Contraception and Family Planning Practice Questions

Q: Which of the following drugs is NOT used as a post-coital contraceptive?

Misoprostol. **Explanation:** The correct answer is **Misoprostol**. Post-coital (emergency) contraception aims to prevent pregnancy by delaying ovulation or interfering with fertilization/implantation *before* pregnancy is established. **Why Misoprostol is the correct answer:** Misoprostol is a synthetic Prostaglandin E1 (PGE1) analogue. It causes uterine contractions and cervical ripening. It is used for **medical abortion** (terminating an established pregnancy), induction of labor, and management of PPH. It is **not** used as an emergency contraceptive because it does not prevent conception; it acts as an abortifacient. **Analysis of other options:** * **Danazol:** Historically used as an emergency contraceptive (high-dose ethisterone derivative). While rarely used now due to side effects, it is pharmacologically categorized as a post-coital agent. * **Ethinyl Estradiol:** Used in the **Yuzpe Regimen** (combined oral contraceptive pills containing Ethinyl Estradiol + Levonorgestrel). * **Levonorgestrel (LNG):** The current "gold standard" for hormonal emergency contraception (e.g., i-Pill, 1.5mg single dose). It works primarily by inhibiting the LH surge and delaying ovulation. **High-Yield Clinical Pearls for NEET-PG:** * **Most effective emergency contraceptive:** Copper-T (IUD) inserted within 5 days (120 hours). * **Most effective oral agent:** Ulipristal acetate (Selective Progesterone Receptor Modulator). * **Time limit:** Most oral emergency contraceptives are effective up to 72 hours, though Ulipristal and Copper-T are effective up to 120 hours. * **Yuzpe Regimen:** 100 mcg Ethinyl Estradiol + 0.5 mg LNG, repeated after 12 hours.

Q: A pregnant patient who is using a Copper T intrauterine device wishes to terminate the pregnancy. What is the treatment of choice?

Menstrual regulation and sterilization. **Explanation:** The correct answer is **Menstrual regulation and sterilization**. This question addresses the management of a contraceptive failure in a patient who no longer desires the pregnancy. **1. Why Option D is Correct:** When a patient becomes pregnant with a Copper T (Cu-T) in situ and expresses a desire to terminate the pregnancy, the standard management is to perform a termination of pregnancy (TOP). In early pregnancy, this is often referred to as **Menstrual Regulation (MR)**. Since the pregnancy occurred despite using an effective long-acting reversible contraceptive (LARC), it indicates a contraceptive failure. If the patient has completed her family, **sterilization** is offered as a permanent method to prevent future unintended pregnancies. **2. Why the other options are incorrect:** * **Option A & B:** These are incorrect because the patient specifically wishes to **terminate** the pregnancy. While removing the Cu-T is mandatory if a patient chooses to *continue* a pregnancy (to reduce the risk of septic abortion and preterm labor), it does not apply here. * **Option C:** Performing an abortion with the Cu-T in situ is technically difficult and increases the risk of uterine trauma or incomplete evacuation. The device must be removed during the procedure. **High-Yield Clinical Pearls for NEET-PG:** * **Ectopic Risk:** If a patient conceives with a Cu-T in situ, the absolute risk of pregnancy is low, but the *relative* risk of the pregnancy being **ectopic** is significantly increased (approx. 3–4%). Always rule out ectopic pregnancy via ultrasound. * **Management if continuing pregnancy:** If the patient wants to keep the baby, the Cu-T should be removed if the strings are visible. This reduces the risk of spontaneous abortion from 50% to about 25%. * **Mechanism of Cu-T:** It primarily acts as a spermicide by causing a sterile inflammatory response in the endometrium.

Q: Which of the following is NOT a benefit of oral contraceptive pills (OCPs)?

Protection from breast cancer. **Explanation:** The correct answer is **C (Protection from breast cancer)**. Combined Oral Contraceptive Pills (COCPs) do not provide protection against breast cancer; in fact, epidemiological data suggests a slight, transient increase in the relative risk of breast cancer among current and recent users. This risk returns to baseline approximately 10 years after discontinuation. **Why other options are incorrect:** * **Option A:** OCPs are a first-line treatment for **menstrual abnormalities** like menorrhagia and dysmenorrhea. They induce a predictable withdrawal bleed and thin the endometrial lining, reducing blood loss. * **Option B:** Their primary function is **protection against unwanted pregnancy** by inhibiting ovulation through the suppression of FSH and LH. * **Option D:** OCPs provide significant **protection from endometrial cancer** (risk reduced by ~50%) and **ovarian cancer** (risk reduced by ~40%). This protective effect persists for 15–20 years after stopping the pill. **High-Yield Clinical Pearls for NEET-PG:** * **Cancer Protection:** OCPs reduce the risk of three major cancers: **Endometrial, Ovarian, and Colorectal cancer.** * **Cancer Risk:** OCPs are associated with a slight increase in the risk of **Breast cancer** and **Cervical cancer** (especially with >5 years of use). * **Non-Contraceptive Benefits:** Reduced incidence of Benign Prostatic Hyperplasia (BPH) is NOT a benefit, but reduced **Benign Breast Disease** (like fibroadenoma) and **Functional Ovarian Cysts** are. * **Mechanism:** OCPs prevent pregnancy primarily by **preventing ovulation**, thickening cervical mucus, and making the endometrium unfavorable for implantation.

