Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 351: Norplant contains how many capsules of levonorgestrel?

A. 4
B. 6 (Correct Answer)
C. 8
D. 10

Explanation: **Explanation:** **Norplant** is a first-generation subdermal contraceptive implant system. The correct answer is **6 capsules** because the original Norplant system consists of six flexible Silastic (silicone rubber) capsules, each measuring 34 mm in length and 2.4 mm in diameter. Each capsule contains **36 mg of Levonorgestrel (LNG)**, totaling 216 mg for the entire set. It provides highly effective contraception for up to **5 years** by releasing a low, continuous dose of progestogen. **Analysis of Options:** * **Option A (4):** Incorrect. There is no standard LNG implant system using 4 capsules. * **Option B (6):** **Correct.** This is the classic Norplant configuration. * **Option C (8) & D (10):** Incorrect. These numbers are not used in clinical contraceptive implant designs, as they would be surgically cumbersome to insert and remove. **High-Yield Clinical Pearls for NEET-PG:** * **Norplant vs. Norplant-2 (Jadelle):** While Norplant has 6 capsules, **Norplant-2 (Jadelle)** consists of only **2 rods**, each containing 75 mg of LNG (total 150 mg), also effective for 5 years. * **Mechanism of Action:** Primarily works by thickening cervical mucus (preventing sperm penetration) and suppressing ovulation in about 50% of cycles. * **Implanon/Nexplanon:** These are single-rod implants containing **Etonogestrel** (68 mg), effective for 3 years. * **Insertion Site:** Subdermally in the inner aspect of the non-dominant upper arm. * **Side Effects:** The most common side effect is **irregular menstrual bleeding** (spotting or breakthrough bleeding).

Question 352: What is the cumulative pregnancy rate at 5 years for a levonorgestrel-releasing intrauterine device (LNG-IUD)?

A. 0.5% (Correct Answer)
B. 1%
C. 1.5%
D. 2%

Explanation: The **Levonorgestrel-releasing Intrauterine Device (LNG-IUD)**, specifically the 52mg system (Mirena), is one of the most effective forms of Long-Acting Reversible Contraception (LARC). ### **Explanation of the Correct Answer** The correct answer is **0.5%**. According to large-scale clinical trials and the Pearl Index, the cumulative failure rate for the LNG-IUD over a 5-year period is approximately **0.5 to 0.8 per 100 users**. Its high efficacy is attributed to its local mechanism: it thickens cervical mucus (preventing sperm penetration), inhibits sperm motility, and causes endometrial atrophy. Unlike oral contraceptives, its efficacy is not dependent on patient compliance, making its "typical use" failure rate nearly identical to its "perfect use" rate. ### **Analysis of Incorrect Options** * **Option B (1%):** This is higher than the observed 5-year rate for LNG-IUD. However, 1% is closer to the failure rate of the Copper T 380A (approx. 0.8% at 1 year). * **Options C and D (1.5% and 2%):** These rates are significantly higher than the failure rates of modern LARCs. A 2% failure rate is more characteristic of the first-year "typical use" of injectable progestogens or male condoms. ### **High-Yield Clinical Pearls for NEET-PG** * **Most Effective Contraceptive:** The LNG-IUD and Subdermal Implants (Etonogestrel) have lower failure rates than permanent sterilization (Tubal Ligation). * **Non-Contraceptive Benefit:** LNG-IUD is the **drug of choice (DOC)** for Idiopathic Menorrhagia and is highly effective in managing endometriosis-associated pain. * **Comparison:** The 10-year cumulative failure rate for Copper T 380A is approximately 2%, whereas the LNG-IUD remains superior in efficacy over its 5-year lifespan. * **Mechanism:** Primarily local; it does not consistently suppress ovulation (unlike the POP or COCP).

Question 353: What is the Pearl Index?

