Contraception and Family Planning Practice Questions

Q: Which of the following medications is used as a post-coital pill?

0.75 mg Levonorgestrel. **Explanation:** **1. Why Levonorgestrel (LNG) is correct:** Levonorgestrel is a synthetic progestogen and is the most widely used emergency contraceptive (EC) pill. The standard regimen involves either a single dose of **1.5 mg** or two doses of **0.75 mg** taken 12 hours apart. To be effective, it must be administered within **72 hours** of unprotected intercourse. Its primary mechanism of action is the **inhibition or delay of ovulation** by suppressing the LH surge; it does not disrupt an established pregnancy. **2. Analysis of Incorrect Options:** * **A. 25 mg Mifepristone:** While Mifepristone (an anti-progestin) is highly effective as an EC, the standard low-dose used for this purpose is **10 mg**. A 25 mg dose is not the conventional EC strength; higher doses (200 mg) are used for medical abortion in combination with Misoprostol. * **B. Misoprostol:** This is a Prostaglandin E1 analogue used for cervical ripening, induction of labor, and medical abortion. It has no role as a primary post-coital contraceptive. * **C. 10 mg Ethinylestradiol:** High-dose estrogens alone are no longer used due to severe side effects like nausea and vomiting. In the older **Yuzpe Regimen**, 100 mcg of Ethinylestradiol was combined with 0.5 mg of LNG. **3. High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The most effective emergency contraceptive is the **Copper-T (IUCD)**, which can be inserted up to 5 days after intercourse. * **Ulipristal Acetate (30 mg):** A selective progesterone receptor modulator (SPRM) that is effective up to **120 hours (5 days)** and is superior to LNG in efficacy. * **Failure Rate:** LNG has a failure rate of approximately 1–3%. It is less effective in women with a BMI >30 kg/m². * **Centchroman (Saheli):** A non-steroidal SERM used as a weekly oral contraceptive, not as a standard post-coital pill.

Q: While using the "safe period" method for contraception, what is considered the unsafe period?

Days 12-18 of the menstrual cycle. **Explanation:** The "Safe Period" or **Rhythm Method** is based on the physiological timing of ovulation and the lifespan of gametes. To determine the unsafe period, we consider two key factors: the **ovum survives for about 24 hours** after ovulation, and **sperm can survive for up to 48–72 hours** in the female reproductive tract. In a standard 28-day cycle, ovulation typically occurs on Day 14. To account for the viability of sperm deposited before ovulation and the survival of the egg after, a "buffer" is created. The **unsafe period** (fertile window) is generally calculated as **3 days before and 3 days after ovulation** (Day 11 to Day 17). Option B (Days 12–18) most closely aligns with this high-risk window for conception. **Analysis of Incorrect Options:** * **Option A (Days 3–7):** This is the early follicular phase/menstrual phase. Estrogen levels are low, and the follicle is not yet mature, making conception highly unlikely. * **Option C (Days 7–21):** While this range includes the unsafe period, it is overly broad. In a regular cycle, the first week and the third week are generally considered safe. * **Option D (Days 21–28):** This is the late luteal phase. After the ovum degenerates (24 hours post-ovulation), fertilization is impossible. This is the "absolute safe period." **NEET-PG High-Yield Pearls:** * **Ogino-Knaus Formula:** For irregular cycles, the fertile period is calculated as: (Shortest cycle minus 18 days) to (Longest cycle minus 11 days). * **Pearl Index:** The failure rate of the rhythm method is high (approx. 20–25 per 100 woman-years). * **Standard Days Method:** Uses "CycleBeads" to identify Days 8–19 as unsafe for women with cycles between 26–32 days.

Q: DMPA is administered every:

3 months. **Explanation:** **DMPA (Depot Medroxyprogesterone Acetate)**, commonly known by the brand name **Antara** in the Government of India’s family planning program, is an injectable progestogen-only contraceptive. 1. **Why 3 months is correct:** The standard dose of DMPA is **150 mg**, administered via **deep intramuscular (IM)** injection into the gluteus maximus or deltoid. It works primarily by suppressing ovulation through the inhibition of gonadotropin secretion. The pharmacological half-life and duration of action of a 150 mg dose provide effective contraception for **13 weeks (3 months)**. A grace period of up to 2–4 weeks is usually permitted if a dose is delayed. 2. **Analysis of Incorrect Options:** * **6 months & 9 months:** These intervals are too long; the hormone levels would fall below the therapeutic threshold, leading to a failure of ovulation suppression. * **45 days:** This is the interval for **NET-EN (Norethisterone Enanthate)**, another injectable contraceptive (brand name Chhaya/Nari) which is given as 200 mg IM every **2 months (8 weeks)**. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily prevents ovulation; secondarily thickens cervical mucus and thins the endometrium. * **Side Effects:** The most common side effect is **irregular menstrual bleeding** (spotting), eventually leading to **amenorrhea** in 50% of users after one year. * **Weight Gain:** DMPA is significantly associated with weight gain. * **Bone Mineral Density (BMD):** Long-term use may cause a reversible decrease in BMD (FDA Black Box Warning). * **Return to Fertility:** There is a characteristic **delay in the return to fertility**, averaging 7–10 months after the last injection.

