Contraception and Family Planning — MCQs

A 39-year-old patient is contemplating discontinuing birth control pills to conceive. She is concerned about her fertility at this age and inquires about when she can anticipate the resumption of normal menses. What proportion of patients resume normal menses within 3 months after discontinuing birth control pills?

Q437Easy

What is considered the safe period for contraception?

Q438Medium

Which of the following is NOT a drug used in emergency contraception?

Q439Easy

Which of the following is NOT a natural family planning method?

Q440Easy

Oral contraceptives increase the risk of all the following conditions except?

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 431: Oral contraceptive pills are contraindicated in:

A. Premenstrual tension
B. Endometriosis
C. Hepatadenoma (Correct Answer)
D. Pelvic inflammatory disease

Explanation: **Explanation:** The correct answer is **Hepatadenoma (Hepatic Adenoma)**. Combined Oral Contraceptive Pills (COCPs) are absolute contraindications in patients with benign or malignant liver tumors because the estrogen component can stimulate the growth of these tumors and increase the risk of rupture and life-threatening intraperitoneal hemorrhage. **Why the other options are incorrect:** * **Premenstrual Tension (PMT):** COCPs are often used as a **treatment** for PMT/PMS. By suppressing ovulation and stabilizing hormonal fluctuations throughout the cycle, they help alleviate physical and emotional symptoms. * **Endometriosis:** COCPs are a **first-line medical management** strategy. They induce a state of "pseudopregnancy," causing atrophy of the ectopic endometrial tissue and reducing dysmenorrhea. * **Pelvic Inflammatory Disease (PID):** COCPs are actually considered **protective** against PID. They increase the viscosity of cervical mucus, making it difficult for ascending pathogens (like *N. gonorrhoeae*) to enter the upper reproductive tract. **High-Yield NEET-PG Pearls:** * **WHO Eligibility Criteria Category 4 (Absolute Contraindications):** * Smokers >35 years (≥15 cigarettes/day). * History of Thromboembolism (DVT/PE) or Stroke. * Current Breast Cancer. * Decompensated Cirrhosis, Hepatoma, or Viral Hepatitis (Active). * Migraine with Aura (increased risk of ischemic stroke). * Uncontrolled Hypertension (>160/100 mmHg). * **Key Benefit:** COCPs significantly reduce the risk of **Ovarian and Endometrial cancers** (protective effect lasts years after discontinuation).

Question 432: What is the expulsion rate following intrauterine device insertion?

A. 1%
B. 5%
C. 20% (Correct Answer)
D. 30%

Explanation: **Explanation:** The correct answer is **20% (Option C)**. This question specifically refers to the **expulsion rate** of an Intrauterine Contraceptive Device (IUCD). **1. Why 20% is correct:** In clinical practice and standard textbooks (like DC Dutta), the expulsion rate for IUCDs is generally cited between **5% to 20%**. When presented with a range in NEET-PG, the upper limit or the most commonly cited statistical average for "early" or "post-partum" expulsion is often tested. Specifically, the expulsion rate is highest in the first year of use, particularly within the first three months. Factors increasing this rate include nulliparity, insertion immediately postpartum (PPIUCD), or insertion by an inexperienced provider. **2. Analysis of Incorrect Options:** * **Option A (1%):** This is too low for expulsion. However, 1% (or less) is the typical **failure rate (Pearl Index)** for Cu-T 380A, representing its high contraceptive efficacy. * **Option B (5%):** While 5% is the lower end of the expulsion range, it is less frequently cited as the definitive "high-yield" figure compared to the 10-20% range in standard Indian medical curriculum contexts. * **Option D (30%):** This is excessively high. If expulsion rates were 30%, the method would not be considered a reliable long-term reversible contraceptive (LARC). **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Excessive menstrual bleeding (Menorrhagia). * **Most common reason for removal:** Pain and bleeding. * **Ideal time for insertion:** Within 10 days of the onset of menstruation (to ensure the patient is not pregnant and the cervix is slightly dilated). * **PPIUCD Timing:** Best inserted within 48 hours of delivery; if not, wait for 6 weeks (involution). * **Cu-T 380A Life:** Effective for **10 years**.

