Contraception and Family Planning Practice Questions

Q: Copper T is ideally inserted at-

Just after menstruation. ***Just after menstruation*** - The **endometrium is thin** immediately after menstruation, making insertion easier and reducing the risk of pain and perforation. - Inserting it after menstruation also helps to ensure the woman is **not pregnant** at the time of insertion, as the uterus has shed its lining. *Just before menstruation* - The endometrium is typically **thicker and more vascular** just before menstruation, increasing the risk of bleeding and pain during insertion. - There is a higher possibility of **early pregnancy**, which would contraindicate IUD insertion. *On the 26th day* - The 26th day of the menstrual cycle is usually in the **luteal phase**, when the endometrium is highly vascularized and receptive, which could increase discomfort and bleeding during insertion. - This timing also carries a **higher risk of pregnancy**, making IUD insertion potentially hazardous if not confirmed otherwise. *On the 14th day* - The 14th day typically corresponds to the **ovulation period**, making it a high-risk time for conception if protection has not been used. - The uterus is also more sensitive during ovulation, potentially leading to increased discomfort or complications during insertion.

Q: Which of the following is a method of natural family planning that involves tracking basal body temperature?

Basal body temperature (BBT) method. ***Basal body temperature (BBT) method*** - The **basal body temperature** (BBT) method relies on a slight increase in a woman's resting body temperature, typically by 0.5 to 1.0°F, occurring after **ovulation**. - This temperature shift signals that ovulation has occurred, allowing couples to identify the **fertile window** and avoid intercourse during that time. - This method involves tracking daily basal body temperature to predict ovulation. *Coitus interruptus (withdrawal method)* - This method involves the male withdrawing his penis from the vagina just before **ejaculation**. - It does not involve tracking **basal body temperature** and has a higher failure rate compared to many other contraceptive methods due to potential pre-ejaculatory fluid containing sperm. *Safe period (calendar method)* - The calendar method, also known as the **rhythm method** or **Ogino-Knaus method**, estimates the fertile window based on the typical length of a woman's menstrual cycles. - This method relies on calculating the approximate times of ovulation and avoiding intercourse during those days; it does not involve daily **temperature tracking**. *Abstinence (not having sexual intercourse)* - **Abstinence** involves completely refraining from sexual intercourse and is the only 100% effective method of preventing pregnancy and sexually transmitted infections (STIs). - This method does not involve any form of physical tracking, such as **basal body temperature**, as there is no risk of conception.

Q: In which scenario is the I-pill (emergency contraceptive) most appropriately used?

In case of contraceptive failure or unprotected sex. ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.

Q: What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

7 weeks. ***7 weeks (49 days)*** - Medical termination of pregnancy using **mifepristone and misoprostol** is most effective up to **49 days (7 weeks) of gestation** from the first day of the last menstrual period (LMP). - This is the **FDA-approved and WHO-recommended timeframe** for medical abortion with optimal efficacy (95-98% success rate). - The **MTP Act in India** allows medical methods up to **63 days (9 weeks)**, but 49 days represents the timeframe with highest efficacy and lowest complication rates. - Beyond this period, success rates decline and surgical methods may be more appropriate. *21 days* - This is only **3 weeks of gestation**, far too early and restrictive for medical abortion guidelines. - Most women wouldn't have confirmed pregnancy by this time. - This is not aligned with any standard medical abortion protocol. *4 weeks* - At **4 weeks gestation**, pregnancy has just been missed (around time of expected period). - This is too restrictive and not the maximum allowable timeframe for medical abortion. - Medical abortion can safely be performed well beyond this point. *14 days* - This is only **2 weeks of gestation** (around the time of ovulation in a typical cycle). - Pregnancy cannot even be reliably detected at this point. - This timeframe has no relevance to medical abortion guidelines.

Q: The mechanism of action of emergency contraception includes the following except:

Degeneration of corpus luteum. ***Degeneration of corpus luteum*** - Emergency contraception primarily works by interfering with ovulation and fertilization. It does **not directly cause degeneration of the corpus luteum**. - The **corpus luteum** forms after ovulation, and its degradation is a natural process (luteolysis) if pregnancy does not occur. Emergency contraception acts earlier in the reproductive process and does not target the corpus luteum. - This is the **correct answer** as it is NOT a mechanism of emergency contraception. *By preventing or delaying ovulation* - This is the **primary mechanism** of action for most forms of emergency contraception, particularly those containing **levonorgestrel (LNG)** and **ulipristal acetate (UPA)**. - By delaying the release of an egg from the ovary, it prevents the possibility of fertilization. - This is the most established and clinically significant mechanism. *Inhibition of fertilization* - Emergency contraception may affect fertilization by altering **cervical mucus** thickness, making it less penetrable to sperm. - Some evidence suggests effects on **sperm motility** or function, though this mechanism is less well-established than ovulation inhibition. - This represents a possible secondary mechanism. *Prevention of implantation of fertilized egg* - **Current evidence does NOT support this as a mechanism** for levonorgestrel or ulipristal acetate emergency contraception. - Studies by **WHO, ACOG, FIGO, and ICMR** have shown that LNG-EC is ineffective once fertilization has occurred. - The **copper IUD** used for emergency contraception may have some anti-implantation effects due to its inflammatory action on the endometrium. - However, for hormonal EC (the most common form), prevention of implantation is **not an established mechanism** based on current medical evidence.

