Contraception and Family Planning Practice Questions

Q: What is the most common side effect of progestin-only pills (POPs)?

Irregular bleeding. **Explanation:** The most common side effect of **Progestin-Only Pills (POPs)**, also known as the "mini-pill," is **irregular menstrual bleeding**. Unlike combined oral contraceptives (COCs), POPs do not contain estrogen. Estrogen is responsible for stabilizing the endometrium; without it, the endometrial lining becomes thin and unstable, leading to breakthrough bleeding, spotting, or amenorrhea. This is the primary reason for patient dissatisfaction and discontinuation of the method. **Analysis of Options:** * **A. Deep Vein Thrombosis (DVT):** This is a risk associated with **estrogen-containing** contraceptives. Estrogen increases the synthesis of clotting factors in the liver. Progestin-only methods do not significantly increase the risk of venous thromboembolism and are often the preferred choice for women with a history of DVT. * **C. Acne:** While some older progestins with androgenic activity can worsen acne, it is not the *most common* side effect. In fact, many modern progestins have minimal impact on skin. * **D. Hypertension:** Estrogen is the component primarily linked to blood pressure elevation via the renin-angiotensin-aldosterone system. POPs are generally considered safe for women with controlled hypertension. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** POPs primarily work by **thickening the cervical mucus**, preventing sperm penetration. They also cause endometrial thinning and, in some cycles, suppress ovulation. * **The "3-Hour Rule":** Traditional POPs (e.g., Norethindrone) must be taken at the same time every day. If a dose is delayed by **>3 hours**, it is considered a "missed pill," and backup contraception is required for 48 hours. * **Ideal Candidates:** POPs are the contraceptive of choice for **lactating mothers** (as they do not suppress milk production) and women with contraindications to estrogen (e.g., smokers >35 years, migraine with aura, or history of VTE).

Q: Which of the following is NOT an adverse effect of oral contraceptive pills?

Dysmenorrhea. **Explanation:** The correct answer is **D. Dysmenorrhea**. Combined Oral Contraceptive Pills (COCPs) are actually a primary medical treatment for dysmenorrhea, rather than a cause. **Why Dysmenorrhea is the correct choice:** COCPs work by inhibiting ovulation. This leads to a reduction in the production of endometrial prostaglandins (specifically PGF2α), which are the primary mediators of uterine contractions and pain during menstruation. By creating a thinner endometrial lining and preventing the "prostaglandin surge" associated with ovulatory cycles, COCPs significantly **relieve** dysmenorrhea. **Analysis of Incorrect Options:** * **A. Weight Gain:** Though often perceived as a minor side effect, estrogen can cause fluid retention and progestogens can increase appetite, leading to perceived or actual weight gain in some users. * **B. Hypertension:** Estrogen increases the hepatic production of angiotensinogen. This can activate the Renin-Angiotensin-Aldosterone System (RAAS), leading to a mild increase in blood pressure in susceptible individuals. * **C. Thromboembolism:** This is the most serious side effect. Estrogen increases the synthesis of clotting factors (II, VII, IX, X) and decreases anticoagulants like Protein S and Antithrombin III, significantly raising the risk of Venous Thromboembolism (VTE). **High-Yield NEET-PG Pearls:** * **Protective Effects:** COCPs reduce the risk of **Ovarian cancer** (by 50%), **Endometrial cancer** (by 50%), and **Benign breast disease**. * **Risk Factors:** The risk of MI and Stroke is significantly higher in COCP users who are **smokers** and aged **>35 years**. * **Drug Interactions:** Enzyme inducers like **Rifampicin** and **Antiepileptics** (Phenytoin, Carbamazepine) decrease the efficacy of COCPs, leading to breakthrough bleeding or pregnancy.

Q: A 20-year-old girl experienced rape around the 13th day of her regular menstrual cycle. What is the best emergency contraception that can be offered?