Question 433: A 30-year-old nulliparous patient with primary infertility presents with a pelvic mass. Her CA-125 level is 90 U/L. What is the most probable cause?

A. Epithelial ovarian cancer
B. Dysgerminoma
C. Borderline ovarian tumour
D. Endometrioma (Correct Answer)

Explanation: **Explanation:** The correct answer is **Endometrioma**. This question tests the ability to differentiate causes of an adnexal mass and elevated CA-125 in a reproductive-age woman. 1. **Why Endometrioma is correct:** The clinical triad of **primary infertility**, a **pelvic mass**, and a moderately elevated **CA-125** (typically <200 U/L) in a young patient is classic for endometriosis/endometrioma. While CA-125 is a marker for epithelial ovarian cancer, it is also elevated in benign conditions involving peritoneal irritation, such as endometriosis, pelvic inflammatory disease, and fibroids. In a 30-year-old with infertility, endometriosis is statistically the most probable diagnosis. 2. **Why the other options are incorrect:** * **Epithelial Ovarian Cancer (EOC):** While CA-125 is the marker for EOC, this typically presents in postmenopausal women. In a 30-year-old nulliparous woman, a benign or less aggressive etiology is more likely. * **Dysgerminoma:** This is the most common germ cell tumor in young women. However, its characteristic tumor marker is **LDH**, not CA-125. * **Borderline Ovarian Tumour:** While possible, these usually present with much higher CA-125 levels or specific ultrasound features. Given the history of infertility, endometrioma is a more "textbook" association. **High-Yield Clinical Pearls for NEET-PG:** * **CA-125** is not specific to cancer; it is elevated in any condition that causes inflammation of the pleura, pericardium, or peritoneum. * **Endometrioma Ultrasound:** Classically described as having "ground-glass echoes" or a "chocolate cyst" appearance. * **Tumor Marker Review:** * Dysgerminoma: LDH * Yolk Sac Tumor: Alpha-fetoprotein (AFP) * Choriocarcinoma: beta-hCG * Granulosa Cell Tumor: Inhibin B

Question 434: All of the following are recognized effects of combined oral contraceptives except?

A. Breakthrough bleeding
B. Decreased risk of endometrial cancer
C. Increased risk of ischemic stroke
D. Increased risk of colon cancer (Correct Answer)

Explanation: **Explanation:** Combined Oral Contraceptive Pills (COCPs) exert a wide range of systemic effects, both beneficial and adverse. The correct answer is **D** because COCPs are actually associated with a **decreased risk of colorectal cancer** (approximately 15-20% reduction), rather than an increased risk. **Analysis of Options:** * **Option D (Correct):** Epidemiological studies consistently show that COCP use is a protective factor against colon cancer. Therefore, stating it increases the risk is factually incorrect. * **Option A (Incorrect):** Breakthrough bleeding (spotting) is the most common side effect of COCPs, especially during the first few months of use or with low-dose estrogen formulations. * **Option B (Incorrect):** COCPs provide significant protection against endometrial cancer (by suppressing endometrial proliferation) and ovarian cancer. This protection persists for years after discontinuation. * **Option C (Incorrect):** Estrogen increases the synthesis of clotting factors and can cause endothelial changes. This leads to a slightly increased risk of venous thromboembolism (VTE), myocardial infarction, and ischemic stroke, particularly in women who smoke or have hypertension. **NEET-PG High-Yield Pearls:** 1. **Cancer Protection:** COCPs decrease the risk of three cancers: **Ovarian, Endometrial, and Colorectal.** 2. **Cancer Risk:** COCPs are associated with a slight increase in the risk of **Cervical and Breast cancer.** 3. **Non-Contraceptive Benefits:** Reduced incidence of Pelvic Inflammatory Disease (PID), ectopic pregnancy, benign breast disease, and improvement in dysmenorrhea/menorrhagia. 4. **Absolute Contraindications:** Smokers >35 years (>15 cigarettes/day), history of thromboembolism, migraine with aura, and undiagnosed abnormal uterine bleeding.

