Contraception and Family Planning Practice Questions

Q: What is the recommended interval for administering DMPA, an injectable contraceptive?

Three months. ***Three months*** - **Depot medroxyprogesterone acetate (DMPA)** is a long-acting reversible injectable contraceptive containing 150 mg of medroxyprogesterone acetate. - The standard administration schedule is **every 12 weeks (3 months)**, with a grace period allowing administration up to 13-15 weeks to maintain contraceptive effectiveness. - DMPA works by **suppressing ovulation** through sustained progestogen levels, and the 3-month interval is based on its pharmacokinetics to maintain therapeutic levels. *Three weeks* - A three-week interval is typical for **combined oral contraceptive pill packs** (21 active pills followed by 7-day break), not for DMPA. - Administering DMPA at this frequency would lead to **excessive progestogen exposure** and unnecessary side effects, as the injection maintains contraceptive levels for 12-13 weeks. *Two months* - While a two-month interval provides longer protection than oral contraceptives, it is **not the standard recommended interval** for DMPA. - This interval would result in **premature readministration** before the previous dose's effect wanes, leading to unnecessary injections and potential side effects. *Two years* - A two-year interval is far too long for DMPA, which has a **duration of action of approximately 12-14 weeks** per injection. - Such an interval would result in **complete loss of contraceptive protection** within 3-4 months, with return of ovulation and risk of unintended pregnancy.

Q: What is the preferred method of contraception for a female with a family history of ovarian cancer?

Combined oral contraceptive pills (OCP). ***Combined oral contraceptive pills (OCP)*** - **OCPs** have been shown to significantly **reduce the risk of ovarian cancer by 30-50%**, with the protective effect increasing with duration of use. - This protection is attributed to **suppression of ovulation**, reducing repetitive ovulation-related epithelial damage and inflammation that contributes to ovarian cancer development. - The benefit **persists for years after discontinuation** and is particularly important for individuals with a family history of ovarian cancer, as it addresses a key modifiable risk factor. - **First-line recommendation** for contraception in women with family history of ovarian cancer. *Progestin-only pills (POP)* - While **POPs** are effective contraceptives and generally safe, they do **not offer the same well-established protective effect against ovarian cancer** as combined hormonal contraceptives. - Their primary mechanism is through thickening cervical mucus and suppressing ovulation, without the estrogen component. - Evidence for ovarian cancer protection is limited compared to combined OCPs. *Copper intrauterine device (Cu IUCD)* - The **Cu IUCD** provides highly effective contraception by creating a local inflammatory response in the uterus that is spermicidal. - It is a **non-hormonal method** and therefore does not impact the risk of ovarian cancer. - Excellent contraceptive option for other indications, but not specifically protective against ovarian cancer. *Condoms* - **Condoms** primarily prevent pregnancy by blocking sperm from reaching the egg and are effective in preventing sexually transmitted infections. - They are a **barrier method** and provide no hormonal protection against ovarian cancer. - Useful for STI prevention but not relevant to ovarian cancer risk reduction.

Q: Which of the following is not an absolute contraindication to the use of combined oral contraceptives?

Previous herpes genitalis. ***Previous herpes genitalis*** - Previous herpes genitalis is **not an absolute contraindication** to combined oral contraceptive (COC) use and does not significantly increase the risks associated with COCs. - While active herpes lesions might be a concern for comfort or transmission, the *past history* alone does not preclude COC use. - Per **WHO Medical Eligibility Criteria**, history of herpes is Category 1 (no restriction). *Cerebral haemorrhage* - **Cerebral haemorrhage** (a type of stroke) signifies significant underlying vascular disease and is an absolute contraindication due to the increased risk of **thromboembolic events** associated with COCs. - COCs raise the risk of both ischemic and hemorrhagic strokes, making them unsafe in individuals with a history of such events. - This is **WHO MEC Category 4** (absolute contraindication). *Porphyria* - **Acute porphyria** is an absolute contraindication because exogenous estrogens can **exacerbate acute porphyric attacks** due to their effects on heme synthesis. - This can lead to severe neurological symptoms, abdominal pain, and psychiatric disturbances. - This is **WHO MEC Category 4** (absolute contraindication). *Trophoblastic disease with elevated hCG* - **Gestational trophoblastic disease with persistently elevated hCG levels** is an absolute contraindication because hormonal exposure can potentially **stimulate residual trophoblastic tissue**, promoting disease progression or hindering monitoring. - It is crucial to monitor for complete disease regression with serial hCG levels reaching undetectable values before initiating COCs. - This is **WHO MEC Category 4** (absolute contraindication). Once hCG is undetectable and disease is resolved, COCs become Category 1.

Q: All of the following are postcoital contraception methods except?