Q: Yuzpe regimen should be administered within a maximum of -------

72 hours. ***72 hours*** - The **Yuzpe regimen**, an older form of emergency contraception, is most effective when initiated within **72 hours** (3 days) of unprotected intercourse. - It involves taking two doses of combined **estrogen and progestin pills 12 hours apart**. *3 hours* - This timeframe is too short for the general recommendation of the **Yuzpe regimen**, which has a wider window of effectiveness. - While earlier administration is better, 3 hours is not the maximum recommended time frame. *12 hours* - This timeframe incorrectly represents the recommended window for the **Yuzpe regimen**, which extends much longer. - 12 hours is often the interval between the two doses of the Yuzpe regimen, not the maximum time for the initial dose. *24 hours* - While administering the Yuzpe regimen within **24 hours** is highly effective, it is not the *maximum* time frame within which it can still be used. - The regimen's efficacy significantly decreases after 72 hours, but it can still be considered up to that point.

Q: Which of the following is NOT a mechanism of action of copper IUCDs?

Increase tubal motility. ***Increase tubal motility*** - Copper IUCDs (intrauterine contraceptive devices) prevent pregnancy primarily by creating a **sterile inflammatory reaction** in the uterus, making the environment hostile to sperm and eggs. - While they affect sperm and egg transport through the inflammatory response, **increasing tubal motility is NOT a recognized mechanism** of copper IUCDs. - The contraceptive effect is achieved through spermicidal action, prevention of fertilization, and interference with implantation. *Inhibit ovulation* - This is characteristic of **hormonal contraceptives** and **hormonal IUCDs (LNG-IUS)**, which can suppress the hypothalamic-pituitary-ovarian axis. - **Copper IUCDs** (non-hormonal) act locally within the uterus and do NOT inhibit ovulation. - Women using copper IUCDs continue to ovulate normally. *Induce biochemical changes in the endometrium* - Copper IUCDs release copper ions, which create a **spermicidal inflammatory reaction** in the uterus and fallopian tubes. - This reaction causes biochemical and morphological changes in the endometrium, making it unsuitable for sperm survival and fertilization. - The inflammatory environment is hostile to both sperm and eggs. *Inhibit implantation of the fertilized egg* - This is a key mechanism of action for copper IUCDs. - The local uterine inflammatory changes and endometrial alterations prevent a fertilized egg from successfully implanting in the **uterine wall**. - This is one of the primary contraceptive mechanisms of copper-containing devices.

Q: Combined oral pills reduce the risk of?

Ovarian cancer. ***Ovarian cancer*** - Combined oral contraceptive pills reduce the risk of **ovarian cancer** by suppressing ovulation and reducing exposure of ovarian cells to incessant hormonal stimulation. - The longer the duration of use, the greater the protective effect, which can persist for years after discontinuation. *Breast cancer* - Some studies suggest a **slight increase in breast cancer risk** with current or recent use of combined oral contraceptives, especially in women with a family history or other risk factors. - However, this increased risk typically **reverts to baseline 10 years after cessation** of use. *Cervical cancer* - Long-term use of combined oral contraceptives is associated with a **modestly increased risk of cervical cancer**, particularly in women who are also infected with **human papillomavirus (HPV)**. - This increased risk is thought to be due to chronic inflammation or hormonal effects on the cervix, but it is **HPV infection that drives cervical cancer pathogenesis**. *Vaginal cancer* - Vaginal cancer is a **rare malignancy**, and combined oral contraceptives have generally **not been shown to either increase or decrease its risk**. - **Diethylstilbestrol (DES) exposure in utero** is the primary risk factor for a specific type of vaginal cancer, **clear cell adenocarcinoma**.

