Contraception and Family Planning Practice Questions

Q: When is the Copper T IUD ideally inserted?

During menstruation. **Explanation:** The ideal time for the insertion of a Copper T Intrauterine Device (IUD) is **during menstruation** (specifically within the first 7 days of the cycle). This timing is preferred for three primary clinical reasons: 1. **Exclusion of Pregnancy:** It provides the highest certainty that the woman is not pregnant, preventing accidental insertion during an early gestation. 2. **Ease of Insertion:** The cervical os is naturally slightly dilated during menses, making the procedure technically easier and less painful. 3. **Reduced Side Effects:** Post-insertion bleeding or spotting is masked by the menstrual flow, leading to better patient compliance. **Analysis of Incorrect Options:** * **A. Just before menstruation:** This is the least ideal time. The risk of inserting the IUD into an early (luteal phase) pregnancy is high. Furthermore, the cervix is firm and closed, increasing the risk of pain and uterine perforation. * **C. Just after menstruation:** While acceptable if pregnancy is strictly ruled out, the cervical os begins to close, making insertion slightly more difficult than during active menses. * **D. On the 14th day of the cycle:** This coincides with ovulation. Insertion at this stage carries a risk of "luteal phase pregnancy" where fertilization may have already occurred. **High-Yield Clinical Pearls for NEET-PG:** * **Post-Partum Insertion:** Can be done within 48 hours (PPIUCD) or after 6 weeks (involution complete). * **Post-Abortal:** Can be inserted immediately after a first-trimester abortion. * **Emergency Contraception:** Copper T is the most effective emergency contraceptive if inserted within **5 days** of unprotected intercourse. * **Mechanism:** Primarily **spermicidal**; it causes a sterile inflammatory response in the endometrium and alters cervical mucus.

Q: All of the following agents are used for emergency contraception, EXCEPT?

Misoprostol. **Explanation:** The correct answer is **Misoprostol**. Emergency contraception (EC) is intended to prevent pregnancy after unprotected intercourse by inhibiting or delaying ovulation or preventing fertilization. **Why Misoprostol is the correct answer:** Misoprostol is a **Prostaglandin E1 (PGE1) analogue**. Its primary roles in obstetrics include medical abortion (in combination with Mifepristone), induction of labor, and management of postpartum hemorrhage (PPH) due to its potent uterine-contracting properties. It does **not** prevent conception or inhibit ovulation, making it ineffective as an emergency contraceptive. **Analysis of other options:** * **Combined Oral Contraceptive Pills (COCs):** Used in the **Yuzpe Regimen** (two doses of 100 mcg Ethinylestradiol + 0.5 mg Levonorgestrel, 12 hours apart). While effective, it is less preferred now due to high rates of nausea and vomiting. * **Levonorgestrel (LNG):** The current "Gold Standard" for hormonal EC (e.g., i-Pill, 72-H). It is taken as a single dose of **1.5 mg** within 72 hours. It works primarily by delaying the LH surge and inhibiting ovulation. * **Mifepristone:** An anti-progestin that can be used for EC in low doses (**10–25 mg**). It is highly effective with fewer side effects than the Yuzpe regimen. **High-Yield Clinical Pearls for NEET-PG:** * **Most Effective EC:** The **Copper-T (IUCD)** is the most effective method of emergency contraception if inserted within 5 days (120 hours) of unprotected intercourse. * **Ulipristal Acetate:** A selective progesterone receptor modulator (SPRM) used as a single 30 mg dose; it is effective up to 120 hours and is superior to LNG in efficacy. * **Time Frame:** Most hormonal ECs are licensed for use within 72 hours, but Ulipristal and Copper-T are effective up to 120 hours.

