Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 371: Which of the following contraceptive methods have a failure rate of less than 5%?

A. Copper T, Oral Contraceptive Pills, Tubectomy
B. Vaginal sponge, Tubectomy, Oral Contraceptive Pills
C. Copper T, Oral Contraceptive Pills, Condom (Correct Answer)
D. Copper T, Condom

Explanation: To answer this question correctly, it is essential to distinguish between **Theoretical (Perfect Use)** failure rates and **Typical Use** failure rates. For NEET-PG, the Pearl Index (pregnancies per 100 woman-years) is the standard measure for contraceptive efficacy. ### 1. Why Option C is Correct The methods listed in Option C all have a theoretical failure rate significantly lower than 5%: * **Copper T (IUCD):** Highly effective with a failure rate of **0.6–0.8%**. * **Oral Contraceptive Pills (OCPs):** Theoretical failure rate is **0.3%** (though typical use is ~7-9%). * **Condoms:** Theoretical failure rate is **2–3%** (though typical use is ~13-18%). Since the question asks for methods with a failure rate *less than 5%*, these three qualify under perfect use conditions. ### 2. Analysis of Incorrect Options * **Option A & B (Tubectomy):** While Tubectomy is highly effective (failure rate **0.5%**), these options are often considered "distractors" in specific MCQ formats if the focus is on reversible vs. permanent methods, or if the grouping includes methods with higher typical failure rates like the vaginal sponge. * **Option B (Vaginal Sponge):** This is the primary reason Option B is incorrect. The failure rate for a vaginal sponge is high: **9-12%** in nulliparous women and up to **20-24%** in multiparous women. * **Option D:** While both are <5%, it is an incomplete list compared to Option C. ### 3. High-Yield Clinical Pearls for NEET-PG * **Most Effective Reversible Method:** Lng-20 (Mirena) with a failure rate of **0.2%** (comparable to or better than sterilization). * **Pearl Index Definition:** Number of accidental pregnancies per 100 woman-years of exposure ($Pearl Index = \frac{\text{Total Accidental Pregnancies} \times 1200}{\text{Total months of exposure}}$). * **Ideal Contraceptive for Lactating Mothers:** Progestogen-only pills (POPs) or Centchroman (Saheli). * **Emergency Contraception:** Most effective is the **Copper T** (inserted within 5 days), followed by Ulipristal acetate.

Question 372: What is the advantage of laparoscopic sterilization over mini-laparotomy sterilization?

A. Lower failure rate
B. Less blood loss
C. Very small scar (Correct Answer)
D. Easier procedure

Explanation: **Explanation:** Female sterilization can be performed via **Laparoscopy** or **Mini-laparotomy** (the most common method used in postpartum sterilization, e.g., Pomeroy’s technique). The primary advantage of laparoscopic sterilization is its **superior cosmetic outcome**. It requires only one or two tiny incisions (usually 0.5–1 cm), resulting in a **very small scar** compared to the 2–5 cm incision required for a mini-laparotomy. Additionally, laparoscopy offers a faster recovery time and shorter hospital stay. **Analysis of Options:** * **A. Lower failure rate:** Incorrect. Both methods have similar long-term efficacy. The failure rate for tubal sterilization is approximately 0.5 per 100 women (1 in 200). * **B. Less blood loss:** Incorrect. While laparoscopy is minimally invasive, the blood loss in a standard mini-laparotomy is already negligible (usually <10-20 ml). Therefore, this is not a significant clinical advantage. * **D. Easier procedure:** Incorrect. Laparoscopy is technically more demanding. It requires specialized equipment (insufflators, laparoscope), general anesthesia, and specific surgical training. Mini-laparotomy is simpler, cheaper, and can be performed under local anesthesia or sedation. **High-Yield Pearls for NEET-PG:** * **Ideal Time:** Laparoscopic sterilization is the method of choice for **interval sterilization** (non-pregnant state). * **Contraindication:** Laparoscopy is generally avoided in the immediate postpartum period due to the enlarged, friable uterus and increased risk of injury; **Mini-laparotomy** is preferred then. * **Most Common Site of Occlusion:** The **Isthmus** of the fallopian tube. * **Failure:** If pregnancy occurs after sterilization, there is a high risk of it being an **Ectopic Pregnancy**.

