Contraceptive Pills (COCPs):** (Though not an option here) These are strictly **Contraindicated (WHO MEC 4)** because estrogen increases clotting factors and the risk of recurrent DVT. **Clinical Pearls for NEET-PG:** * **Gold Standard:** For any patient with a history of thromboembolism, **Non-hormonal methods (Cu-T)** or **Progestogen-only methods** are preferred. * **MEC 4 (Absolute Contraindication) for COCPs:** History of DVT/PE, Migraine with aura, Smoking >15 cigarettes/day in women >35 years, and Breast Cancer. * **Warfarin & Pregnancy:** Warfarin is **teratogenic** (causes fetal warfarin syndrome/chondrodysplasia punctata); hence, highly effective contraception like an IUCD is mandatory.

Question 345: Which of the following best describes conventional contraceptives?

A. Contraceptives discovered before 1960
B. Contraceptives that require action after intercourse
C. Contraceptives that require action at the time of intercourse (Correct Answer)
D. Contraceptives that require action before intercourse

Explanation: ### Explanation **Concept Overview:** In family planning, contraceptives are broadly classified into **Conventional** and **Non-conventional** methods based on their timing and mode of action. **Conventional contraceptives** are those that require specific action or application **at the time of intercourse** to be effective. These methods primarily act as mechanical or chemical barriers to prevent the meeting of sperm and ovum. **Why Option C is Correct:** Conventional methods include **barrier methods** (condoms, diaphragms, cervical caps) and **spermicides**. Their efficacy is strictly dependent on their use during the sexual act. If the couple fails to use them during intercourse, there is no residual contraceptive protection. **Analysis of Incorrect Options:** * **Option A:** The classification is based on the **mechanism and timing of use**, not the historical date of discovery. While many conventional methods are old, "pre-1960" is not a medical definition. * **Option B:** Methods used after intercourse are termed **Emergency Contraceptives** (e.g., Levonorgestrel 1.5mg or Copper-T insertion). * **Option C:** Methods that require action *before* intercourse (independent of the act) include **Long-Acting Reversible Contraceptives (LARC)** like IUCDs, hormonal implants, or daily Oral Contraceptive Pills (OCPs). **High-Yield Clinical Pearls for NEET-PG:** * **Condoms:** The only conventional contraceptive that provides dual protection against both pregnancy and **STIs/HIV**. * **Failure Rates:** Conventional methods generally have higher **user-failure rates** (Typical use) compared to non-conventional methods like IUCDs because they require high motivation and correct technique during every act of intercourse. * **Spermicides:** Most commonly contain **Nonoxynol-9**, which acts by disrupting the sperm cell membrane. * **Today Vaginal Sponge:** A combined mechanical and chemical barrier containing Nonoxynol-9; it must be moistened before insertion and left in place for 6 hours post-intercourse.

Question 346: All of the following are mechanisms of action of intrauterine contraceptive devices (IUCD) except:

A. Impeding sperm transport and inhibiting their capacitation
B. Foreign body reaction in the endometrium
C. Inhibition of ovulation
D. Production of anti-sperm antibodies (Correct Answer)

Explanation: ### Explanation The primary mechanism of action of an Intrauterine Contraceptive Device (IUCD) is to create a sterile inflammatory environment within the uterus that is hostile to both sperm and the blastocyst. **Why Option D is the Correct Answer:** **Production of anti-sperm antibodies** is **not** a mechanism of IUCDs. Anti-sperm antibodies are typically associated with immunological infertility or conditions where the blood-testis barrier is breached (e.g., vasectomy). IUCDs act through local biochemical and cellular changes, not by inducing a systemic or local antibody-mediated immune response against spermatozoa. **Analysis of Other Options:** * **Option A (Impeding sperm transport/capacitation):** Copper ions (Cu2+) released from Cu-T devices are toxic to sperm. They inhibit sperm motility and interfere with **capacitation** (the final maturation step required for fertilization), preventing the sperm from reaching the fallopian tube. * **Option B (Foreign body reaction):** The presence of the device triggers a massive infiltration of polymorphonuclear leukocytes (neutrophils), prostaglandins, and cytokines in the endometrium. This "foreign body reaction" makes the uterine environment spermicidal and prevents implantation. * **Option C (Inhibition of ovulation):** While **non-hormonal** IUCDs (like Cu-T 380A) do *not* inhibit ovulation, **Hormonal IUCDs (LNG-IUD/Mirena)** can cause anovulation in about 15–25% of cycles due to partial systemic absorption of levonorgestrel. Since the question asks for mechanisms of "IUCDs" in general, this is considered a valid mechanism for the hormonal subtype. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect of Cu-T:** Menorrhagia (heavy menstrual bleeding). * **Most common reason for removal of Cu-T:** Pain and bleeding. * **Ideal time for insertion:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated). * **Mechanism of LNG-IUD (Mirena):** Primarily works by **thickening cervical mucus** and causing endometrial atrophy.