A. Accidental pregnancies per 1000 women-years of exposure
B. Accidental pregnancies per 100 women-years of exposure (Correct Answer)
C. Accidental pregnancies per 10 women-years of exposure
D. Accidental pregnancies per women-years of exposure

Explanation: The **Pearl Index** is the most common method used in clinical trials and epidemiological studies to measure the **effectiveness of a contraceptive method**. ### **Explanation of the Correct Answer** The Pearl Index is defined as the number of unintended pregnancies per **100 woman-years** of exposure. It represents the failure rate of a contraceptive method. A lower Pearl Index indicates a more effective contraceptive method. The formula used is: $$\text{Pearl Index} = \frac{\text{Total number of accidental pregnancies} \times 1200}{\text{Total months of exposure}}$$ *(Note: 1200 is used to convert the denominator into 100 woman-years, as $100 \text{ women} \times 12 \text{ months} = 1200$).* ### **Analysis of Incorrect Options** * **Option A (1000 women-years):** This is a common distractor. Standard epidemiological reporting for contraception uses a base of 100 to express results as a percentage-like failure rate. * **Options C & D (10 or 1 women-years):** These values are too small to provide a statistically significant or standardized representation of contraceptive failure across a population. ### **NEET-PG High-Yield Pearls** * **Perfect Use vs. Typical Use:** The Pearl Index varies based on whether the method is used correctly every time (perfect) or how it is used in real-world conditions (typical). * **Lowest Pearl Index (Most Effective):** Implants (e.g., Nexplanon) have the lowest Pearl Index (~0.05), followed by Vasectomy and IUCDs. * **Highest Pearl Index (Least Effective):** Barrier methods (Condoms) and behavioral methods (Withdrawal/Rhythm method) have higher Pearl Indices. * **Alternative Measure:** The **Life Table Analysis** is considered superior to the Pearl Index because it calculates failure rates at specific intervals (e.g., at 6 months vs. 24 months), accounting for the fact that failure rates usually decrease over time as users become more proficient.

Question 354: Which of the following is NOT a characteristic of an ideal candidate for copper-T insertion?

A. Has borne at least one child
B. Is willing to check the IUD tail
C. Has a history of ectopic pregnancy (Correct Answer)
D. Has normal menstrual periods

Explanation: ### Explanation The goal of selecting an "ideal candidate" for an Intrauterine Device (IUD) like Copper-T is to maximize contraceptive efficacy while minimizing the risk of expulsion, infection, and complications. **Why Option C is the Correct Answer:** A **history of ectopic pregnancy** is a relative contraindication (WHO MEC Category 3 for continuation, though not necessarily for initiation, it makes a patient "less than ideal"). While IUDs are highly effective at preventing all types of pregnancy, if a pregnancy *does* occur with an IUD in situ, there is a higher statistical probability that it will be ectopic. Therefore, a woman with a prior history of ectopic pregnancy is not considered an "ideal" candidate because she is already at a higher baseline risk for recurrence. **Analysis of Incorrect Options:** * **Option A (Has borne at least one child):** Multiparous women are ideal candidates because the cervical canal is more patulous, making insertion easier, and the uterine cavity is more accommodating, which reduces the risk of expulsion and pain compared to nulliparous women. * **Option B (Willing to check the IUD tail):** An ideal user must be motivated to perform a self-examination (feeling for the string) after each menstrual cycle to ensure the device has not been expelled. * **Option D (Has normal menstrual periods):** Copper-T often increases menstrual blood flow and cramping. Therefore, a woman who already has heavy or painful periods (menorrhagia/dysmenorrhea) is a poor candidate; an ideal candidate should have a normal baseline cycle. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Copper-T primarily acts as a **spermicide** by causing a sterile inflammatory response in the endometrium and altering tubal motility. * **Most Common Side Effect:** Bleeding (Menorrhagia) is the #1 reason for discontinuation. * **WHO MEC Category 4 (Absolute Contraindications):** Pregnancy, unexplained vaginal bleeding, current PID, and distorted uterine cavity (e.g., large fibroids). * **Ideal Insertion Time:** Within 10 days of the start of the menstrual cycle (to ensure the patient is not pregnant and the cervix is slightly dilated).