Question 373: Centchroman is a?

A. Female oral contraceptive (Correct Answer)
B. Male contraceptive
C. Tocolytic
D. Oxytocic

Explanation: **Explanation:** **Centchroman (Ormeloxifene)** is a unique **Selective Estrogen Receptor Modulator (SERM)**. It is the world’s first non-steroidal, non-hormonal oral contraceptive pill, developed by the Central Drug Research Institute (CDRI) in Lucknow, India. It is marketed under the brand names **Saheli** and **Chhaya**. **Why Option A is correct:** Centchroman acts as a female oral contraceptive by antagonizing estrogen receptors in the uterus. This prevents the normal preparation of the endometrium for implantation (asynchrony) and alters cervical mucus. It does not suppress ovulation in most cycles, making it a safer alternative to steroidal pills as it avoids side effects like weight gain, nausea, and thromboembolism. **Why other options are incorrect:** * **B. Male contraceptive:** Centchroman is specifically designed for the female reproductive system. Male contraceptives currently include barrier methods, vasectomy, or experimental hormonal/non-hormonal agents (e.g., RISUG), but not Centchroman. * **C. Tocolytic:** Tocolytics (e.g., Nifedipine, Ritodrine) are used to suppress uterine contractions in preterm labor. Centchroman has no such inhibitory effect on myometrial contractions. * **D. Oxytocic:** Oxytocics (e.g., Oxytocin, Misoprostol) stimulate uterine contractions to induce labor or manage postpartum hemorrhage. Centchroman does not stimulate the myometrium. **High-Yield Clinical Pearls for NEET-PG:** * **Dosage Schedule:** It follows a unique "Twice-a-week for first 3 months, then Once-a-week" regimen (e.g., Sunday and Wednesday for 12 weeks, then only Sundays). * **Inclusion in National Program:** It is provided free of cost in India under the **Antara program** (Injectables) and **Chhaya** (Centchroman) initiatives. * **Other Uses:** Due to its SERM properties, it is also used in the management of **Dysfunctional Uterine Bleeding (DUB)** and **Mastalgia**. * **Side Effect:** The most common side effect is a slight delay in the menstrual cycle (prolonged cycles).

Question 374: A couple had unprotected intercourse and they are worried about pregnancy. What is the progesterone of choice for emergency contraception?

A. Norethisterone
B. Medroxyprogesterone acetate
C. Levonorgestrel (Correct Answer)
D. Desogestrel

Explanation: **Explanation:** **Levonorgestrel (LNG)** is the gold standard progesterone for emergency contraception (EC). The primary mechanism of action is the **inhibition or delay of ovulation** by suppressing the Luteinizing Hormone (LH) surge. It is most effective when taken as soon as possible, ideally within 72 hours of unprotected intercourse, though it may be used up to 120 hours. **Why Levonorgestrel is correct:** * It is the most widely studied and recommended progestogen-only EC pill (POEC). * The standard dose is a single **1.5 mg tablet** (or two 0.75 mg doses 12 hours apart). * It has a superior safety profile and higher efficacy compared to older methods like the Yuzpe regimen. **Analysis of Incorrect Options:** * **A. Norethisterone:** Primarily used for menstrual cycle regulation, dysfunctional uterine bleeding, and endometriosis. It is not used for emergency contraception. * **B. Medroxyprogesterone acetate (DMPA):** Used as an injectable contraceptive (Depo-Provera) for long-term protection (3 months), not for post-coital emergency use. * **D. Desogestrel:** A third-generation progestogen used in daily Combined Oral Contraceptive Pills (COCPs) or Progestogen-Only Pills (POPs), but not as a dedicated emergency contraceptive. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** LNG is effective up to 72–120 hours, but **Ulipristal acetate** (a selective progesterone receptor modulator) is more effective between 72–120 hours. * **Most Effective EC:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days. * **Failure Rate:** LNG-EC has a failure rate of approximately 1–3%. It does not work if implantation has already occurred and is not an abortifacient. * **Vomiting:** If the patient vomits within 2 hours of taking the LNG pill, the dose must be repeated.