Q: The best contraceptive method in a patient with heart disease is:

Double barrier. **Explanation:** In patients with heart disease, the primary goal of contraception is to avoid methods that increase hemodynamic stress, risk of thromboembolism, or infective endocarditis. **Why Double Barrier is the Correct Answer:** The **Double Barrier method** (e.g., condom plus diaphragm/spermicide) is considered the safest because it is **non-hormonal and non-invasive**. It carries zero risk of thromboembolism, does not alter blood pressure, and poses no risk of pelvic infection or vasovagal syncope. While it has a higher failure rate than hormonal methods, in the context of cardiac safety, it is the preferred choice to avoid systemic complications. **Why Other Options are Incorrect:** * **IUCD (Intrauterine Contraceptive Device):** It is generally avoided in cardiac patients due to the risk of **vasovagal shock** during insertion. Furthermore, there is a theoretical risk of pelvic infections leading to **Infective Endocarditis**, particularly in patients with valvular heart disease. * **Tubectomy:** This is a surgical procedure requiring anesthesia and often involves creating a pneumoperitoneum (in laparoscopy), which can severely compromise cardiac output and venous return. It is considered too high-risk for many cardiac patients. * **Oral Pills (Combined Oral Contraceptives):** These are strictly **contraindicated** in most heart diseases because the estrogen component increases the risk of **thromboembolism**, hypertension, and fluid retention, which can precipitate heart failure. **High-Yield Clinical Pearls for NEET-PG:** * **Progesterone-only pills (POPs)** or implants are safer than COCs if a hormonal method is needed, as they lack estrogen. * If a cardiac patient requires sterilization, **Vasectomy** (of the partner) is the safest permanent method. * For IUCD insertion in cardiac patients (if absolutely necessary), **prophylactic antibiotics** are recommended to prevent endocarditis.

Q: All of the following are advantages of depot progestogen contraception EXCEPT:

It provides good cycle control.. **Explanation:** The correct answer is **C (It provides good cycle control)** because depot progestogen (DMPA) is notorious for causing **menstrual irregularities**. Since it contains only progestogen and no estrogen, the endometrium becomes thin and unstable. This leads to breakthrough bleeding, spotting, or most commonly, **amenorrhea** (seen in 50-70% of users after one year). Therefore, it does not provide "good cycle control." **Analysis of other options:** * **Option A:** Progestogen-only contraceptives do not interfere with the quantity or quality of breast milk. In fact, they may slightly increase milk production, making them the preferred choice for **lactating mothers** (can be started 6 weeks postpartum). * **Option B:** The standard dose of **DMPA (Depot Medroxyprogesterone Acetate)** is **150 mg intramuscularly every 3 months (12 weeks)**. It works primarily by suppressing ovulation via the HPO axis. * **Option C:** By effectively suppressing ovulation, DMPA significantly reduces the absolute risk of both intrauterine and **ectopic pregnancies**. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Primarily inhibits ovulation (suppresses LH surge) and increases cervical mucus viscosity. * **Return of Fertility:** There is a **delayed return to fertility** (average 7–10 months after the last injection). * **Side Effects:** Weight gain (most common reason for discontinuation) and a reversible decrease in **Bone Mineral Density (BMD)**. * **Antara Program:** Under India’s public health program, DMPA is marketed as the **"Antara"** injection.

Q: Centchroman, a non-hormonal contraceptive pill, is taken orally:

Twice a week for the first three months, then once a week.. **Explanation:** **Centchroman (Ormeloxifene)** is a unique Selective Estrogen Receptor Modulator (SERM) developed by CDRI, Lucknow. It is the world’s first non-steroidal, non-hormonal oral contraceptive pill. **1. Why Option B is Correct:** The standard dosage schedule for Centchroman (marketed as **Saheli** or **Chhaya**) is **30 mg twice a week for the first 3 months**, followed by **once a week** thereafter. The twice-weekly loading dose is necessary to achieve steady-state plasma concentrations and ensure immediate contraceptive efficacy. It is ideally started on the first day of the menstrual cycle. **2. Why Other Options are Incorrect:** * **Option A:** Daily dosing is characteristic of Combined Oral Contraceptive Pills (COCPs) or Progesterone-Only Pills (POPs). Centchroman has a long half-life (approx. 170 hours), making daily administration unnecessary and potentially toxic. * **Option C & D:** Thrice-weekly or five-month loading periods do not align with the pharmacokinetics of the drug. Clinical trials established that a 3-month twice-weekly regimen provides the optimal balance between efficacy (Pearl Index ~1.3–1.8) and safety. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** It acts as an estrogen antagonist in the uterus (preventing implantation by altering the endometrium) and as a weak agonist in other tissues. It does not suppress ovulation in most cycles. * **Side Effects:** The most common side effect is **delayed menstruation** (prolonged cycles), which occurs in about 8% of users. It does not cause nausea, weight gain, or mood swings typical of hormonal pills. * **Contraindications:** Polycystic Ovarian Syndrome (PCOS), cervical dysplasia, and recent history of jaundice or liver disease. * **Government Initiative:** Under the National Family Planning Programme (Antara program), it is distributed free of cost as **'Chhaya'**.