Question 347: All of the following are used for contraception in patients with sickle cell anemia except?

A. Oral contraceptive pills (Correct Answer)
B. Intrauterine contraceptive device (IUCD)
C. Progestin-only pills
D. Progesterone implants

Explanation: **Explanation:** The primary concern in managing contraception for patients with **Sickle Cell Anemia (SCA)** is the risk of triggering a vaso-occlusive crisis or thromboembolic events. **1. Why Oral Contraceptive Pills (OCPs) are the Correct Answer:** Combined Oral Contraceptive Pills contain **Estrogen**, which is known to increase the synthesis of clotting factors and enhance platelet aggregation. In patients with SCA, who are already at a baseline hypercoagulable state and prone to vascular stasis, the addition of estrogen significantly increases the risk of **thromboembolism and stroke**. Therefore, estrogen-containing methods are generally avoided (WHO MEC Category 4 or 3 depending on severity). **2. Analysis of Other Options:** * **IUCD (Option B):** Copper IUCDs are safe as they are non-hormonal. However, Levonorgestrel-IUS (Mirena) is often preferred as it reduces menstrual blood loss, helping with the anemia common in SCA. * **Progestin-only Pills (Option C) & Progesterone Implants (Option D):** Progesterone-only methods do not carry the same thromboembolic risks as estrogen. In fact, **Depot Medroxyprogesterone Acetate (DMPA)** is often considered a "gold standard" for SCA because it has been shown to stabilize red cell membranes and reduce the frequency of painful crises. **Clinical Pearls for NEET-PG:** * **Best Choice:** DMPA (Injectable) is highly recommended for SCA as it reduces sickling and crises. * **Avoid:** Any combined hormonal contraceptive (Pills, Patch, Ring) due to the estrogen component. * **WHO MEC:** For Sickle Cell Disease, Combined Hormonal Contraceptives are Category 4 (Unacceptable health risk).

Question 348: Which of the following is NOT a complication of oral contraceptive pills?

A. Weight loss (Correct Answer)
B. Hyperlipidemia
C. Hypertension
D. Depression

Explanation: **Explanation:** The correct answer is **Weight loss**. Combined Oral Contraceptive Pills (COCPs) are more commonly associated with **weight gain** rather than weight loss. This occurs due to the anabolic effects of progestogens and estrogen-induced sodium and water retention. **Why the other options are complications:** * **Hyperlipidemia:** Estrogen increases the synthesis of hepatic triglycerides and VLDL. While it may raise HDL (the "good" cholesterol), the overall effect on the lipid profile can be significant, especially in women with pre-existing dyslipidemia. * **Hypertension:** COCPs stimulate the hepatic production of angiotensinogen (renin substrate) via the mineralocorticoid effect of estrogen, leading to the activation of the Renin-Angiotensin-Aldosterone System (RAAS). This can cause a mild to moderate rise in blood pressure in susceptible individuals. * **Depression:** Progestogens in the pills can influence neurotransmitters like serotonin. Mood swings and depressive symptoms are documented side effects that often lead to the discontinuation of the pill. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Breakthrough bleeding (spotting), especially in the first few months of use. * **Most serious side effect:** Venous Thromboembolism (VTE) and increased risk of stroke/MI (especially in smokers >35 years). * **Protective effects:** COCPs significantly reduce the risk of **Ovarian cancer** and **Endometrial cancer** (protection lasts for years after discontinuation). * **Absolute Contraindications:** Undiagnosed vaginal bleeding, history of thromboembolism, estrogen-dependent tumors (Breast CA), and active liver disease.