Question 375: What is the most common side effect of Intrauterine Devices (IUDs)?

A. Abdominal pain
B. Increased vaginal bleeding (Correct Answer)
C. Abortion
D. Pelvic inflammation

Explanation: **Explanation:** The most common side effect of non-hormonal Intrauterine Devices (IUDs), such as Cu-T 380A, is **increased vaginal bleeding** (menorrhagia or polymenorrhea). This occurs due to a local inflammatory response in the endometrium, which increases vascularity and capillary permeability, often accompanied by an increase in local fibrinolytic activity. **Analysis of Options:** * **B. Increased vaginal bleeding (Correct):** This is the leading cause of IUD discontinuation. It typically manifests as heavier or prolonged menstrual periods, especially during the first 3–6 months of use. * **A. Abdominal pain:** This is the **second** most common side effect. It usually presents as colicky pain or dysmenorrhea due to uterine contractions attempting to expel the foreign body. * **C. Abortion:** While an IUD increases the risk of spontaneous abortion if pregnancy occurs *with* the device in situ, it is a complication of failure, not a common side effect of the device itself. * **D. Pelvic inflammation:** Pelvic Inflammatory Disease (PID) is a serious complication but is relatively rare. The risk is highest only during the first 20 days post-insertion, usually due to pre-existing asymptomatic infections (e.g., Chlamydia). **High-Yield NEET-PG Pearls:** * **Most common side effect:** Bleeding. * **Second most common side effect:** Pain. * **Most common cause for removal:** Bleeding. * **Most common complication:** Expulsion (most likely in the first year, especially during the first three months). * **Ectopic Pregnancy:** IUDs provide high protection against all pregnancies; however, if a woman *does* get pregnant with an IUD in situ, the **likelihood** of that pregnancy being ectopic is higher compared to a non-user. * **Mirena (LNG-IUS):** Unlike Copper-T, the most common side effect of the hormonal IUD is **amenorrhea** or spotting, making it a treatment for menorrhagia.

Question 376: Congenital vaginal foam tablet contains ______

A. Nonoxynol 9 (Correct Answer)
B. Octoxynol 8
C. Menfegol
D. None of the above

Explanation: **Explanation:** **Nonoxynol-9 (N-9)** is the primary active ingredient in most spermicidal preparations, including the **Congenital vaginal foam tablet**. It is a non-ionic surfactant that acts by disrupting the integrity of the sperm cell membrane (acrosome and midpiece), leading to loss of motility and eventual cell death. It also provides a mechanical barrier when it foams, preventing sperm from entering the cervical canal. **Analysis of Options:** * **Option A (Correct):** Nonoxynol-9 is the most widely used spermicide globally. In India, it is the active component of the "Congenital" brand of foam tablets. * **Option B (Incorrect):** **Octoxynol-8** (and Octoxynol-9) are also surfactants used as spermicides (e.g., in Ortho-Gynol), but they are not the constituents of the specific brand mentioned in the question. * **Option C (Incorrect):** **Menfegol** is a foaming agent and spermicide used in some vaginal tablets (popular in Japan and parts of Europe), but it is not the ingredient in Congenital tablets. **High-Yield Clinical Pearls for NEET-PG:** 1. **Failure Rate:** Spermicides have a high typical-use failure rate (approx. 18–28%), making them less effective than hormonal or intrauterine methods. 2. **HIV/STI Risk:** Contrary to earlier beliefs, N-9 does **not** protect against HIV/STIs. Frequent use can cause vaginal irritation and micro-abrasions, which may actually **increase** the risk of HIV transmission. 3. **Application:** Foam tablets must be inserted high into the vagina at least **10–15 minutes before intercourse** to allow for adequate dispersion. 4. **Other Spermicides:** Benzalkonium chloride and Chlorhexidine are other agents occasionally used in spermicidal formulations.