Q: Oral contraceptive pills (OCPs) are a risk factor for the development of all EXCEPT:

Ectopic pregnancy. **Explanation:** The correct answer is **C. Ectopic pregnancy**. Combined Oral Contraceptive Pills (OCPs) primarily work by suppressing ovulation through the inhibition of the hypothalamic-pituitary-ovarian axis. Since ovulation is prevented, the risk of any pregnancy—including ectopic pregnancy—is significantly **decreased** compared to the general population. While progesterone-only pills (POPs) or Levonorgestrel-IUDs may have a higher *proportion* of pregnancies being ectopic if failure occurs, OCPs are overall protective against ectopic pregnancy. **Analysis of Incorrect Options:** * **Deep Vein Thrombosis (DVT) & Pulmonary Embolism (Options A & B):** The estrogen component (Ethinyl Estradiol) in OCPs increases the hepatic synthesis of clotting factors (II, VII, IX, X) and decreases anticoagulants like Protein S and Antithrombin III. This creates a hypercoagulable state, significantly increasing the risk of venous thromboembolism (VTE). * **Breast Cancer (Option D):** Long-term use of OCPs is associated with a slight, transient increase in the relative risk of breast cancer. However, this risk typically returns to baseline 10 years after discontinuing the pill. **High-Yield Facts for NEET-PG:** * **Protective Effects of OCPs:** OCPs significantly reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Colorectal cancer**. They also reduce the incidence of Benign Breast Disease and Pelvic Inflammatory Disease (PID). * **Increased Risks:** OCPs increase the risk of **Cervical cancer** (especially with >5 years of use) and **Hepatic adenomas**. * **Absolute Contraindications:** History of VTE, smokers >35 years old (>15 cigarettes/day), undiagnosed vaginal bleeding, and estrogen-dependent tumors.

Q: What is the progesterone release rate in Progestasert?

65 mg/day. **Explanation:** **Progestasert** is a first-generation hormone-releasing Intrauterine System (IUS). It is a T-shaped device made of ethylene-vinyl acetate copolymer. The vertical stem contains a reservoir of **38 mg of natural progesterone** mixed with barium sulfate (for radiopacity) and silicone oil. 1. **Why Option C is Correct:** The device is designed to release progesterone at a steady, controlled rate of **65 µg/day** (micrograms per day) directly into the uterine cavity. This local release causes endometrial atrophy and thickens cervical mucus, providing contraception for a period of **one year**, after which it must be replaced. 2. **Why Other Options are Incorrect:** * **Options A, B, and D:** These values (25, 40, and 80) do not correspond to the pharmacokinetics of Progestasert. It is crucial to note the unit: the release is in **micrograms (µg)**, not milligrams (mg). A release of 65 mg/day would be a massive overdose, as the total reservoir itself only contains 38 mg. 3. **High-Yield Clinical Pearls for NEET-PG:** * **Comparison with LNG-IUD (Mirena):** While Progestasert releases 65 µg/day of natural progesterone and lasts 1 year, Mirena releases **20 µg/day of Levonorgestrel** and is effective for 5–8 years. * **Mechanism:** Primarily local; it does not consistently inhibit ovulation. * **Side Effects:** A common disadvantage of Progestasert compared to Copper-T is a higher incidence of intermenstrual spotting and the requirement for annual replacement. * **Status:** Progestasert has largely been replaced by the more effective and longer-lasting LNG-IUS (Mirena) in clinical practice.

Q: Combined oral contraceptive pills act mainly by which mechanism?

Inhibition of ovulation. **Explanation:** **1. Why the Correct Answer is Right:** Combined Oral Contraceptive Pills (COCPs) contain both Estrogen (usually Ethinyl Estradiol) and Progestogen. Their primary mechanism of action is the **inhibition of ovulation** via negative feedback on the hypothalamo-pituitary-ovarian axis. * **Estrogen** suppresses **FSH** (Follicle Stimulating Hormone), which prevents the selection and maturation of a dominant follicle. * **Progestogen** suppresses the **LH surge** (Luteinizing Hormone), which is essential for the release of the ovum. While COCPs also cause thickening of cervical mucus and endometrial thinning, the **primary/main** mechanism is the suppression of ovulation. **2. Why Incorrect Options are Wrong:** * **Options B & C:** These are physiologically incorrect. COCPs actually **decrease** fallopian tube motility (due to the progestogen component), which slows the transport of the ovum. Early transport to the uterus would not prevent pregnancy; rather, a "hostile" endometrium or altered tubal transport are secondary effects, but they do not involve "increased motility." **3. NEET-PG High-Yield Pearls:** * **Most common side effect:** Breakthrough bleeding (especially with low-dose pills). * **Most serious side effect:** Venous Thromboembolism (VTE) due to the estrogen component (increases clotting factors II, VII, IX, and X). * **Non-contraceptive benefits:** Reduced risk of Ovarian and Endometrial cancers (protective effect persists for years), reduced PID, and improvement in dysmenorrhea. * **Drug Interactions:** Enzyme inducers like **Rifampicin** and anti-epileptics (Phenytoin, Carbamazepine) decrease the efficacy of COCPs. * **WHO Eligibility Criteria (Category 4 - Absolute Contraindication):** Smokers >35 years (>15 cigarettes/day), history of VTE, Migraine with aura, and Breast Cancer.