Question 349: A 26-year-old female on a progestin-only pill contraceptive attends the gynecology OPD concerned about not taking her pill at the same time every day. She took her pill daily at 10 a.m. except for one day when she took it at 5 p.m. What is your advice?

A. No need to worry, continue the same contraceptive.
B. Use an additional form of contraceptive for the next 48 hours. (Correct Answer)
C. Change over to combined oral contraceptive pills.
D. Take a double dose of the pill the next morning.

Explanation: ### Explanation **1. Why Option B is Correct:** The Progestin-Only Pill (POP), often called the "mini-pill," has a very narrow therapeutic window. Most traditional POPs (containing levonorgestrel or norethindrone) are considered **"missed" if taken more than 3 hours late**. In this case, the patient took the pill 7 hours late (5 p.m. instead of 10 a.m.). Unlike combined pills, POPs primarily work by **thickening the cervical mucus**, an effect that begins to diminish rapidly after 24 hours. If a dose is missed by >3 hours, the mucus becomes permeable to sperm. It takes approximately **48 hours** of consistent dosing to re-establish the contraceptive effect of the cervical mucus; hence, backup contraception (like condoms) is mandatory for the next 2 days. **2. Why Other Options are Incorrect:** * **Option A:** Incorrect because a 7-hour delay exceeds the 3-hour safety margin, putting the patient at risk of unintended pregnancy. * **Option C:** While she could switch in the future, it does not address the immediate risk caused by the missed dose. * **Option D:** Doubling the dose does not immediately restore the cervical mucus barrier and is not the standard protocol for POPs. **3. Clinical Pearls for NEET-PG:** * **The "3-Hour Rule":** Traditional POPs (Norethindrone) have a 3-hour window. *Exception:* The newer **Desogestrel** (75mcg) POP has a wider **12-hour window**, similar to COCs. * **Mechanism of Action:** POPs primarily work via cervical mucus thickening. They do not consistently suppress ovulation (only in ~50% of cycles). * **Ideal Candidate:** POPs are the contraceptive of choice for **lactating mothers** (do not suppress milk production) and women with contraindications to estrogen (e.g., history of DVT, smokers >35 years, or migraine with aura). * **Side Effect:** The most common side effect of POPs is **irregular spotting or breakthrough bleeding**.

Question 350: Which method of sterilization is least suited for recanalisation?

A. Clips
B. Bipolar cauterization (Correct Answer)
C. Fallopian rings
D. Pomeroys technique

Explanation: **Explanation:** The success of tubal recanalization (reversal of sterilization) depends primarily on the **length of the healthy fallopian tube remaining** and the **degree of tissue destruction** caused during the initial procedure. **Why Bipolar Cauterization is the correct answer:** Bipolar cauterization involves passing an electric current through a segment of the fallopian tube. This causes extensive **thermal damage** and lateral heat spread, leading to significant necrosis and scarring of the tubal tissue. Typically, 2–3 cm of the tube is destroyed. Because the damage is widespread and the blood supply is often compromised, there is insufficient healthy tissue left for a successful end-to-end anastomosis, making it the least suited for recanalization. **Analysis of Incorrect Options:** * **Clips (e.g., Hulka-Clemens, Filshie):** These cause the **least amount of damage** (approx. 4 mm of the tube). They have the highest success rates for recanalization. * **Fallopian Rings (Silastic bands):** These cause intermediate damage (approx. 2 cm) by causing ischemic necrosis of a small loop. Recanalization success is better than cauterization but lower than clips. * **Pomeroy’s Technique:** This is a surgical method involving ligation and excision of a mid-segment loop. While it removes a segment of the tube, the remaining ends are usually healthy and not thermally damaged, allowing for relatively successful surgical reversal. **High-Yield Clinical Pearls for NEET-PG:** * **Best method for recanalization:** Clips (Minimal tissue destruction). * **Most common method used in India:** Minilap with Pomeroy’s technique. * **Most common method used globally (Laparoscopic):** Falope rings. * **Ideal length of tube for successful reversal:** At least 4 cm of healthy tube must remain. * **Site of reversal:** The **isthmus-isthmus** anastomosis yields the highest pregnancy rates.

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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