Question 377: Oral contraceptive pills (OCPs) do not offer protection against which of the following conditions?

A. Cervical cancer (Correct Answer)
B. Endometrial cancer
C. Ovarian cancer
D. Breast cancer

Explanation: **Explanation:** Combined Oral Contraceptive Pills (OCPs) provide significant non-contraceptive benefits, particularly in reducing the risk of certain gynecological malignancies. However, they do not protect against **Cervical Cancer**. **1. Why Cervical Cancer is the Correct Answer:** Epidemiological studies indicate that long-term use of OCPs (typically >5 years) is associated with a **slight increase in the risk of cervical cancer**. This is attributed to two factors: * **Biological:** Estrogen and progesterone may enhance the expression of HPV (Human Papillomavirus) oncogenes (E6/E7). * **Behavioral:** OCP users are less likely to use barrier methods (condoms), leading to increased exposure to HPV, the primary causative agent of cervical cancer. **2. Analysis of Incorrect Options:** * **Endometrial Cancer:** OCPs provide a protective effect (approx. 50% reduction) because the progestogen component antagonizes the mitogenic effect of estrogen on the endometrium, preventing hyperplasia. * **Ovarian Cancer:** OCPs reduce the risk (approx. 40-50%) by suppressing ovulation. This prevents the "incessant ovulation" and repetitive trauma to the ovarian epithelium, which is a key theory in ovarian oncogenesis. * **Breast Cancer:** While the relationship is complex, current evidence suggests that OCPs do not offer *protection* against breast cancer. However, in the context of this specific question, **Cervical Cancer** is the classic "high-yield" answer because OCPs are explicitly linked to an *increased* risk, whereas they are definitively *protective* for Endometrial and Ovarian cancers. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effect Duration:** The protection against Ovarian and Endometrial cancer persists for **15–20 years** even after discontinuing OCPs. * **Benign Conditions:** OCPs also protect against Benign Breast Disease (Fibroadenoma/Fibrocystic disease), Pelvic Inflammatory Disease (PID), and Ectopic Pregnancy. * **Cervical Screening:** OCP users should be strictly advised to undergo regular Pap smears due to the increased risk profile.

Question 378: Which of the following progestins is preferred in combination with estrogen in low-dose oral contraceptive pills?

A. Desogestrel (Correct Answer)
B. Norethisterone
C. Norgestrel
D. Levonorgestrel

Explanation: **Explanation:** The evolution of oral contraceptive pills (OCPs) has focused on reducing the dose of estrogen (to minimize thromboembolic risks) and developing progestins with higher potency and lower androgenic activity. **Why Desogestrel is the Correct Answer:** Desogestrel is a **third-generation progestin**. In low-dose OCPs, it is preferred because it possesses **high progestational activity** with **minimal androgenic side effects**. Unlike older generations, third-generation progestins do not adversely affect the lipid profile (they may actually increase HDL) and do not cause weight gain, acne, or hirsutism, making them highly tolerable for long-term use. **Analysis of Incorrect Options:** * **B. Norethisterone:** A first-generation progestin. It has lower potency and requires higher doses, often leading to breakthrough bleeding and mild androgenic effects. * **C. Norgestrel:** A second-generation progestin. While potent, it is a racemic mixture containing both active and inactive isomers, leading to a higher side-effect profile compared to pure isomers. * **D. Levonorgestrel:** The active isomer of norgestrel (second-generation). While widely used and safe, it retains significant **androgenic activity**, which can cause oily skin and acne in sensitive patients. **High-Yield Clinical Pearls for NEET-PG:** * **Generations:** 1st (Norethisterone), 2nd (Levonorgestrel), 3rd (Desogestrel, Gestodene, Norgestimate), 4th (Drospirenone). * **Drospirenone:** An analogue of spironolactone; it is anti-androgenic and anti-mineralocorticoid (helps prevent water retention). * **The "Third-Generation Paradox":** While they have fewer androgenic side effects, third-generation progestins carry a slightly higher risk of **Venous Thromboembolism (VTE)** compared to second-generation pills. * **Standard Low-Dose OCP:** Usually contains 30–35 µg of Ethinyl Estradiol. Ultra-low dose contains 20 µg.