Q: Emergency contraception prevents pregnancy by all of the following mechanisms, except?

Interrupting an early pregnancy. **Explanation:** The core concept to understand is that **Emergency Contraception (EC)** is a preventive measure, not an abortifacient. According to the WHO and medical guidelines, pregnancy is defined as beginning at the point of implantation. **Why Option D is the correct answer:** Emergency contraception works strictly **before** a pregnancy is established. It cannot terminate or interrupt an existing clinical pregnancy. If a woman is already pregnant, taking EC (like Levonorgestrel or Ulipristal) will not cause an abortion or harm the developing fetus. Medications that interrupt early pregnancy are classified as **Mifepristone and Misoprostol** (Medical Abortion), not emergency contraception. **Why other options are incorrect:** * **A. Delaying or inhibiting ovulation:** This is the **primary mechanism** of hormonal ECs. Levonorgestrel (LNG) suppresses the LH surge, thereby preventing the release of an egg. * **B. Inhibiting fertilization:** ECs can alter cervical mucus or affect sperm migration and function, making it difficult for sperm to reach and fertilize the egg. * **C. Preventing implantation:** While controversial in some studies, it is traditionally accepted that ECs (especially the Copper-T IUD) can cause endometrial changes that make the uterus inhospitable for a fertilized egg to implant. **High-Yield NEET-PG Pearls:** * **Most effective EC:** Copper-T 380A (can be used up to 5 days after unprotected intercourse). * **Drug of Choice (Hormonal):** Levonorgestrel (1.5 mg single dose) is preferred over the older Yuzpe regimen (combined pills) due to fewer side effects. * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) effective up to 120 hours (5 days) and is more effective than LNG in obese women. * **Timeframe:** For maximum efficacy, hormonal EC should be taken as soon as possible, ideally within 72 hours.

Q: After withdrawal of DMPA, most women conceive within what timeframe?

1 year. **Explanation:** The correct answer is **1 year (Option C)**. **1. Understanding the Concept:** Depot Medroxyprogesterone Acetate (DMPA) is a long-acting injectable progestogen that inhibits ovulation by suppressing the hypothalamic-pituitary-ovarian axis. Unlike oral contraceptives, DMPA has a **delayed return to fertility**. This is because the drug is highly lipophilic and is released slowly from the muscle/fat depot. Even after the 3-month contraceptive effect wears off, sub-therapeutic levels may persist in the body, delaying the resumption of regular ovulation. On average, it takes about **7 to 10 months** for fertility to return, with approximately **60-70% of women conceiving by 12 months** and over 90% by 24 months. **2. Analysis of Incorrect Options:** * **Option A & B (Immediately / 2-4 weeks):** These are incorrect because the suppression of the pituitary axis by DMPA is profound and long-lasting. Unlike Barrier methods or Copper-T, where fertility returns immediately upon removal, DMPA requires time for the drug to be completely metabolized. * **Option D (6 months):** While some women may ovulate by 6 months, the majority of the population requires a longer duration (closer to 10-12 months) to achieve pregnancy. **3. High-Yield Facts for NEET-PG:** * **Dose:** 150 mg intramuscularly (IM) every 3 months (12 weeks). * **Mechanism:** Primarily inhibits ovulation; also thickens cervical mucus and thins the endometrium. * **Side Effects:** Menstrual irregularities (most common), weight gain, and a **reversible decrease in Bone Mineral Density (BMD)**. * **Amenorrhea:** Approximately 50% of users develop amenorrhea after 1 year of use. * **Clinical Pearl:** Always counsel patients that DMPA does *not* cause permanent infertility, but they must be prepared for a significant delay (up to 12-18 months) before conception.

Q: Which of the following is NOT a benefit of using a levonorgestrel intrauterine system (IUS) for the treatment of abnormal uterine bleeding?

No breakthrough bleeding. The Levonorgestrel Intrauterine System (LNG-IUS), such as Mirena, is a highly effective treatment for heavy menstrual bleeding (HMB). However, it is notorious for causing **breakthrough bleeding (spotting)** during the initial 3 to 6 months of use. ### Explanation of Options: * **Correct Answer (C):** The statement "No breakthrough bleeding" is incorrect. Irregular spotting or breakthrough bleeding is the **most common side effect** and the primary reason for early discontinuation. This occurs due to the local effect of progestogen causing endometrial atrophy and vascular fragility before the lining stabilizes. * **Option A:** LNG-IUS provides highly effective, long-term reversible contraception (LARC) with a Pearl Index comparable to sterilization, making it ideal for women needing both therapy and birth control. * **Option B:** By suppressing endometrial proliferation and reducing prostaglandin synthesis, the LNG-IUS significantly improves associated spasmodic dysmenorrhea. * **Option D:** Approximately 20–50% of women become amenorrheic within one year of insertion due to profound endometrial atrophy. This is considered a therapeutic benefit in the context of abnormal uterine bleeding. ### High-Yield Clinical Pearls for NEET-PG: * **Mechanism:** Releases 20 µg of Levonorgestrel daily; primarily acts by thickening cervical mucus and causing endometrial atrophy. * **First-line Treatment:** LNG-IUS is the **medical treatment of choice** for HMB (NICE guidelines) and is also used in endometriosis and endometrial hyperplasia without atypia. * **Life Span:** Currently approved for **8 years** for contraception (Mirena) but usually replaced every 5 years for HMB management. * **Non-Contraceptive Benefit:** It reduces the risk of Pelvic Inflammatory Disease (PID) by thickening cervical mucus, preventing sperm and bacteria from entering the upper genital tract.