Q: A depot contraceptive, DMPA, is to be given every:

3 months. ***3 months*** - **Depot medroxyprogesterone acetate (DMPA)**, commonly known as **Depo-Provera**, is a highly effective injectable contraceptive. - It works by preventing ovulation and thickening cervical mucus and is administered as an **intramuscular injection** every **12 to 13 weeks** (approximately 3 months). *1 month* - While some **combined oral contraceptives** and **vaginal rings** are used on a monthly cycle, DMPA is not [1]. - Administering DMPA monthly would result in unnecessarily high hormone levels and potential side effects. *2 months* - Administering DMPA every two months is not the standard dosing regimen for this contraceptive. - The efficacy and duration of action of DMPA are well-established for a 3-month interval. *6 months* - The contraceptive effect of DMPA typically lasts for about 3 months; therefore, waiting 6 months between injections would leave the user unprotected for a significant period. - Other long-acting reversible contraceptives (LARCs) like some **subdermal implants** or **intrauterine devices (IUDs)** can provide protection for longer periods, but not DMPA.

Q: Best long-acting reversible contraception (LARC) that can be inserted immediately postpartum in a lactating mother is:

Post Partum IUCD. ***Post Partum IUCD*** - **Intrauterine contraceptive devices (IUCDs)** are highly effective long-acting reversible contraceptives (LARC) that can be inserted **immediately postpartum** (within 10 minutes of placental delivery) or within 48 hours of delivery. - They are **safe for breastfeeding mothers** as copper IUCDs are non-hormonal and levonorgestrel-releasing IUCDs (LNG-IUS) have only localized hormonal effects. - **WHO MEC Category 1** for breastfeeding women, with no interference with lactation or infant growth. - Provide immediate, long-term protection (3-10 years depending on type) with high continuation rates. *Depot provera* - **Depot medroxyprogesterone acetate (DMPA)** is a progestin-only injectable contraceptive that is also safe for breastfeeding mothers (WHO MEC Category 1 after 6 weeks postpartum). - However, it is **not a LARC method that can be inserted immediately postpartum** - it requires injection and has a 3-month duration requiring repeat visits. - While effective for lactating women, it cannot be given in the immediate postpartum period like IUCD insertion. *Combined oral contraceptive pills (OCPs)* - **Combined OCPs** contain estrogen, which can **reduce milk supply** and alter milk composition, especially in the early postpartum period. - **WHO MEC Category 3-4** for breastfeeding women (depending on timing postpartum), contraindicated in the first 6 weeks and generally avoided during lactation. - Not recommended as first-line contraception for lactating mothers. *Calendar method* - The **calendar method** is a natural family planning method that relies on tracking menstrual cycles to predict fertile windows. - It is **highly unreliable** in the postpartum period due to unpredictable ovulation and irregular cycles, especially during breastfeeding (lactational amenorrhea makes cycle tracking impossible). - Not an effective contraceptive method for postpartum women.

Question 1

Copper T is ideally inserted at-

Accepted Answer

Just after menstruation

Answer

Just before menstruation

Answer

On the 26th day

Answer

On the 14th day

Question 2

Which of the following is a method of natural family planning that involves tracking basal body temperature?

Accepted Answer

Basal body temperature (BBT) method

Answer

Coitus interruptus (withdrawal method)

Answer

Safe period (calendar method)

Answer

Abstinence (not having sexual intercourse)

Question 3

In which scenario is the I-pill (emergency contraceptive) most appropriately used?

Accepted Answer

In case of contraceptive failure or unprotected sex

Answer

When a contraceptive method fails

Answer

After unprotected sexual intercourse

Answer

As a regular contraceptive method

Question 4

What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

Accepted Answer

7 weeks

Answer

21 days

Answer

4 weeks

Answer

14 days

Question 5

The mechanism of action of emergency contraception includes the following except:

Accepted Answer

Degeneration of corpus luteum

Answer

Prevention of implantation of fertilized egg.

Answer

Inhibition of fertilization

Answer

By preventing or delaying ovulation

Question 6

Yuzpe regimen should be administered within a maximum of -------

Accepted Answer

72 hours

Answer

3 hours

Answer

12 hours

Answer

24 hours

Question 7

Which of the following is NOT a mechanism of action of copper IUCDs?

Accepted Answer

Increase tubal motility

Answer

Inhibit implantation of the fertilized egg

Answer

Inhibit ovulation

Answer

Induce biochemical changes in the endometrium

Question 8

Combined oral pills reduce the risk of?

Accepted Answer

Ovarian cancer

Answer

Breast cancer

Answer

Cervical cancer

Answer

Vaginal cancer

Question 9

A depot contraceptive, DMPA, is to be given every:

Accepted Answer

3 months

Answer

1 month

Answer

2 months

Answer

6 months

Question 10

Best long-acting reversible contraception (LARC) that can be inserted immediately postpartum in a lactating mother is:

Accepted Answer

Post Partum IUCD

Answer

Depot provera

Answer

Combined oral contraceptive pills (OCPs)

Answer

Calendar method

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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