Question 435: Which vaccine is contraindicated in pregnancy?

A. Diphtheria
B. Hepatitis-B
C. MMR (Correct Answer)
D. Killed polio vaccine

Explanation: **Explanation:** The core principle in obstetric immunization is that **Live Attenuated Vaccines** are generally **contraindicated** during pregnancy. This is due to the theoretical risk of the live virus crossing the placenta and causing fetal infection or teratogenic effects. **Why MMR is the Correct Answer:** The **MMR (Measles, Mumps, and Rubella)** vaccine contains live attenuated viruses. The Rubella component is of particular concern as it can theoretically cause **Congenital Rubella Syndrome (CRS)**. Therefore, MMR should be administered either before conception (with a recommendation to avoid pregnancy for 28 days/1 month post-vaccination) or in the immediate postpartum period. **Analysis of Incorrect Options:** * **Diphtheria:** This is a **toxoid** vaccine. It is safe and routinely administered during pregnancy (usually as Tdap) to provide passive immunity to the newborn against neonatal tetanus and pertussis. * **Hepatitis-B:** This is a **subunit (recombinant)** vaccine. It is safe and indicated for pregnant women at high risk of infection. * **Killed Polio Vaccine (IPV):** Inactivated (killed) vaccines do not pose a risk of replication or fetal infection. While IPV is not routinely given unless there is a high risk of exposure, it is not contraindicated like the live oral version (OPV). **High-Yield Clinical Pearls for NEET-PG:** 1. **Safe Vaccines:** All Inactivated/Killed vaccines (Flu shot, Rabies, IPV), Toxoids (Tetanus, Diphtheria), and Recombinant vaccines (Hep-B, HPV—though HPV is usually deferred). 2. **Contraindicated Vaccines:** "Live" vaccines—**MMR, Varicella, BCG, Yellow Fever, and Oral Polio (OPV).** 3. **Exception:** Yellow Fever vaccine may be given if the risk of disease outweighs the risk of vaccination (e.g., unavoidable travel to endemic zones). 4. **Best Time for Tdap:** Between **27 and 36 weeks** of gestation to maximize transplacental antibody transfer.

Question 436: A 39-year-old patient is contemplating discontinuing birth control pills to conceive. She is concerned about her fertility at this age and inquires about when she can anticipate the resumption of normal menses. What proportion of patients resume normal menses within 3 months after discontinuing birth control pills?

A. 99%
B. 95%
C. 80% (Correct Answer)
D. 50%

Explanation: ### Explanation **1. Understanding the Correct Answer (Option C: 80%)** After discontinuing combined oral contraceptive pills (COCPs), most women experience a rapid return of the hypothalamic-pituitary-ovarian (HPO) axis to its baseline state. Clinical studies indicate that approximately **80% of women will resume normal, ovulatory menses within 3 months** of stopping the pill. While the first cycle may be slightly delayed (often by a few days), the long-term fertility outcomes for former COCP users are comparable to those who have never used hormonal contraception. **2. Analysis of Incorrect Options** * **Option A (99%) & B (95%):** These figures are too high for the immediate 3-month window. While nearly all women eventually resume menses, a significant minority (about 20%) may experience "post-pill amenorrhea" or irregular cycles for a short duration due to the time required for the HPO axis to recalibrate. * **Option D (50%):** This is an underestimate. COCPs do not cause permanent suppression of the ovaries. A 50% resumption rate would suggest a high incidence of secondary amenorrhea, which is not supported by clinical data. **3. High-Yield Clinical Pearls for NEET-PG** * **Post-Pill Amenorrhea:** Defined as the failure to resume menses within 6 months of discontinuing COCPs. It occurs in <3% of users. If it persists beyond 6 months, the clinician must investigate other causes (e.g., PCOS, premature ovarian failure, or weight changes) rather than attributing it solely to the pill. * **Fertility Delay:** There is no evidence that COCPs cause permanent infertility. However, injectable progestogens (like **DMPA**) can cause a significant delay in the return of fertility, averaging **7–9 months** after the last injection. * **Age Factor:** While menses return quickly, the patient should be counseled that fecundability (the probability of conceiving in one cycle) naturally declines after age 35 due to decreased ovarian reserve.