Q: Use of progestin-only pills as a mode of contraception is contraindicated in all of the following conditions, EXCEPT:

Lactation. **Explanation:** Progestin-only pills (POPs), also known as the "mini-pill," are a preferred method of contraception in specific clinical scenarios where estrogen is contraindicated. **Why Lactation is the Correct Answer:** Lactation is an **indication**, not a contraindication, for POPs. Unlike combined oral contraceptives (COCs), POPs do not contain estrogen. Estrogen is known to suppress milk production (hypogalactia). Therefore, POPs are the hormonal contraceptive of choice for breastfeeding mothers as they do not affect the quantity or quality of breast milk and have no adverse effects on the infant. **Why the Other Options are Wrong (Contraindications):** According to the WHO Medical Eligibility Criteria (MEC Category 4): * **Liver Tumors (Benign or Malignant) and Acute Liver Disease:** Progestins are metabolized in the liver. In the presence of active liver disease (e.g., acute viral hepatitis, cirrhosis, or hepatoma), the metabolism of these hormones is impaired, potentially exacerbating the condition. * **Known Breast Cancer:** Breast cancer is often a hormone-sensitive tumor. Progestins may stimulate the growth of breast cancer cells; thus, any current breast malignancy is an absolute contraindication for all hormonal contraceptives. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** The primary mechanism of POPs is **thickening of the cervical mucus**, which prevents sperm penetration. They also cause endometrial thinning. Unlike COCs, they do not consistently inhibit ovulation (ovulation is inhibited in only ~60-80% of cycles). * **The "3-Hour Rule":** POPs must be taken at the same time every day. A delay of more than 3 hours is considered a "missed pill." * **MEC Category 4 (Absolute Contraindication):** Current Breast Cancer is the most significant absolute contraindication for POPs.

Question 1

Which of the following medications is used as a post-coital pill?

Accepted Answer

0.75 mg Levonorgestrel

Answer

25 mg Mifepristone

Answer

Misoprostol

Answer

10 mg Ethinylestradiol

Question 2

What is the effect of progesterone-only pills?

Accepted Answer

All of the above

Answer

Completely suppresses ovulation

Answer

Thins the lining of the uterus

Answer

Thickens cervical mucus

Question 3

While using the "safe period" method for contraception, what is considered the unsafe period?

Accepted Answer

Days 12-18 of the menstrual cycle

Answer

Days 3-7 of the menstrual cycle

Answer

Days 7-21 of the menstrual cycle

Answer

Days 21-28 of the menstrual cycle

Question 4

DMPA is administered every:

Accepted Answer

3 months

Answer

6 months

Answer

9 months

Answer

45 days

Question 5

Emergency contraception prevents pregnancy by all of the following mechanisms, except?

Accepted Answer

Interrupting an early pregnancy

Answer

Delaying or inhibiting ovulation

Answer

Inhibiting fertilization

Answer

Preventing implantation of the fertilized egg

Question 6

What is the fertile period in a woman with a menstrual cycle length varying between 26 to 31 days?

Accepted Answer

Days 8 to 21 of the cycle

Answer

Days 15 to 25 of the cycle

Answer

Days 5 to 15 of the cycle

Answer

The first 5 days of the cycle

Question 7

After withdrawal of DMPA, most women conceive within what timeframe?

Accepted Answer

1 year

Answer

Immediately

Answer

2-4 weeks

Answer

6 months

Question 8

A woman is taking very low-dose combined oral contraceptive pills. After missing to take pills for how many consecutive days is there a failure of the contraceptive method?

Accepted Answer

Two missed pills

Answer

One missed pill

Answer

Three missed pills

Answer

Four missed pills

Question 9

Which of the following is NOT a benefit of using a levonorgestrel intrauterine system (IUS) for the treatment of abnormal uterine bleeding?

Accepted Answer

No breakthrough bleeding

Answer

Provides contraceptive cover

Answer

Effective for associated dysmenorrhea

Answer

Women become amenorrheic within one year after insertion

Question 10

Use of progestin-only pills as a mode of contraception is contraindicated in all of the following conditions, EXCEPT:

Accepted Answer

Lactation

Answer

Liver tumors

Answer

Acute liver disease

Answer

Known breast cancer

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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