Question 379: Which of the following is NOT a mechanism of action of oral contraceptive pills?

A. Inhibiting sperm penetration into the cervical mucus
B. Inducing an anovulatory cycle
C. Preventing blastocyst implantation
D. Blocking the fimbrial ostia (Correct Answer)

Explanation: **Explanation:** The mechanism of action of Combined Oral Contraceptive Pills (COCPs) is multi-factorial, primarily targeting the Hypothalamic-Pituitary-Ovarian (HPO) axis and the female reproductive tract environment. **Why Option D is Correct:** **Blocking the fimbrial ostia** is a mechanical/anatomical barrier. This occurs during surgical procedures like **Tubal Ligation** (e.g., Pomeroy’s technique) or due to pathological conditions like Salpingitis/PID. OCPs are pharmacological agents and do not physically obstruct the fallopian tubes. **Why the other options are incorrect (Mechanisms of OCPs):** * **Option B (Primary Mechanism):** The estrogen and progestogen components provide negative feedback to the hypothalamus and anterior pituitary. This suppresses **GnRH, FSH, and LH**, preventing the mid-cycle LH surge. Without the LH surge, ovulation does not occur, resulting in an **anovulatory cycle**. * **Option A:** Progestogen increases the viscosity and thickness of the **cervical mucus**, making it "hostile" and impenetrable to sperm. * **Option C:** OCPs cause the endometrium to become thin, atrophic, and out of sync with the menstrual cycle (decidualization), which **prevents the implantation** of a blastocyst should fertilization occur. **High-Yield Clinical Pearls for NEET-PG:** * **Most potent component for ovulation inhibition:** Progestogen (suppresses LH). * **Role of Estrogen:** Primarily inhibits FSH (preventing follicle selection) and provides cycle control (prevents breakthrough bleeding). * **Failure Rate:** The Pearl Index for perfect use of COCPs is **0.1 per 100 woman-years**. * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years after discontinuation).

Question 380: All of the following drugs have been used for medical abortion except?

A. Mifepristone
B. Misoprostol
C. Methotrexate
D. Atosiban (Correct Answer)

Explanation: **Explanation:** The correct answer is **Atosiban** because it is a **tocolytic agent**, not an abortifacient. Its primary clinical use is to delay imminent preterm birth by inhibiting uterine contractions. **Why Atosiban is the correct answer:** Atosiban is a competitive **Oxytocin receptor antagonist**. By blocking these receptors in the myometrium, it decreases the frequency of contractions and uterine tone. In the context of pregnancy management, it is used to "stop" labor (tocolysis), which is the functional opposite of medical abortion. **Why the other options are incorrect:** * **Mifepristone (RU-486):** An anti-progestational agent. It blocks progesterone receptors, leading to decidual necrosis, cervical softening, and increased uterine sensitivity to prostaglandins. It is the first step in the standard medical abortion regimen. * **Misoprostol:** A Prostaglandin E1 (PGE1) analogue. It causes cervical ripening and potent uterine contractions to expel the products of conception. It is typically administered 24–48 hours after Mifepristone. * **Methotrexate:** A folate antagonist that inhibits dihydrofolate reductase. It targets rapidly dividing cells (trophoblastic tissue) and is used medically for early unruptured ectopic pregnancies and occasionally in combination with misoprostol for early induced abortion. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Regimen (WHO/GOI):** Mifepristone 200 mg orally followed by Misoprostol 800 mcg (vaginal/buccal/sublingual) for up to 9 weeks (63 days) of gestation. * **MTP Act 2021 Update:** Medical abortion is legal up to 24 weeks under specific conditions, but the "pills-only" method is most effective in the first trimester. * **Atosiban Side Effects:** Generally well-tolerated; most common are nausea, headache, and tachycardia (less than beta-mimetics).

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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