Contraception and Family Planning Practice Questions

Q: Which one of the following is the most suitable situation for prescribing the progestin-only pill for the purpose of contraception?

Lactational mother. **Explanation:** The **Progestin-Only Pill (POP)**, also known as the "mini-pill," is the contraceptive of choice for **lactating mothers** (Option C). Unlike Combined Oral Contraceptives (COCs), POPs do not contain estrogen. Estrogen is known to suppress prolactin, thereby decreasing the quantity and quality of breast milk. Progestins, however, have no adverse effect on lactation and are safe for the infant, making them ideal for use starting 6 weeks postpartum. **Analysis of Incorrect Options:** * **Active Liver Disease (Option B):** This is a **strict contraindication** for almost all hormonal contraceptives, including POPs. Steroid hormones are metabolized in the liver; impaired hepatic function can lead to hormone accumulation and further liver stress. * **Perimenopausal Patients (Option A):** While POPs can be used, they are often not the "most suitable" due to the high incidence of irregular spotting and breakthrough bleeding—side effects that can mask endometrial pathology (like hyperplasia or malignancy) common in this age group. * **Diabetes (Option D):** While POPs are generally safe in diabetics without vascular complications, they are not specifically "indicated" for them over other methods. In fact, certain progestins can slightly affect carbohydrate metabolism. **High-Yield NEET-PG Pearls:** * **Mechanism of Action:** POPs primarily work by thickening cervical mucus (preventing sperm penetration) and making the endometrium atrophic. They do not consistently inhibit ovulation (unlike COCs). * **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." * **Ideal Candidate:** Women with contraindications to estrogen (e.g., breastfeeding, smokers >35 years, history of DVT, or migraine with aura).

Q: What is the dose of ulipristal acetate when used for emergency contraception?

30 mg. **Explanation:** Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) and is currently considered the most effective oral emergency contraceptive (EC). **1. Why 30 mg is correct:** The standard dose for emergency contraception is a **single 30 mg tablet** taken orally. Its primary mechanism of action is the inhibition or delay of ovulation. Unlike Levonorgestrel (LNG), which is only effective before the LH surge begins, Ulipristal can delay ovulation even after the LH surge has started (but before it peaks), making it effective for up to **120 hours (5 days)** after unprotected intercourse. **2. Why other options are incorrect:** * **300 mg (Option A):** This is a massive overdose for EC. Higher doses of UPA (e.g., 5-10 mg daily) are used for the medical management of uterine fibroids, but 300 mg is not a standard clinical dose. * **300 µg and 30 µg (Options C & D):** These doses are far too low to inhibit ovulation. For comparison, the "Minipill" (Progestogen-only pill) typically contains doses in the microgram range (e.g., Levonorgestrel 30 µg), but emergency contraception requires a much higher "stat" dose to be effective. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** Ulipristal is effective up to 120 hours (5 days), whereas LNG is ideally taken within 72 hours. * **Efficacy in Obesity:** Ulipristal is more effective than LNG in women with a BMI >30 kg/m². * **Breastfeeding Caution:** Women should avoid breastfeeding for **one week** after taking Ulipristal (express and discard milk), unlike LNG which is safe during lactation. * **Drug Interaction:** Do not start hormonal contraception (like OCPs) for at least 5 days after taking UPA, as they may interfere with each other's efficacy.

Q: Which natural family planning method is based on the Ogino-Knauss theory?

