Contraception and Family Planning — MCQs

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 531: Mirena (LNG IUCD) has to be replaced after:

A. 1 year
B. 5 years (Correct Answer)
C. 3 years
D. 6 months

Explanation: **Explanation:** The **Mirena (Levonorgestrel-releasing Intrauterine System)** is a hormone-releasing device that contains 52 mg of Levonorgestrel. It works by releasing the hormone at an initial rate of 20 µg/day directly into the uterine cavity. **1. Why 5 years is correct:** The reservoir of Levonorgestrel is designed to provide effective contraception for a duration of **5 years**. While recent clinical studies suggest efficacy may extend up to 8 years for contraception, the standard FDA-approved and textbook recommendation (Park’s PSM and Williams Gynecology) remains 5 years. After this period, the hormone release rate declines significantly, reducing its efficacy in preventing pregnancy and managing conditions like Menorrhagia or Endometriosis. **2. Why other options are incorrect:** * **6 months / 1 year:** These durations are too short. No modern IUCD requires replacement within a year unless there is a complication (e.g., expulsion or infection). Progestasert (an older progesterone IUCD) required annual replacement, but it is no longer in common use. * **3 years:** This is the duration for the **Jaydess (Skyla)**, which is a smaller LNG-IUS containing 13.5 mg of Levonorgestrel. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily thickens cervical mucus (prevents sperm penetration) and causes endometrial atrophy (prevents implantation). * **Non-contraceptive use:** It is the **Gold Standard (Medical treatment of choice)** for Menorrhagia (DUB). * **Comparison:** Unlike Copper-T (which increases menstrual blood loss), Mirena significantly **reduces** menstrual flow and can lead to amenorrhea. * **Other IUCD Lifespans:** Cu-T 380A (10 years), Cu-T 200 (3 years), Multiload 375 (5 years).

Question 532: Which of the following statements is true regarding RU-486?

A. It is used for inducing abortion in the early weeks of pregnancy. (Correct Answer)
B. It can be used in conjunction with a contraceptive pill.
C. It acts on the cytoplasmic receptor.
D. It is used for preventing ectopic implantation.

Explanation: **Explanation:** **RU-486 (Mifepristone)** is a potent synthetic steroid with high affinity for progesterone receptors. **1. Why Option A is correct:** Mifepristone acts as a **competitive progesterone receptor antagonist**. Progesterone is essential for maintaining the decidua during early pregnancy. By blocking these receptors, RU-486 leads to decidual breakdown, cervical softening, and increased uterine contractility. It is FDA-approved for the medical termination of pregnancy (MTP) up to **10 weeks (70 days)** of gestation, typically followed by a prostaglandin (Misoprostol) 24–48 hours later to expel the products of conception. **2. Why the other options are incorrect:** * **Option B:** It is not used "in conjunction" with oral contraceptive pills (OCPs). OCPs prevent ovulation, whereas RU-486 is an abortifacient or emergency contraceptive. * **Option C:** Progesterone receptors (like most steroid receptors) are primarily **nuclear receptors**, not cytoplasmic. Mifepristone binds to these nuclear receptors to inhibit gene transcription. * **Option D:** RU-486 is **ineffective** in treating or preventing ectopic pregnancy. Because ectopic tissue lacks the same decidual environment as the endometrium, Mifepristone cannot terminate a tubal pregnancy. **High-Yield Clinical Pearls for NEET-PG:** * **MTP Regimen:** 200 mg Mifepristone (Oral) + 800 mcg Misoprostol (Vaginal/Oral/Buccal). * **Other Uses:** Emergency contraception (10 mg dose), management of Cushing’s syndrome (blocks glucocorticoid receptors), and cervical ripening. * **Contraindications:** Chronic adrenal failure, ectopic pregnancy, and patients on long-term corticosteroid therapy.

Question 533: Which of the following is NOT a benefit of LNG-IUD?