Barrier methods. ***Barrier methods*** - **Barrier methods** like condoms or diaphragms are used *during* intercourse to prevent pregnancy and STIs. - They are not a form of **postcoital contraception** as they do not act *after* unprotected sex has occurred. *Mifepristone* - **Mifepristone** can be used as an **emergency contraceptive** by delaying or inhibiting ovulation, or by altering the endometrium to prevent implantation. - It works *after* unprotected intercourse and is an effective form of **postcoital contraception**. *IUD* - The **copper intrauterine device (IUD)** can be inserted as an **emergency contraceptive** up to 5 days after unprotected intercourse. - It prevents pregnancy primarily by creating a **spermicidal inflammatory reaction** in the uterus, making it unsuitable for implantation. *Levonorgestrel* - **Levonorgestrel-only pills** are a common form of **emergency contraception**, sometimes known as the "morning-after" pill. - They work by **delaying or inhibiting ovulation** and are effective when taken *within 72 hours* of unprotected sex.

Q: Which of the following is considered a temporary method of contraception?

OCP. ***OCP*** - **Oral Contraceptive Pills (OCPs)** are a common type of hormonal contraception that require daily administration and are easily reversible, fitting the definition of a **temporary method**. - They work by preventing ovulation, thickening cervical mucus, and thinning the uterine lining, effects that cease once the pills are stopped. *Vasectomy* - A **vasectomy** is a surgical procedure for male sterilization where the vas deferens are cut or sealed, making it a **permanent method** of contraception. - While sometimes reversible, reversal procedures are complex, expensive, and not always successful, making it generally considered irreversible. *Tubectomy* - A **tubectomy**, or tubal ligation, is a surgical procedure for female sterilization where the fallopian tubes are cut, tied, or sealed, making it a **permanent method** of contraception. - It is intended as an irreversible method to prevent the egg from reaching the uterus or sperm from reaching the egg. *Postpartum sterilisation* - **Postpartum sterilization** refers to a tubectomy performed after childbirth, which is a **permanent method** of contraception. - It falls under permanent surgical contraception and is not considered temporary, as its intent is to prevent future pregnancies indefinitely.

Q: In which of the following conditions is IUCD contraindicated?

Infection. ***Infection*** - An **active pelvic infection** (e.g., cervicitis, endometritis, pelvic inflammatory disease) is an absolute contraindication to IUCD insertion, as it can worsen the infection and lead to serious reproductive complications. - IUCD insertion in the presence of infection increases the risk of **sepsis** and damage to the fallopian tubes or uterus. *Anemia* - **Anemia** itself is not a contraindication for IUCD insertion, though specific types of IUCDs might be preferred. - For example, **copper IUCDs** can sometimes increase menstrual bleeding, which could worsen pre-existing anemia, but this is a relative consideration, not an absolute contraindication, and can be managed. *Hypertension* - **Hypertension** is not a contraindication for the use of IUCDs, as they do not significantly affect blood pressure. - This is a particular advantage of IUCDs for women who cannot use **estrogen-containing contraceptives** due to blood pressure concerns. *Option: "None of the options"* - This option is incorrect because **active infection** is a clear contraindication for IUCD insertion, as explained above. - There are specific medical conditions that absolutely preclude the safe placement of an IUCD.

Q: All are long-acting reversible contraceptives except:

OCP. ***OCP (Oral Contraceptive Pills)*** - **Oral Contraceptive Pills (OCPs)** are taken daily and require consistent user adherence for effectiveness. - OCPs are classified as **short-acting reversible contraceptives**, not long-acting reversible contraceptives (LARCs). - LARCs are defined as contraceptive methods that require administration less than once per cycle and provide effective contraception for ≥2-3 years. *Implanon* - **Implanon** is a single-rod subdermal contraceptive implant that releases etonogestrel and provides contraception for up to **3 years**. - It is a highly effective LARC with a failure rate <1% and is easily reversible upon removal. *IUCD (Intrauterine Contraceptive Device)* - IUCDs include copper IUDs (effective for 5-10 years) and hormonal IUDs like Mirena (effective for 3-5 years). - They are highly effective LARCs with minimal user compliance required once inserted and are immediately reversible upon removal. *Jadelle* - **Jadelle** is a two-rod subdermal contraceptive implant that releases levonorgestrel and provides contraception for up to **5 years**. - Like other implants, it offers long-term protection, high efficacy (>99%), and is easily reversible.