Rhythm method. **Explanation:** The **Rhythm method** (also known as the Calendar method) is based on the **Ogino-Knauss theory**, which calculates the fertile window based on the length of previous menstrual cycles. **1. Why the Rhythm Method is correct:** The theory relies on three physiological assumptions: * **Ovulation** occurs 14 days (± 2 days) before the onset of the next menses. * **Spermatozoa** can survive in the female reproductive tract for up to 48–72 hours. * The **Ovum** survives for approximately 12–24 hours after release. By subtracting 18 days from the shortest cycle (to find the first fertile day) and 11 days from the longest cycle (to find the last fertile day), a woman can estimate her "unsafe" period. **2. Why other options are incorrect:** * **Basal Body Temperature (BBT):** Relies on the thermogenic effect of **Progesterone**, which causes a rise in body temperature (0.5–1°F) *after* ovulation has occurred. * **Lactational Amenorrhea (LAM):** Based on the physiological suppression of GnRH, LH, and FSH due to high **Prolactin** levels during exclusive breastfeeding. * **Withdrawal method (Coitus Interruptus):** A behavioral method involving the removal of the penis from the vagina before ejaculation; it is not based on cyclical timing or the Ogino-Knauss theory. **Clinical Pearls for NEET-PG:** * **Pearl 1:** The Rhythm method is the **least reliable** natural method due to cycle variability (Failure rate: ~25%). * **Pearl 2:** The **Billings method** (Cervical Mucus method) identifies the fertile period by observing "Spinnbarkeit" (thin, stretchy, egg-white mucus) caused by high estrogen. * **Pearl 3:** The **Symptothermal method** is the most effective natural method as it combines BBT, cervical mucus changes, and calendar calculations.

Q: All the following are contraindications for copper-containing IUCDs except?

Ischemic heart disease. **Explanation:** The correct answer is **Ischemic Heart Disease (IHD)**. According to the WHO Medical Eligibility Criteria (MEC), IHD is classified as **Category 1** for Copper IUCDs (Cu-IUD), meaning there is no restriction for its use. Unlike hormonal contraceptives (like OCPs), Cu-IUDs do not contain estrogen or progestogens, which are associated with thromboembolic risks and adverse lipid profiles. Therefore, they are safe for women with cardiovascular conditions. **Analysis of Contraindications:** * **Wilson’s Disease (Option A):** This is a specific contraindication for **Copper-containing** IUCDs because the device can potentially interfere with copper metabolism or exacerbate the systemic copper burden in these patients. (Note: LNG-IUS is an alternative here). * **Pregnancy (Option B):** This is an absolute contraindication (MEC Category 4). Insertion during pregnancy can lead to septic abortion, pelvic infection, or preterm labor. * **Undiagnosed Genital Bleeding (Option C):** This is a Category 4 contraindication. Insertion must be delayed until a serious underlying pathology (like endometrial or cervical malignancy) is ruled out, as the IUCD may worsen bleeding or complicate the diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **MEC Category 4 (Absolute Contraindications):** Current PID, unexplained vaginal bleeding, copper allergy (for Cu-IUD), and gestational trophoblastic disease with high hCG levels. * **Ideal Candidate:** A parous woman in a stable monogamous relationship with no history of PID. * **Most Common Side Effect:** Increased menstrual blood loss (menorrhagia) and dysmenorrhea. * **Most Common Reason for Removal:** Excessive menstrual bleeding. * **Post-exposure Prophylaxis:** Cu-IUD is the most effective emergency contraceptive if inserted within 5 days of unprotected intercourse.

Q: What is the maximum amount of progesterone (in micrograms) contained in a low-dose oral contraceptive pill?

35. **Explanation:** The term **"Low-dose Oral Contraceptive Pill" (OCP)** specifically refers to the concentration of the estrogen component (Ethinyl Estradiol), not the progesterone. However, the classification of these pills is strictly defined by pharmacological standards to minimize metabolic side effects while maintaining contraceptive efficacy. 1. **Why 35 µg is correct:** In modern clinical practice, a "low-dose" OCP is defined as a pill containing **less than 50 µg** of Ethinyl Estradiol. Most standard low-dose formulations available (such as Mala-N or Mala-D) contain exactly **30 µg to 35 µg** of estrogen. Therefore, 35 µg represents the upper limit of what is classified as a standard low-dose pill. 2. **Why other options are incorrect:** * **15 µg & 25 µg:** These are considered "ultra-low-dose" pills. While they have fewer estrogenic side effects, they are associated with higher rates of breakthrough bleeding and a narrower margin for error if a dose is missed. * **45 µg:** This falls just below the 50 µg threshold but is not a standard manufactured dose for low-dose categorization in competitive exams; 35 µg is the classic textbook benchmark. **High-Yield Clinical Pearls for NEET-PG:** * **Generation Gap:** First-generation pills contained >50 µg of estrogen. Modern "Low-dose" pills (2nd/3rd Gen) contain 30–35 µg. * **Mechanism:** The estrogen component primarily inhibits **FSH** (preventing follicular selection), while the progestogen inhibits **LH** (preventing ovulation) and thickens cervical mucus. * **Mala-N vs. Mala-D:** Both contain 0.03 mg (30 µg) Ethinyl Estradiol and 0.15 mg Levonorgestrel. Mala-N is free (Government supply), while Mala-D is subsidized. * **Centchroman (Saheli):** A high-yield non-steroidal alternative; it is a SERM taken twice weekly for 3 months, then once weekly.