Q: What menstrual abnormality is typically seen in a woman using a subdermal progesterone implant for contraception?

Metrorrhagia. **Explanation:** Subdermal progesterone implants (e.g., Nexplanon/Implanon) primarily work by suppressing ovulation and thickening cervical mucus. However, their effect on the endometrium is the primary cause of menstrual changes. **Why Metrorrhagia is correct:** The continuous, low-dose release of progestogen leads to **endometrial atrophy** and an unstable endometrial lining. This results in **irregular, unpredictable spotting or breakthrough bleeding (metrorrhagia)**. This is the most common reason for discontinuation of the method. While some women eventually develop amenorrhea, irregular bleeding remains the hallmark side effect during the initial months of use. **Analysis of Incorrect Options:** * **A. Menorrhagia:** Heavy menstrual bleeding is rare with progestogen-only methods. In fact, these implants typically reduce total menstrual blood loss. * **C. Polymenorrhea:** While cycles may become frequent, the bleeding pattern is usually too irregular to be classified as regular frequent cycles (polymenorrhea); it is better described as unscheduled spotting. * **D. Amenorrhea:** While approximately 20% of users may develop amenorrhea after one year, it is less "typical" or characteristic in the early phase compared to the high incidence of irregular spotting. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Nexplanon contains **Etonogestrel** (68 mg). * **Duration:** Effective for **3 years**. * **Mechanism:** Primarily inhibits ovulation (suppresses LH surge). * **Failure Rate:** It is the **most effective** reversible contraceptive method (Pearl Index ~0.05). * **Contraindication:** Active breast cancer or unexplained vaginal bleeding.

Q: What is the preferred investigation to confirm the presence of an intrauterine device (IUD) when its strings are not visible?

Ultrasound (USG). **Explanation:** When the strings of an Intrauterine Device (IUD) are not visible during a speculum examination (a condition known as "Missing Strings"), the primary clinical concern is to differentiate between **expulsion**, **malposition**, or **uterine perforation**. **1. Why Ultrasound (USG) is the Correct Answer:** Ultrasound is the **first-line investigation** of choice because it is non-invasive, cost-effective, and lacks ionizing radiation. It is highly sensitive in confirming the intrauterine location of the device. A properly placed IUD will appear as a highly echogenic (bright) linear structure with posterior acoustic shadowing within the endometrial cavity. **2. Why Other Options are Incorrect:** * **Pelvic X-ray:** This is the second-line investigation. It is only performed if the USG fails to locate the IUD in the uterus. An X-ray (including the abdomen and pelvis) helps identify an extrauterine IUD (perforation) or confirm expulsion if the device is absent from the film. * **CT Abdomen:** While CT can locate a perforated IUD, it is not the initial investigation due to high radiation doses and unnecessary cost. * **MRI Pelvis:** MRI is rarely indicated for IUD localization. While safe, it is expensive and provides no significant diagnostic advantage over USG or X-ray in this context. **Clinical Pearls for NEET-PG:** * **Initial Step:** If strings are missing, the first step is to rule out pregnancy and then perform a USG. * **Uterine Perforation:** If USG shows an empty uterus and the patient did not notice the IUD falling out, an **X-ray Abdomen/Pelvis (Erect and Supine)** is mandatory to locate the device in the peritoneal cavity. * **Management of Perforation:** A perforated IUD (especially Copper-T) must be removed via **Laparoscopy** due to the risk of adhesion formation.

Q: Which of the following mechanisms best explains the contraceptive effect of birth control pills that contain both synthetic estrogen and progestin?