Q: The most common complication of intrauterine contraceptive devices is:

Bleeding. ***Bleeding*** - **Irregular bleeding** and **heavier menstrual periods (menorrhagia)** are the most common reasons for IUD discontinuation. - This is particularly true for **non-hormonal copper IUDs**, which can increase menstrual blood loss and dysmenorrhea. *Ectopic pregnancy* - While IUDs significantly reduce the overall risk of pregnancy, if a pregnancy does occur with an IUD in place, there is a **higher relative risk** that it will be **ectopic**. - However, the **absolute number** of ectopic pregnancies is low due to the high effectiveness of IUDs in preventing pregnancy altogether. *Backache* - Backache is **not a common complication** directly attributed to IUD use. - It could be a general discomfort but isn't specifically caused by the device itself or its mechanism of action. *Cervical stenosis* - **Cervical stenosis** is a narrowing of the cervical canal, which is **not typically caused by IUD insertion or presence**. - More commonly, it results from **surgical procedures** on the cervix, infection, or radiation.

Q: Most preferable contraceptive method for a female suffering from rheumatic heart disease who has completed her family is:

Surgical sterilization (Tubal ligation). ***Surgical sterilization (Tubal ligation)*** - This option offers **permanent contraception**, which is ideal for a woman with **rheumatic heart disease** who has completed her family, minimizing future pregnancy risks. - It avoids the systemic or local side effects of other contraceptive methods, which is crucial for patients with pre-existing health conditions. *Long-term intrauterine device (IUCD)* - While effective, IUCDs carry a small risk of **infection** and potential for increased menstrual bleeding or pain, which might be undesirable in patients with cardiac conditions. - The insertion procedure itself can sometimes be associated with discomfort or risks of perforation. *Non-hormonal barrier methods* - These methods, such as condoms or diaphragms, have a **higher failure rate** compared to other options, making them less reliable for a woman who must avoid pregnancy due to health reasons. - Their effectiveness depends heavily on consistent and correct use, which can be challenging. *Hormonal contraceptive implant* - Hormonal methods, including implants, can sometimes have **systemic side effects**, such as changes in mood, weight, or bleeding patterns, which might impact a patient with chronic health conditions. - While generally safe, some hormonal contraceptives might have contraindications or require careful monitoring in patients with specific cardiac issues.

Question 1

What is the recommended interval for administering DMPA, an injectable contraceptive?

Accepted Answer

Three months

Answer

Three weeks

Answer

Two months

Answer

Two years

Question 2

What is the preferred method of contraception for a female with a family history of ovarian cancer?

Accepted Answer

Combined oral contraceptive pills (OCP)

Answer

Progestin-only pills (POP)

Answer

Copper intrauterine device (Cu IUCD)

Answer

Condoms

Question 3

Which of the following is not an absolute contraindication to the use of combined oral contraceptives?

Accepted Answer

Previous herpes genitalis

Answer

Cerebral haemorrhage

Answer

Porphyria

Answer

Trophoblastic disease with elevated hCG

Question 4

All of the following are postcoital contraception methods except?

Accepted Answer

Barrier methods

Answer

IUD

Answer

Levonorgestrel

Answer

Mifepristone

Question 5

Which of the following is considered a temporary method of contraception?

Accepted Answer

OCP

Answer

Vasectomy

Answer

Tubectomy

Answer

Postpartum sterilisation

Question 6

In which of the following conditions is IUCD contraindicated?

Accepted Answer

Infection

Answer

Anemia

Answer

None of the options

Answer

Hypertension

Question 7

All are long-acting reversible contraceptives except:

Accepted Answer

OCP

Answer

Implanon

Answer

IUCD

Answer

Jadelle

Question 8

The most common complication of intrauterine contraceptive devices is:

Accepted Answer

Bleeding

Answer

Ectopic pregnancy

Answer

Backache

Answer

Cervical stenosis

Question 9

A 28-year-old nonsmoking woman presents to discuss birth control methods. She requests a contraceptive option that is not associated with weight gain. She and her husband agree that they desire no children for the next few years. Her periods are regular, but heavy and painful, with severe lower abdominal cramping and back pain, requiring pad changes every 4 hours. This pattern of bleeding has been present since she was 15 years old. For a week before her period begins, she experiences uncharacteristic tearfulness, irritability, and depression, which are affecting her personal relationships. Her physical examination reveals blood pressure 110/75, BMI 22, and moderate acne on her face and neck. What recommendation would best address her mood, skin, and contraceptive needs?

Accepted Answer

Combination oral contraceptive pill with drospirenone and ethinyl estradiol

Answer

Progesterone intrauterine device (IUD)

Answer

Depo-Provera (medroxyprogesterone acetate) shots every 3 months

Answer

Tubal ligation (permanent sterilization)

Question 10

Most preferable contraceptive method for a female suffering from rheumatic heart disease who has completed her family is:

Accepted Answer

Surgical sterilization (Tubal ligation)

Answer

Non-hormonal barrier methods

Answer

Long-term intrauterine device (IUCD)

Answer

Hormonal contraceptive implant

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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