Question 355: Oral contraceptive pills do not decrease the risk of which of the following?

A. Sexually transmitted diseases (Correct Answer)
B. Benign breast disease
C. Ovarian cyst
D. Ectopic pregnancy

Explanation: **Explanation:** The correct answer is **A. Sexually transmitted diseases**. Combined Oral Contraceptive Pills (COCPs) provide highly effective systemic contraception but offer **no physical barrier** against pathogens. In fact, some studies suggest that OCP use may indirectly increase the risk of STDs due to "behavioral disinhibition" (decreased condom use) and physiological changes like cervical ectopy, which may increase susceptibility to *Chlamydia trachomatis*. **Why the other options are incorrect:** * **Benign Breast Disease (BBD):** OCPs significantly reduce the incidence of fibrocystic disease and fibroadenomas. The progestogen component is thought to limit the proliferative effect of estrogen on mammary tissue. * **Ovarian Cysts:** By suppressing the Hypothalamic-Pituitary-Ovarian (HPO) axis and inhibiting ovulation, OCPs prevent the formation of functional follicular and corpus luteum cysts. * **Ectopic Pregnancy:** While OCPs do not prevent the *site* of an ectopic pregnancy if fertilization occurs, they are so effective at preventing ovulation (conception) that the **absolute risk** of an ectopic pregnancy is significantly lower in OCP users compared to women not using contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects of OCPs:** They reduce the risk of **Endometrial cancer** (by 50%) and **Ovarian cancer** (by 40%). This protection persists for 15+ years after discontinuation. * **Other Benefits:** Reduced risk of Pelvic Inflammatory Disease (PID) due to thickening of cervical mucus, and improvement in Iron Deficiency Anemia (due to reduced menstrual flow). * **Increased Risks:** OCPs are associated with an increased risk of Venous Thromboembolism (VTE), Stroke, Myocardial Infarction, and **Cervical Cancer** (with long-term use >5 years).

Question 356: Which of the following agents cannot be used for postcoital contraception?

A. Danazol (Correct Answer)
B. Copper T
C. Mifepristone
D. High dose estrogen

Explanation: **Explanation:** The correct answer is **Danazol**. While historically explored as a potential emergency contraceptive, Danazol (an ethinyl testosterone derivative) has been proven **ineffective** for postcoital contraception and is no longer recommended or used for this purpose. Its primary roles in gynecology are the treatment of endometriosis and hereditary angioedema. **Analysis of Options:** * **Copper T (Option B):** This is the **most effective** method of emergency contraception (failure rate <0.1%). It can be inserted up to 5 days (120 hours) after unprotected intercourse and provides the added benefit of long-term reversible contraception. * **Mifepristone (Option C):** A selective progesterone receptor modulator (SPRM). In low doses (10 mg or 25 mg), it is highly effective for emergency contraception by delaying ovulation. It is often preferred over the Yuzpe regimen due to fewer side effects. * **High-dose Estrogen (Option D):** Historically used as the "morning-after pill" (e.g., Ethinyl estradiol 5mg for 5 days). While effective, it is rarely used today due to severe nausea and vomiting. It has been largely replaced by the **Yuzpe Regimen** (combined E+P) or Levonorgestrel-only pills. **NEET-PG High-Yield Pearls:** 1. **Gold Standard:** The most effective emergency contraceptive is the **Copper-T 380A**. 2. **Drug of Choice (DOC):** The current hormonal DOC is **Levonorgestrel (1.5 mg single dose)**, effective up to 72 hours. 3. **Ulipristal Acetate:** A newer SPRM effective up to **120 hours (5 days)**; it is more effective than LNG in obese women. 4. **Mechanism:** Most hormonal emergency contraceptives work primarily by **delaying or inhibiting ovulation**; they are not abortifacients.

Question 357: Which of the following is NOT a non-contraceptive use of oral contraceptive pills?