Levonorgestrel tablets. **Explanation:** The correct answer is **Levonorgestrel (LNG) tablets**. In cases of sexual assault, emergency contraception (EC) should be provided as soon as possible to prevent unintended pregnancy. **Why Levonorgestrel is the best choice here:** While the Copper-T (Cu-T) is technically the most effective EC, **Levonorgestrel (1.5 mg single dose)** is considered the first-line medical management in rape victims due to several practical and clinical reasons. It is highly effective when taken within 72 hours (up to 120 hours), easy to administer, and does not require a pelvic examination or sterile procedure, which may be traumatic for a rape survivor. It works primarily by delaying ovulation. **Analysis of Incorrect Options:** * **A & D (COCPs and Ethinylestradiol):** The Yuzpe regimen (combined pills) is less effective and associated with significantly higher rates of nausea and vomiting compared to LNG. Pure Ethinylestradiol is not a standard EC protocol. * **B (Cu-T insertion):** Although Cu-T is the most effective EC (failure rate <0.1%), it is generally avoided as the *first* choice in rape cases due to the high risk of **Pelvic Inflammatory Disease (PID)**. Rape victims are at high risk for undiagnosed Sexually Transmitted Infections (STIs) like Chlamydia and Gonorrhea; inserting an IUD through an infected cervix can lead to ascending infection. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard EC:** Copper-T (most effective, can be used up to 5 days). * **Drug of Choice (DOC) for EC:** Levonorgestrel 1.5mg (Single dose). * **Ulipristal Acetate (30mg):** More effective than LNG, especially between 72–120 hours, but LNG remains the standard in many government protocols. * **Mifepristone:** Can be used as EC in low doses (10–25 mg). * **Rape Protocol:** Always prioritize psychological support and STI prophylaxis (Ceftriaxone, Azithromycin, and Tinidazole) alongside EC.

Q: Which of the following statements about DMPA (Depot Medroxyprogesterone Acetate) is FALSE?

It typically causes weight loss.. **Explanation:** **Why Option C is the correct (False) statement:** Depot Medroxyprogesterone Acetate (DMPA) is clinically associated with **weight gain**, not weight loss. This is one of its most common side effects and a frequent reason for discontinuation. The weight gain is attributed to both an increase in appetite (anabolic effect of progestogen) and an increase in body fat deposition. Studies show an average gain of 1.5–2.5 kg in the first year of use. **Analysis of other options:** * **Option A (True):** DMPA is a highly effective contraceptive. With perfect use, the failure rate is approximately **0.3 per 100 woman-years**, making it comparable to sterilization and LARC methods. * **Option B (True):** The standard dose for the intramuscular (IM) formulation is **150 mg every 12 weeks (3 months)**. It is usually administered in the gluteal or deltoid muscle. * **Option D (True):** High-dose progestogens like DMPA can decrease insulin sensitivity and lead to **mild glucose intolerance**. While usually not clinically significant in healthy women, it requires caution in patients with pre-existing diabetes. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily inhibits ovulation by suppressing the LH surge. It also thickens cervical mucus. * **Amenorrhea:** About 50% of users develop amenorrhea after one year of use (a "benefit" for women with menorrhagia). * **Bone Mineral Density (BMD):** Long-term use is associated with a reversible decrease in BMD. The FDA provides a "Black Box Warning" for use exceeding 2 years. * **Return to Fertility:** There is a **delayed return to fertility**, taking an average of 7–10 months after the last injection. * **Anticonvulsant Effect:** DMPA is the contraceptive of choice for women with epilepsy as it raises the seizure threshold.

Q: Maximum success rate in reversal of sterilization is achieved in cases which follow which technique?

Laparoscopic ring application. **Explanation:** The success of tubal sterilization reversal (tubal re-anastomosis) is primarily determined by the **length of the healthy fallopian tube remaining** and the **extent of tissue destruction** caused during the initial procedure. **Why Laparoscopic Ring Application is Correct:** Laparoscopic sterilization using a **Falope ring (Silastic band)** is a mechanical method that causes minimal tissue damage. It typically destroys only a very small segment (about 1–2 cm) of the fallopian tube. Because a significant length of the tube remains healthy and the blood supply is well-preserved, surgical re-anastomosis has the highest success rate (up to 70–80%) compared to other methods. **Analysis of Incorrect Options:** * **Pomeroy’s Technique:** This is the most common method used during postpartum sterilization. It involves ligating a loop of the tube and excising it. While effective, it destroys a larger segment of the tube (3–4 cm) than a ring, leading to lower reversal success rates. * **Parkland’s Technique:** Similar to Pomeroy’s, this involves mid-segment resection. It ensures the ends are separated to prevent recanalization, but the resulting gap makes surgical reversal more difficult. * **Uchida’s Technique:** This is a complex method involving subserosal stripping and resection. It is highly effective at preventing pregnancy but is the most destructive to the tubal anatomy, making it the most difficult to reverse. **High-Yield Facts for NEET-PG:** * **Best Site for Reversal:** Isthmus-to-isthmus anastomosis yields the highest success. * **Worst Prognosis for Reversal:** Electro-cautery (especially unipolar) causes extensive thermal damage and has the lowest reversal success. * **Pearl:** For a successful reversal, the total remaining length of the fallopian tube should ideally be **>4 cm**. * **Failure Rate:** The failure rate of the Falope ring is approximately 1.7 per 1000 procedures.