A. Management of menorrhagia
B. Contraceptive effect
C. Hormone replacement therapy after menopause
D. Treatment of stage 2 endometrial cancer (Correct Answer)

Explanation: **Explanation:** The **Levonorgestrel-releasing Intrauterine Device (LNG-IUD)**, commonly known by the brand name Mirena, releases 20 µg of levonorgestrel daily. Its primary mechanism is local progestogenic action on the endometrium. **Why Option D is Correct:** LNG-IUD is **not** a treatment for Stage 2 endometrial cancer. Stage 2 endometrial cancer involves invasion of the cervical stroma and requires definitive surgical management (Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy) and potentially radiotherapy. While LNG-IUD can be used for **Endometrial Hyperplasia** or very early-stage (Stage 1A), well-differentiated adenocarcinoma in patients who are unfit for surgery or wish to preserve fertility, it has no role in Stage 2 disease. **Analysis of Incorrect Options:** * **A. Management of menorrhagia:** LNG-IUD is the **medical gold standard** for treating Idiopathic Menorrhagia. It causes profound endometrial atrophy, reducing menstrual blood loss by up to 90%. * **B. Contraceptive effect:** It is a highly effective Long-Acting Reversible Contraceptive (LARC) with a Pearl Index of approximately 0.2. It works by thickening cervical mucus and causing endometrial thinning. * **C. Hormone replacement therapy (HRT):** In postmenopausal women, LNG-IUD provides the "progestogen component" to protect the endometrium from hyperplasia when the patient is taking systemic estrogen therapy. **High-Yield Clinical Pearls for NEET-PG:** * **Life span:** Approved for 5 years (Mirena) to 8 years (recent updates). * **Non-contraceptive benefits:** Reduces dysmenorrhea, treats endometriosis/adenomyosis, and prevents endometrial hyperplasia during Tamoxifen therapy. * **Most common side effect:** Initial irregular spotting/breakthrough bleeding for the first 3–6 months, followed by amenorrhea in many users.

Question 534: Oral contraceptive pills protect against all of the following EXCEPT:

A. Hepatic adenoma (Correct Answer)
B. Fibroadenoma of the breast
C. Carcinoma of the ovary
D. Uterine malignancy

Explanation: **Explanation:** The correct answer is **Hepatic adenoma**. This is because Combined Oral Contraceptive Pills (COCPs) are a well-documented **risk factor** for the development of hepatic adenomas, rather than a protective factor. The estrogen component in the pills can stimulate the growth of these benign liver tumors; therefore, COCPs are contraindicated in women with a history of hepatic adenoma. **Analysis of other options:** * **Fibroadenoma of the breast:** COCPs have a protective effect against **benign breast diseases**, including fibroadenomas and fibrocystic disease. (Note: Their effect on breast *cancer* remains controversial/slightly increased risk). * **Carcinoma of the ovary:** COCPs significantly reduce the risk of epithelial ovarian cancer (by ~50%). This protection increases with the duration of use and persists for up to 15–20 years after discontinuation. * **Uterine malignancy (Endometrial Cancer):** COCPs reduce the risk of endometrial cancer by approximately 50% due to the progestogen component, which prevents estrogen-induced endometrial hyperplasia. **High-Yield NEET-PG Pearls:** 1. **Protective Effects of COCPs:** Reduced risk of Ovarian cancer, Endometrial cancer, Colorectal cancer, PID, Ectopic pregnancy, and Iron deficiency anemia. 2. **Increased Risks with COCPs:** Hepatic adenoma, Venous Thromboembolism (VTE), Hypertension, and Cervical cancer (with long-term use). 3. **Mnemonic for Cancer Protection:** COCPs protect against the "Inside" cancers (Ovary, Endometrium, Colon) but may increase risk for "Outside/Surface" cancers (Cervix, Breast).

Question 535: In a young female of reproductive age, what is an absolute contraindication for prescribing oral contraceptive pills?