A. Endometrial carcinoma
B. Breast carcinoma (Correct Answer)
C. Rheumatoid arthritis
D. Endometriosis

Explanation: Combined Oral Contraceptive Pills (COCPs) offer several health benefits beyond pregnancy prevention. However, their relationship with breast cancer is a critical distinction for the NEET-PG exam. ### **Explanation** **Breast carcinoma** is the correct answer because COCPs are **not** protective against it. In fact, long-term use of COCPs is associated with a slight **increase in the risk** of breast cancer (Relative Risk ~1.24), which returns to baseline 10 years after discontinuation. Therefore, it is a potential risk rather than a non-contraceptive benefit. ### **Analysis of Other Options** * **Endometrial Carcinoma:** COCPs are highly protective. Progestogen in the pill opposes the action of estrogen, preventing endometrial hyperplasia. Use for 12 months reduces risk by 50%, and protection persists for up to 15–20 years after stopping. * **Rheumatoid Arthritis:** Epidemiological studies suggest that COCPs may reduce the progression and severity of Rheumatoid Arthritis, possibly due to the anti-inflammatory effects of sex steroids. * **Endometriosis:** COCPs are a first-line medical management. They induce a state of "pseudopregnancy," causing decidualization and subsequent atrophy of ectopic 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 40-50%) and **Endometrial cancer**. They also reduce the risk of **Colorectal cancer**. * **Cancer Risk:** COCPs are associated with an increased risk of **Cervical cancer** (especially with >5 years of use) and **Hepatic adenoma**. * **Benign Breast Disease:** While they increase the risk of breast *carcinoma*, COCPs actually **reduce** the incidence of *benign* breast diseases like fibroadenoma and cystic changes. * **Other Benefits:** Reduction in Pelvic Inflammatory Disease (PID), ectopic pregnancy, and iron-deficiency anemia (due to reduced menstrual flow).

Question 358: A patient was placed on depot medroxy progesterone acetate. She now complains of irregular spotting. Which of the following is NOT a treatment option?

A. Add combined oral contraceptive pills for 4 weeks.
B. Give mefenamic acid for 1 week.
C. Give premarin for 4 weeks.
D. Place a progestin-only implant. (Correct Answer)

Explanation: **Explanation:** The primary side effect of Depot Medroxyprogesterone Acetate (DMPA) is **breakthrough bleeding or irregular spotting**, caused by the thinning of the endometrial lining (endometrial atrophy) and increased fragility of the capillaries due to the lack of estrogen. **Why Option D is the Correct Answer:** Placing a **progestin-only implant** (like Nexplanon) is **not** a treatment for DMPA-induced spotting. In fact, it would likely exacerbate the problem. The underlying cause of spotting in DMPA users is a "progestin-only" environment leading to an unstable, atrophic endometrium. Adding more progestin does not stabilize the lining; instead, it further suppresses endogenous estrogen, worsening the irregular bleeding. **Why the other options are incorrect (Management of Spotting):** * **Option A (COCPs):** Combined Oral Contraceptive Pills provide ethinyl estradiol, which helps stabilize the endometrium and promote organized growth, effectively stopping the spotting. * **Option B (Mefenamic Acid):** NSAIDs are a first-line non-hormonal treatment. They work by inhibiting prostaglandin synthesis, which reduces local inflammation and decreases menstrual blood flow. * **Option C (Premarin):** Premarin (conjugated equine estrogen) provides exogenous estrogen to "rescue" the atrophic endometrium, promoting healing and stabilization of the lining. **High-Yield Clinical Pearls for NEET-PG:** * **DMPA Schedule:** 150 mg intramuscularly every 3 months (12 weeks). * **Amenorrhea:** After 1 year of DMPA use, approximately 50-70% of women develop amenorrhea, which is a normal and expected effect. * **Bone Mineral Density (BMD):** Long-term DMPA use is associated with a reversible decrease in BMD (FDA Black Box Warning). * **Weight Gain:** DMPA is the only contraceptive significantly associated with weight gain.

Question 359: A 28-year-old female, with a one-year-old daughter, diagnosed with diabetes a few months ago which is controlled with diet and exercise, presents seeking contraception. Which of the following is the best contraceptive method of choice for this patient?