Q: All of the following are mechanisms of action of oral contraceptive pills, except:

Interference with placental functioning. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is to prevent pregnancy by acting on the hypothalamic-pituitary-ovarian axis. **Why Option D is the correct answer:** Oral contraceptive pills are used to **prevent** conception. Placental functioning only begins after successful implantation and the development of the trophoblast. Since COCPs act primarily to prevent fertilization and implantation, they do not have a physiological role in interfering with an established placenta. Therefore, interference with placental functioning is not a mechanism of OCPs. **Analysis of other options:** * **Inhibition of Ovulation (Option A):** This is the **most important** mechanism. The estrogen component suppresses FSH (preventing follicular development), while the progestogen component suppresses the LH surge, thereby preventing ovulation. * **Prevention of Fertilization (Option B):** Progestogens make the cervical mucus thick, viscid, and scanty. This creates a "hostile" environment that inhibits sperm penetration and transport, preventing the sperm from reaching the ovum. * **Interference with Implantation (Option C):** OCPs cause the endometrium to become thin and atrophic (decidualization), making it unreceptive for a blastocyst to implant. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Action:** Suppression of LH surge (Progestogen effect). * **Pearl:** Progestogen-only pills (POPs) primarily act by thickening cervical mucus; they do not consistently inhibit ovulation like COCPs. * **Non-contraceptive benefits:** Reduced risk of ovarian and endometrial cancers, and improvement in dysmenorrhea and menorrhagia. * **Contraindication:** OCPs are strictly contraindicated in smokers >35 years and women with a history of Thromboembolism.

Q: Which of the following is NOT a mechanism of action of intrauterine contraceptive devices (IUCDs)?

Inhibition of ovulation. ### Explanation The primary mechanism of action for all Intrauterine Contraceptive Devices (IUCDs) is to create a **spermicidal intrauterine environment**. They do not interfere with the Hypothalamic-Pituitary-Ovarian (HPO) axis; therefore, **inhibition of ovulation is NOT a mechanism of IUCDs.** #### Why the other options are mechanisms of IUCDs: * **Aseptic Inflammation (Option B):** The presence of a foreign body (the IUCD) triggers a sterile inflammatory response in the endometrium. This leads to an increase in macrophages, lymphocytes, and plasma cells, which are toxic to spermatozoa and prevent implantation. * **Increased Uterine Motility (Option A):** The mechanical presence of the device increases uterine and tubal peristalsis, which alters the transport time of the ovum and sperm, preventing fertilization. * **Altered Cervical Mucus (Option C):** This is specifically characteristic of **Hormonal IUCDs (e.g., LNG-IUD/Mirena)**. The progestogen thickens the cervical mucus, making it "hostile" and impenetrable to sperm. #### High-Yield Clinical Pearls for NEET-PG: * **Copper T (Cu-T):** Primarily acts as a spermicide by releasing copper ions that inhibit sperm motility and viability. * **LNG-IUD (Mirena):** Its most important mechanism is thickening cervical mucus and causing endometrial atrophy. * **Ideal Candidate:** Multiparous women in a stable monogamous relationship. * **Most Common Side Effect:** Bleeding (menorrhagia) is the most common reason for removal of Cu-T, whereas pain is the second most common. * **Post-Coital Contraception:** Cu-T 380A is the most effective emergency contraceptive if inserted within 5 days (120 hours) of unprotected intercourse.

Q: Which IUCD has the longest lifespan?

Cu T 380A. **Explanation:** The lifespan of an Intrauterine Contraceptive Device (IUCD) is primarily determined by the amount of active medication or surface area of copper it contains. **Why Cu T 380A is the correct answer:** The **Cu T 380A** is a second-generation copper-bearing IUCD. The "380" signifies that it has a surface area of 380 mm² of copper wire. Due to this high copper content, it has the longest approved clinical lifespan among all commonly used IUCDs. According to WHO and the Government of India guidelines, it is effective for **10 years**. **Analysis of Incorrect Options:** * **Progestasert:** This was the first-generation hormone-releasing IUCD. It contained Progesterone and had a very short lifespan of only **1 year**, requiring annual replacement. * **Mirena (LNG-20):** This is a Levonorgestrel-releasing system. While highly effective, its approved lifespan is currently **5 to 8 years** (depending on the guideline), which is shorter than the Cu T 380A. * **Nova T:** This is a copper device with a silver core to prevent fragmentation. It contains 200 mm² of copper and has a lifespan of **5 years**. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Copper IUCDs act primarily as a **spermicide** by causing a local sterile inflammatory response in the endometrium. * **Ideal Candidate:** The Cu T 380A is the "Gold Standard" for long-term reversible contraception in parous women. * **Emergency Contraception:** Cu T 380A is the **most effective** method of emergency contraception if inserted within 5 days of unprotected intercourse. * **Cu T 375 (Multiload):** Has a lifespan of **5 years**.