Question 437: What is considered the safe period for contraception?

A. Days 1-5 of the menstrual cycle
B. Days 8-11 of the menstrual cycle
C. Days 16-20 of the menstrual cycle
D. Days 21-28 of the menstrual cycle (Correct Answer)

Explanation: The "Safe Period" (Rhythm Method) is based on the physiological timing of ovulation and the lifespan of gametes. In a standard 28-day cycle, ovulation typically occurs on Day 14. To calculate the unsafe (fertile) period, we account for the lifespan of sperm (up to 5 days) and the ovum (12–24 hours). **Why Option D is correct:** The period from **Day 21 to Day 28** is considered the "post-ovulatory safe period." By Day 21, ovulation has already occurred, and the ovum has degenerated, making fertilization impossible. This is the most reliable part of the safe period because the luteal phase is constant (14 days), unlike the variable pre-ovulatory phase. **Analysis of Incorrect Options:** * **Option A (Days 1-5):** While pregnancy risk is low during menstruation, it is not as "safe" as the late luteal phase, especially in women with shorter cycles where ovulation may occur early. * **Option B (Days 8-11):** This is the "pre-ovulatory" window. Since sperm can survive for 5 days, intercourse on Day 11 can lead to fertilization if ovulation occurs on Day 14 or 15. * **Option C (Days 16-20):** This is highly unsafe. In a 28-day cycle, the fertile window is generally considered Days 10–17. Intercourse during Days 16–20 carries a high risk as the ovum may still be viable. **NEET-PG High-Yield Pearls:** * **Ogino-Knaus Formula:** To calculate the fertile period, subtract 18 days from the shortest cycle and 11 days from the longest cycle. * **Pearl Index:** The failure rate for the rhythm method is high (approx. 20–25 per 100 woman-years), making it less effective than modern contraceptives. * **Standard Days Method:** Uses "CycleBeads" to identify Days 8–19 as the permanent unsafe window for cycles between 26–32 days.

Question 438: Which of the following is NOT a drug used in emergency contraception?

A. Levonorgestrel
B. Estrogen + progesterone
C. Danazol (Correct Answer)
D. Mifepristone

Explanation: **Explanation:** The correct answer is **Danazol**. While Danazol was historically used for various gynecological conditions like endometriosis, it is **not** used as an emergency contraceptive (EC). Modern emergency contraception relies on hormonal modulation to delay ovulation or prevent implantation. **Why Danazol is the correct answer:** Danazol is a synthetic androgen (an ethinyl testosterone derivative) that suppresses the pituitary-ovarian axis. While it inhibits ovulation when taken chronically, it has no proven efficacy as a post-coital emergency contraceptive and is not part of any standard EC protocol. **Analysis of incorrect options:** * **Levonorgestrel (LNG):** The current "Gold Standard" for hormonal EC. A single dose of 1.5 mg (or two doses of 0.75 mg) is highly effective if taken within 72 hours of unprotected intercourse. It works primarily by delaying the LH surge and inhibiting ovulation. * **Estrogen + Progesterone:** Known as the **Yuzpe Regimen**. It involves taking two doses of combined oral contraceptive pills (each containing 100 mcg Ethinyl Estradiol + 0.5 mg Levonorgestrel) 12 hours apart. Due to high side effects (nausea/vomiting), it is now less preferred than LNG-only pills. * **Mifepristone:** An anti-progestin. In low doses (10–25 mg), it is a highly effective emergency contraceptive. It acts by delaying ovulation and altering the endometrium to prevent implantation. **High-Yield NEET-PG Pearls:** * **Most effective EC:** The **Copper T (IUCD)** is the most effective method of emergency contraception (up to 99%) and can be inserted up to 5 days after unprotected sex. * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) used as a single 30 mg dose; it is effective up to 120 hours (5 days) and is more effective than LNG in obese women. * **Timeframe:** Hormonal methods are best used within 72 hours, though they may show some efficacy up to 120 hours.