Q: Mifepristone is not used in which of the following conditions?

Threatened abortion. **Explanation:** **Mifepristone** is a potent **progesterone receptor antagonist**. Since progesterone is the "hormone of pregnancy" essential for maintaining the decidua and uterine quiescence, blocking its receptors leads to decidual breakdown, cervical softening, and increased uterine contractility. 1. **Why Threatened Abortion is the Correct Answer:** In a **threatened abortion**, the goal of management is to **save the pregnancy**. Progesterone supplementation is often used to support the pregnancy. Administering Mifepristone (an anti-progesterone) would actively promote the detachment of the embryo and induce uterine contractions, leading to an inevitable or complete abortion. Therefore, it is strictly contraindicated. 2. **Analysis of Other Options:** * **Fibroids (Leiomyoma):** Mifepristone is used off-label to reduce the size of fibroids and control heavy menstrual bleeding by inhibiting progesterone-dependent growth of the myoma. * **Ectopic Pregnancy:** While Methotrexate is the primary medical management, Mifepristone is sometimes used as an adjunct to increase the success rate of tubal resolution by causing trophoblastic degeneration. * **Molar Pregnancy:** Mifepristone can be used as a priming agent to soften the cervix before suction evacuation, although its use is more common in second-trimester terminations. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Competitive antagonist at progesterone and glucocorticoid receptors. * **Medical Abortion Regimen:** 200 mg Mifepristone (oral) followed by 800 mcg Misoprostol (vaginal/sublingual) after 24–48 hours. Effective up to 9 weeks (63 days) of gestation. * **Other Uses:** Emergency contraception (10 mg dose), induction of labor (in intrauterine fetal death), and management of Cushing’s Syndrome. * **Side Effects:** Nausea, abdominal cramps, and heavy bleeding.

Question 1

Which of the following drugs is NOT used as a post-coital contraceptive?

Accepted Answer

Misoprostol

Answer

Danazol

Answer

Ethinyl estradiol

Answer

Levonorgestrel

Question 2

A primipara with a history of myocardial infarction (MI) presents on the 40th day postpartum requesting contraception. What is the contraceptive of choice?

Accepted Answer

Condom with spermicidal jelly

Answer

Combined oral contraceptive pill

Answer

Intrauterine contraceptive device

Answer

Laparoscopic sterilization

Question 3

A pregnant patient who is using a Copper T intrauterine device wishes to terminate the pregnancy. What is the treatment of choice?

Accepted Answer

Menstrual regulation and sterilization

Answer

Continue the pregnancy

Answer

Remove the Copper T and continue the pregnancy

Answer

Perform abortion with the Copper T in situ

Question 4

Which of the following is NOT a benefit of oral contraceptive pills (OCPs)?

Accepted Answer

Protection from breast cancer

Answer

Improve menstrual abnormalities

Answer

Protection against unwanted pregnancy

Answer

Protection from endometrial cancer

Question 5

Oral contraceptive pills (OCPs) are a risk factor for the development of all EXCEPT:

Accepted Answer

Ectopic pregnancy

Answer

Deep vein thrombosis (DVT)

Answer

Pulmonary embolism

Answer

Breast cancer

Question 6

What is the progesterone release rate in Progestasert?

Accepted Answer

65 mg/day

Answer

25 mg/day

Answer

40 mg/day

Answer

80 mg/day

Question 7

Induction of abortion is best achieved by which of the following methods?

Accepted Answer

PGE2 gel

Answer

Oxytocin

Answer

Stripping of the membranes

Answer

Estrogen

Question 8

Combined oral contraceptive pills act mainly by which mechanism?

Accepted Answer

Inhibition of ovulation

Answer

Increased motility of fallopian tubes

Answer

Early transport of the sperm and ovum to the uterine cavity

Answer

None of the above

Question 9

Which contraceptive method should be avoided in patients with epilepsy?

Accepted Answer

Oral contraceptive pills (OCPs)

Answer

Condom

Answer

Intrauterine contraceptive device (IUCD)

Answer

Levonorgestrel-releasing intrauterine system (Mirena)

Question 10

Mifepristone is not used in which of the following conditions?

Accepted Answer

Threatened abortion

Answer

Fibroid

Answer

Ectopic pregnancy

Answer

Molar pregnancy

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?