Q: Which of the following is NOT used as emergency contraception?

Saheli. **Explanation:** The correct answer is **Saheli (Centchroman)**. **1. Why Saheli is the correct answer:** Saheli is a **Selective Estrogen Receptor Modulator (SERM)**. It is used as a **non-steroidal, weekly oral contraceptive pill** for routine birth control, not for emergency use. Its mechanism involves altering the uterine endometrium to prevent implantation and speeding up ovum transport. Because it requires a steady-state buildup (taken twice weekly for the first 3 months, then once weekly), it is ineffective as a post-coital emergency measure. **2. Why the other options are incorrect (Emergency Contraceptive Methods):** * **Combined Oral Contraceptive Pills (COCs):** Used in the **Yuzpe Regimen**. It involves taking two doses (each containing 100 mcg Ethinyl Estradiol + 0.5 mg Levonorgestrel) 12 hours apart within 72 hours of intercourse. * **Intrauterine Device (IUD):** The **Copper T-380A** is the **most effective** emergency contraceptive. It can be inserted up to 5 days (120 hours) after unprotected intercourse and prevents pregnancy by interfering with fertilization and implantation. * **High-dose Estrogen:** Historically used (e.g., Ethinyl Estradiol 5mg daily for 5 days), this method is now largely obsolete due to severe side effects like nausea and vomiting, but it remains a recognized pharmacological method for emergency contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Levonorgestrel (LNG) 1.5 mg single dose (within 72 hours) is the current standard. * **Most Effective Method:** Copper IUD (failure rate <0.1%). * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) effective up to 120 hours (5 days); it is more effective than LNG in obese women. * **Mifepristone:** Can be used as an emergency contraceptive in low doses (10–25 mg).

Question 1

Which one of the following is the most suitable situation for prescribing the progestin-only pill for the purpose of contraception?

Accepted Answer

Lactational mother

Answer

Perimenopausal patients

Answer

Active liver disease

Answer

Diabetes

Question 2

A couple is advised to use barrier methods after vasectomy until which condition is met?

Accepted Answer

No sperms are detected in the ejaculate

Answer

3 months

Answer

The next 15 ejaculations

Answer

None of the above

Question 3

Which is the ideal contraceptive for a couple who have infrequent coital frequency due to professional commitments?

Accepted Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pill (OCP)

Answer

Depot medroxyprogesterone acetate (DMPA)

Question 4

What is the dose of ulipristal acetate when used for emergency contraception?

Accepted Answer

30 mg

Answer

300 mg

Answer

300 µg

Answer

30 µg

Question 5

Which natural family planning method is based on the Ogino-Knauss theory?

Accepted Answer

Rhythm method

Answer

Basal Body Temperature (BBT) method

Answer

Lactational amenorrhea

Answer

Withdrawal method

Question 6

All the following are contraindications for copper-containing IUCDs except?

Accepted Answer

Ischemic heart disease

Answer

Wilson's disease

Answer

Pregnancy

Answer

Undiagnosed genital bleeding

Question 7

The failure rate of oral contraceptive pills (OCPs) is lowest in which of the following groups?

Accepted Answer

Nullipara

Answer

Multipara

Answer

Grand multipara

Answer

Same in all groups

Question 8

With contraceptive failure, which method has a relatively increased risk of ectopic pregnancy?

Accepted Answer

Tubal sterilization

Answer

Condoms

Answer

Vasectomy

Answer

Vaginal ring

Question 9

What is the maximum amount of progesterone (in micrograms) contained in a low-dose oral contraceptive pill?

Accepted Answer

35

Answer

15

Answer

25

Answer

45

Question 10

Which of the following is NOT used as emergency contraception?

Accepted Answer

Saheli

Answer

Combined oral contraceptive pills

Answer

Intrauterine device (IUD)

Answer

High-dose estrogen for 5 days

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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