A. Condoms used by the husband (Correct Answer)
B. Intrauterine contraceptive device (IUCD)
C. Oral contraceptive pills (OCP)
D. Vaginal sponge

Explanation: **Explanation:** The patient is a young diabetic woman seeking contraception. In the context of diabetes mellitus, the selection of a contraceptive method depends on the presence of vascular complications and the potential impact on metabolic parameters. **1. Why Condoms (Option A) are the correct choice:** Barrier methods, specifically **condoms**, are considered the best choice for this patient because they are **metabolically neutral**. They do not interfere with blood glucose levels, lipid profiles, or cardiovascular risk. For a patient whose diabetes is currently controlled by diet and exercise, avoiding hormonal interference is ideal to prevent the progression to pharmacological management. **2. Why other options are incorrect:** * **Intrauterine Contraceptive Device (IUCD) (Option B):** While modern guidelines (WHO MEC Category 1) state IUCDs are safe for diabetics, they are traditionally avoided in diabetic patients due to a theoretically increased risk of **pelvic inflammatory disease (PID)** and vaginal candidiasis, as hyperglycemia can impair the local immune response. * **Oral Contraceptive Pills (OCP) (Option C):** Combined OCPs contain progestogens that can decrease glucose tolerance and estrogens that may affect lipid metabolism and increase the risk of thromboembolism. They are generally avoided in diabetics, especially if there is any evidence of microvascular disease. * **Vaginal Sponge (Option D):** This method has a high failure rate (especially in parous women) and carries a risk of Toxic Shock Syndrome. It is not a preferred primary method of contraception. **Clinical Pearls for NEET-PG:** * **WHO MEC Category 1 for Diabetes:** Barrier methods, LNG-IUD, and Cu-T (if no vascular disease). * **OCPs and Diabetes:** Avoid if the patient has had diabetes for >20 years or has nephropathy, retinopathy, or neuropathy (MEC Category 3/4). * **Best Permanent Method:** Vasectomy (simplest and most effective). * **Progesterone-only pills (POPs):** A better hormonal alternative to COCPs for diabetics as they have minimal impact on carbohydrate metabolism.

Question 360: Nonoxynol-9 is a/an:

A. Hormonal contraceptive
B. Intrauterine contraceptive
C. Barrier contraceptive (Correct Answer)
D. Post-coital contraceptive

Explanation: **Explanation:** **Nonoxynol-9** is a non-ionic surfactant that acts as a **chemical barrier contraceptive (spermicide)**. It works by disrupting the cell membrane of the spermatozoa, leading to loss of motility and eventual death of the sperm before they can enter the cervical canal. It is commonly available in the form of foams, jellies, creams, and films, or as a coating on condoms and diaphragms. **Analysis of Options:** * **Option A (Hormonal):** Incorrect. Nonoxynol-9 contains no hormones (like Estrogen or Progesterone) and does not interfere with the Hypothalamic-Pituitary-Ovarian axis or ovulation. * **Option B (Intrauterine):** Incorrect. While some medicated IUDs exist (Copper or Levonorgestrel), Nonoxynol-9 is a topical agent applied vaginally, not an intrauterine device. * **Option D (Post-coital):** Incorrect. Spermicides must be applied **before** intercourse to be effective. Post-coital (emergency) contraception typically involves high-dose progestins (Levonorgestrel) or SPRMs (Ulipristal). **Clinical Pearls for NEET-PG:** * **Failure Rate:** When used alone, spermicides have a high failure rate (Typical use: ~28%). They are most effective when used in combination with mechanical barriers like a diaphragm. * **STI Risk:** Contrary to older beliefs, Nonoxynol-9 **does not protect against HIV/STIs**. In fact, frequent use can cause vaginal and rectal irritation/ulceration, which may actually **increase** the risk of HIV transmission. * **Mechanism:** It reduces the surface tension of the sperm midpiece and tail, causing irreversible immobilization.

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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