Q: Which of the following is NOT used for first-trimester abortion?

Extra-amniotic ethacrydine lactate. **Explanation:** The first trimester of pregnancy is defined as the period up to 12 weeks of gestation. Methods for abortion during this period are categorized into medical and surgical techniques. **Why Option B is Correct:** **Extra-amniotic ethacrydine lactate (Emcredil)** is a method used exclusively for **second-trimester** abortions (13–20 weeks). It acts as a mechanical and chemical irritant, stimulating endogenous prostaglandin release to induce uterine contractions. It is not used in the first trimester because the extra-amniotic space is not sufficiently developed to facilitate the procedure effectively, and simpler, safer alternatives exist for early gestations. **Analysis of Incorrect Options:** * **Mifepristone (Option A):** An anti-progestogen used in medical management. Combined with Misoprostol, it is the gold standard for medical abortion up to 9–10 weeks (70 days) of gestation. * **Suction Evacuation (Option D):** This is the surgical method of choice for the first trimester (up to 12 weeks). It involves aspirating the products of conception using a Karman cannula or electric suction. * **Dilatation and Evacuation (Option C):** While more commonly associated with the early second trimester (13–15 weeks), it is frequently used in the late first trimester (10–12 weeks) when the products of conception are too large for simple suction alone. **High-Yield Clinical Pearls for NEET-PG:** 1. **MVA (Manual Vacuum Aspiration):** Can be used up to 12 weeks; it is highly effective and does not require electricity. 2. **Medical Method Regimen:** 200 mg Mifepristone (oral) followed by 800 mcg Misoprostol (vaginal/sublingual) after 24–48 hours. 3. **Ethacrydine Lactate Caution:** It is contraindicated in patients with a history of previous uterine scars (e.g., C-section) due to the risk of uterine rupture. 4. **Most common complication** of first-trimester suction evacuation is **incomplete abortion**.

Question 1

What is the most common side effect of progestin-only pills (POPs)?

Accepted Answer

Irregular bleeding

Answer

Deep vein thrombosis (DVT)

Answer

Acne

Answer

Hypertension

Question 2

Oral contraceptive pills should be initiated on which day of the menstrual cycle?

Accepted Answer

The 1st day

Answer

The 5th day

Answer

The 3rd day

Answer

When menses cease

Question 3

Which of the following is NOT an adverse effect of oral contraceptive pills?

Accepted Answer

Dysmenorrhea

Answer

Weight gain

Answer

Hypertension

Answer

Thromboembolism

Question 4

A 20-year-old girl experienced rape around the 13th day of her regular menstrual cycle. What is the best emergency contraception that can be offered?

Accepted Answer

Levonorgestrel tablets

Answer

Combined oral contraceptive pills

Answer

Intrauterine contraceptive device (Cu-T) insertion

Answer

Ethinylestradiol tablets

Question 5

Which of the following statements about DMPA (Depot Medroxyprogesterone Acetate) is FALSE?

Accepted Answer

It typically causes weight loss.

Answer

The failure rate is approximately 0.3 per 100 woman-years.

Answer

It is administered as 150 mg every 3 months.

Answer

Glucose intolerance can occur with its use.

Question 6

Maximum success rate in reversal of sterilization is achieved in cases which follow which technique?

Accepted Answer

Laparoscopic ring application

Answer

Pomeroy's technique

Answer

Parkland's technique

Answer

Uchida's technique

Question 7

All of the following are mechanisms of action of oral contraceptive pills, except:

Accepted Answer

Interference with placental functioning

Answer

Inhibition of ovulation

Answer

Prevention of fertilization

Answer

Interference with implantation of fertilized ovum

Question 8

Which of the following is NOT a mechanism of action of intrauterine contraceptive devices (IUCDs)?

Accepted Answer

Inhibition of ovulation

Answer

Increased uterine motility

Answer

Aseptic inflammation

Answer

Altered cervical mucus

Question 9

Which IUCD has the longest lifespan?

Accepted Answer

Cu T 380A

Answer

Progestasert

Answer

Mirena

Answer

Nova T

Question 10

Which of the following is NOT used for first-trimester abortion?

Accepted Answer

Extra-amniotic ethacrydine lactate

Answer

Mifepristone

Answer

Dilatation and evacuation

Answer

Suction evacuation

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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