Question 439: Which of the following is NOT a natural family planning method?

A. Basal body temperature
B. Cycloprovera (Correct Answer)
C. Billings method
D. Symptothermal method

Explanation: **Explanation:** The correct answer is **Cycloprovera** because it is a **hormonal contraceptive method**, not a natural family planning (NFP) method. Natural family planning relies on observing physiological signs of the menstrual cycle to identify the fertile window without the use of drugs or devices. **Why Cycloprovera is the correct choice:** Cycloprovera is a **Combined Injectable Contraceptive (CIC)** containing Medroxyprogesterone acetate (25 mg) and Estradiol cypionate (5 mg). It is administered intramuscularly once a month. It works primarily by suppressing ovulation through the hypothalamic-pituitary-ovarian axis, making it an artificial pharmacological intervention. **Why the other options are incorrect:** * **Basal Body Temperature (BBT):** A natural method where a woman tracks her resting body temperature daily. A slight rise (0.4°F to 0.8°F) indicates that ovulation has occurred due to the thermogenic effect of progesterone. * **Billings Method (Cervical Mucus Method):** A natural method based on observing changes in cervical mucus. "Fertile" mucus is thin, watery, and stretchy (high Spinnbarkeit), while "infertile" mucus is thick and tacky. * **Symptothermal Method:** This is a **multi-index natural method** that combines BBT, cervical mucus changes, and sometimes physical symptoms like Mittelschmerz (ovulation pain) to increase accuracy. **High-Yield NEET-PG Pearls:** * **Pearl 1:** The most effective natural method is the **Symptothermal method** due to its multi-parametric approach. * **Pearl 2:** **Lactational Amenorrhea Method (LAM)** is also a natural method, effective only if the mother is exclusively breastfeeding, is less than 6 months postpartum, and remains amenorrheic. * **Pearl 3:** **Pearl Index** for natural methods is generally higher (lower efficacy) compared to hormonal methods like Cycloprovera due to high user dependency.

Question 440: Oral contraceptives increase the risk of all the following conditions except?

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

Explanation: **Explanation:** The correct answer is **Ovarian cancer** because Combined Oral Contraceptive Pills (COCPs) are actually **protective** against it. **1. Why Ovarian Cancer is the Correct Answer:** COCPs suppress ovulation by inhibiting the release of FSH and LH. According to the "Incessant Ovulation Theory," reducing the number of ovulatory cycles decreases repetitive trauma to the ovarian epithelium. This leads to a significant reduction (approx. 50%) in the risk of epithelial ovarian cancer. This protective effect begins after 3–6 months of use and persists for up to 15–20 years after discontinuation. **2. Analysis of Incorrect Options:** * **Breast Cancer:** Most studies indicate a slight, transient increase in the relative risk of breast cancer among current and recent users. The risk typically returns to baseline 10 years after stopping. * **Cervical Cancer:** Long-term use of COCPs (over 5 years) is associated with an increased risk of cervical cancer, likely due to hormonal influences on the transformation zone and a possible association with increased exposure to HPV. * **Liver Cancer:** COCPs are linked to an increased risk of benign liver tumors (Hepatic Adenoma) and, in rare cases, have been associated with an increased risk of Hepatocellular Carcinoma (HCC). **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects:** COCPs reduce the risk of **Ovarian, Endometrial, and Colorectal cancers.** * **Increased Risk:** COCPs increase the risk of **Breast, Cervical, and Liver cancers.** * **Non-Contraceptive Benefits:** They are used to manage dysmenorrhea, menorrhagia, and PCOS, and they decrease the incidence of Benign Breast Disease (BBD) and Pelvic Inflammatory Disease (PID).

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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