Inhibition of ovulation. **Explanation:** The primary mechanism of action of Combined Oral Contraceptive Pills (COCPs) is the **inhibition of ovulation** via negative feedback on the hypothalamic-pituitary-ovarian axis. 1. **Why Option B is Correct:** * **Progestin component:** This is the most critical factor. It suppresses the secretion of Luteinizing Hormone (LH), thereby preventing the **LH surge** necessary for ovulation. * **Estrogen component:** It suppresses Follicle Stimulating Hormone (FSH) secretion, which prevents the recruitment and selection of a dominant follicle. Together, they ensure the ovaries remain in a quiescent state. 2. **Why Other Options are Incorrect:** * **Option A:** Oocyte maturation is arrested in prophase I since fetal life; COCPs do not directly interfere with this cellular process but rather prevent the release of the egg. * **Option C:** COCPs do not produce "toxic" secretions. Instead, progestins cause the cervical mucus to become thick and viscous, creating a physical barrier to sperm penetration. * **Option D:** While COCPs do affect the endometrium, they cause **atrophic/hypoplastic** changes (making it thin and unreceptive), not hyperplastic changes. Hyperplasia is typically a result of unopposed estrogen. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Mechanism:** Inhibition of ovulation (LH surge suppression). * **Secondary Mechanisms:** Thickening of cervical mucus (hostile to sperm) and endometrial atrophy (prevents implantation). * **Pearl:** If a patient misses a pill, the risk of "escape ovulation" increases because FSH levels rise, leading to follicular development. * **Drug Interaction:** Rifampicin is a potent enzyme inducer that decreases the efficacy of COCPs, necessitating additional contraception.

Question 1

When is the Copper T IUD ideally inserted?

Accepted Answer

During menstruation

Answer

Just before menstruation

Answer

Just after menstruation

Answer

On the 14th day of the cycle

Question 2

Absolute contraindications of oral contraceptive pills (OCPs) include all of the following EXCEPT:

Accepted Answer

Thyroid disorder

Answer

Ischemic heart disease

Answer

Hepatoma

Answer

Breast cancer

Question 3

All of the following agents are used for emergency contraception, EXCEPT?

Accepted Answer

Misoprostol

Answer

Combined Pill

Answer

Levonorgestrel

Answer

Mifepristone

Question 4

The best contraceptive method in a patient with heart disease is:

Accepted Answer

Double barrier

Answer

IUCD

Answer

Tubectomy

Answer

Oral pills

Question 5

All of the following are advantages of depot progestogen contraception EXCEPT:

Accepted Answer

It provides good cycle control.

Answer

It can be given to lactating mothers.

Answer

A 150mg dose is effective for a period of 12 weeks.

Answer

It prevents ectopic pregnancy.

Question 6

Centchroman, a non-hormonal contraceptive pill, is taken orally:

Accepted Answer

Twice a week for the first three months, then once a week.

Answer

Daily for the first three months, then once a week.

Answer

Thrice a week for the first three months, then once a week.

Answer

Twice a week for the first five months, then once a week.

Question 7

What menstrual abnormality is typically seen in a woman using a subdermal progesterone implant for contraception?

Accepted Answer

Metrorrhagia

Answer

Menorrhagia

Answer

Polymenorrhea

Answer

Amenorrhea

Question 8

What is the preferred investigation to confirm the presence of an intrauterine device (IUD) when its strings are not visible?

Accepted Answer

Ultrasound (USG)

Answer

Pelvic X-ray

Answer

CT Abdomen

Answer

MRI Pelvis

Question 9

Which of the following mechanisms best explains the contraceptive effect of birth control pills that contain both synthetic estrogen and progestin?

Accepted Answer

Inhibition of ovulation

Answer

Direct inhibition of oocyte maturation

Answer

Production of uterine secretions that are toxic to developing embryos

Answer

Impairment of implantation by hyperplastic changes of the endometrium

Question 10

Which of the following is NOT a contraindication to the use of combined oral contraceptives?

Accepted Answer

Suspected Osteosarcoma

Answer

Migraine with focal neurological deficit

Answer

Coronary artery disease

Answer

Diabetes with vascular involvement

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

On this page

Practice by Chapter

Want unlimited practice?