A. Diabetes
B. Hypertension
C. Obesity
D. Impaired liver function (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Impaired liver function**. Combined Oral Contraceptive Pills (COCPs) contain steroid hormones (estrogen and progesterone) that are primarily metabolized by the liver. In patients with active liver disease, viral hepatitis, or cirrhosis, the liver cannot effectively clear these hormones, leading to toxic accumulation and potential worsening of hepatic dysfunction. Furthermore, estrogens increase the risk of developing hepatic adenomas. **Analysis of Options:** * **A. Diabetes:** This is a **relative contraindication**. COCPs can be used in diabetic patients unless there are associated vascular complications (nephropathy, retinopathy, or neuropathy) or the disease duration is >20 years. * **B. Hypertension:** This is generally a **relative contraindication**. However, it becomes an absolute contraindication only if the blood pressure is severely elevated (Systolic ≥160 mmHg or Diastolic ≥100 mmHg) or if there is associated vascular disease. * **C. Obesity:** Obesity is a **relative contraindication**. While it increases the baseline risk of venous thromboembolism (VTE), it does not strictly prohibit COCP use unless other major risk factors are present. **High-Yield NEET-PG Pearls:** * **Absolute Contraindications (WHO Category 4):** Breast cancer (current), smoking >15 cigarettes/day in women >35 years, history of DVT/PE, ischemic heart disease, migraine with aura, and active liver disease. * **Drug Interactions:** Enzyme inducers like Rifampicin, Phenytoin, and Carbamazepine decrease the efficacy of COCPs, leading to breakthrough bleeding or contraceptive failure. * **Non-contraceptive benefits:** COCPs reduce the risk of ovarian and endometrial cancers (protective effect persists for years after discontinuation).

Question 536: Which of the following is a contraindication to subdermal contraceptive implant?

A. PID
B. Diabetes mellitus
C. Hypertension
D. Undiagnosed genital bleeding (Correct Answer)

Explanation: ***Undiagnosed genital bleeding*** - Undiagnosed abnormal genital bleeding is a key contraindication because hormonal methods, including the implant, may mask potentially serious underlying causes such as **endometrial or cervical cancer**. - Comprehensive evaluation must be completed and a definitive diagnosis established before initiating the implant to ensure patient safety. *Hypertension* - **Mild to moderate hypertension** is generally not a contraindication for progestin-only methods like the contraceptive implant, which has minimal effect on blood pressure. - Progestin implants are often a good alternative for women with hypertension who have contraindications to **estrogen-containing contraceptives**. *Diabetes mellitus* - **Diabetes mellitus** (uncomplicated by vascular disease) is not a contraindication for progestin-only contraceptives, which are safe for diabetic management. - The implant has minimal adverse effects on **glucose metabolism** and is classified as a Category 2 (benefits generally outweigh risks) method by WHO MEC criteria. *PID* - A **history of Pelvic Inflammatory Disease (PID)** is not a contraindication for the contraceptive implant, as it is a systemic hormonal method and not an intrauterine device. - Unlike IUDs, the subdermal implant does not interact with the uterine cavity or tubes, thus posing no risk of inducing or exacerbating **pelvic infection**.

Question 537: OCPs can be given in which of the following conditions?

A. HIV (Correct Answer)
B. DM
C. Hyperlipidemia
D. HTN

Explanation: ***HIV***- HIV infection itself is **not a contraindication** to the use of Oral Contraceptive Pills (OCPs).- OCPs are a safe and highly effective contraceptive method for women living with HIV, though potential interactions with certain **Antiretroviral Therapy (ART)** regimens must be considered.*HTN*- OCPs can cause or exacerbate **hypertension** by activating the renin-angiotensin-aldosterone system through increased **angiotensinogen** production.- The use of OCPs is strongly discouraged in women with **uncontrolled** or **severe hypertension** due to increased risk of stroke and myocardial infarction.*DM*- OCPs are relatively contraindicated in women with diabetes mellitus who have **associated vascular complications** (e.g., retinopathy, nephropathy, neuropathy) or long-standing disease (>20 years).- While modern low-dose OCPs are generally safe for *uncomplicated* DM, they can transiently worsen **glucose tolerance** and require careful monitoring.*Hyperlipidemia*- OCPs, particularly those with higher estrogen content, can significantly increase serum **triglyceride levels**, which dramatically raises the risk of **pancreatitis**.- They are relatively contraindicated in individuals with severe or uncontrolled **hyperlipidemia** due to concerns about accelerating cardiovascular disease risks.

Question 538: In which of the following conditions would the use of an intrauterine contraceptive device (IUCD) require the most careful consideration due to contraindication concerns?

A. Diabetes mellitus
B. HIV infection (Correct Answer)
C. Hypertension
D. Hyperlipidemia

Explanation: ***HIV infection*** - According to WHO Medical Eligibility Criteria (MEC), HIV infection presents varying levels of concern depending on disease status: - **Stable HIV on ART**: MEC Category 2 (benefits generally outweigh risks) - **Severe/Advanced HIV (AIDS)**: MEC Category 3 (risks usually outweigh benefits) - The primary concern is the increased risk of **pelvic inflammatory disease (PID)** in immunocompromised patients - Among the options provided, HIV infection represents the **strongest relative contraindication** requiring careful clinical assessment before IUCD insertion - Recent guidelines emphasize individualized decision-making based on immune status, viral load, and ART adherence *Hypertension* - **Hypertension** is NOT a contraindication for IUCD use (MEC Category 1) - Neither copper IUDs nor levonorgestrel-releasing IUDs (LNG-IUD) affect blood pressure - IUCDs are safe contraceptive options for women with controlled or uncontrolled hypertension - No cardiovascular risk associated with IUD use *Hyperlipidemia* - **Hyperlipidemia** is NOT a contraindication for IUCD use (MEC Category 1) - IUDs do not affect lipid metabolism or lipid levels - Both copper and hormonal IUCDs can be safely used in women with abnormal lipid profiles *Diabetes mellitus* - **Diabetes mellitus** is NOT a contraindication for IUCD use (MEC Category 1/2) - Both copper and hormonal IUDs are safe and effective for diabetic patients - IUCDs are often preferred over combined hormonal contraceptives, which may affect **glycemic control** - No increased risk of complications with proper insertion technique

Question 539: Oral contraceptive pill prevents all except?

A. Colon cancer
B. Cervical cancer (Correct Answer)
C. Endometrial cancer
D. Epithelial ovarian cancer

Explanation: ***Cervical cancer***- Oral contraceptive pills (OCPs) are associated with an *increased* risk of **cervical cancer**, particularly with prolonged use (typically >5 years), not a protective effect. - The mechanisms are unclear, but OCPs may increase the risk of persistent **HPV infection** or cervical ectopy, making the cervix more vulnerable.*Epithelial ovarian cancer*- OCPs provide substantial and long-lasting protection against **epithelial ovarian cancer**, with the benefit persisting for decades after cessation.- The protection is thought to be due to the suppression of **ovulation** and resultant decrease in the number of repair cycles of the ovarian surface epithelium.*Endometrial cancer*- OCPs significantly reduce the risk of **endometrial cancer** by providing a continuous supply of progestins.- The **progestin** component of OCPs counteracts the proliferative effects of estrogen on the endometrium, preventing hyperplasia and subsequent carcinogenesis.*Colon cancer*- OCP use is associated with a modest but consistent reduction in the incidence of **colorectal cancer** across numerous studies.- This protective effect is hypothesized to be due to OCP-induced changes in **bile acid metabolism** or effects on local hormone receptor signaling in the colon.

Question 540: All of the following are protected by OCPs except?

A. Colonic cancer
B. Carcinoma breast (Correct Answer)
C. Carcinoma endometrium
D. Ovarian cancer

Explanation: ***Carcinoma breast*** - OCPs do not protect against **breast cancer**; large meta-analyses suggest a small, transient increase in risk, particularly with **current or recent use**, which generally dissipates 10 years after stopping. - This marginal increase in risk is attributed to the **estrogen component**, which promotes proliferation in hormone-sensitive breast tissue. *Carcinoma endometrium* - OCPs offer significant long-term protection against **endometrial cancer**, mediated primarily by the **progestin component**, which induces endometrial atrophy. - Protection lasts for many years after discontinuing OCPs and is one of the most prominent non-contraceptive benefits. *Colonic cancer* - OCP use is associated with a reduced risk of **colorectal cancer**, a benefit that appears to be related to the duration of use. - This protective effect is thought to be mediated by the actions of estrogen on bile acid metabolism and subsequent modulation of cell proliferation in the **colonic mucosa**. *Ovarian cancer* - OCPs provide robust, durable protection against **ovarian cancer**, with the risk reduction correlating significantly with the duration of intake. - The primary protective mechanism is the **suppression of ovulation**, which reduces trauma and proliferation of the ovarian surface epithelium.

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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