Contraception and Family Planning — MCQs
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Which of the following is NOT a mechanism of action of copper IUCDs?
Combined oral pills reduce the risk of?
Best long-acting reversible contraception (LARC) that can be inserted immediately postpartum in a lactating mother is:
What is the best index of contraceptive efficacy?
What is the best contraceptive option for managing menorrhagia?
Spermicidal jelly acts through what mechanism?
Following vasectomy, what is the recommended approach for contraceptive management?
What is the hormonal contraceptive of choice in a lactating woman?
Which of the following is not typically used as an emergency contraceptive?
Which of the following tubal sterilization procedures is considered the least effective?
Contraception and Family Planning Indian Medical PG Practice Questions and MCQs
Question 691: Which of the following is NOT a mechanism of action of copper IUCDs?
- A. Inhibit implantation of the fertilized egg
- B. Increase tubal motility (Correct Answer)
- C. Inhibit ovulation
- D. Induce biochemical changes in the endometrium
Explanation: ***Increase tubal motility*** - Copper IUCDs (intrauterine contraceptive devices) prevent pregnancy primarily by creating a **sterile inflammatory reaction** in the uterus, making the environment hostile to sperm and eggs. - While they affect sperm and egg transport through the inflammatory response, **increasing tubal motility is NOT a recognized mechanism** of copper IUCDs. - The contraceptive effect is achieved through spermicidal action, prevention of fertilization, and interference with implantation. *Inhibit ovulation* - This is characteristic of **hormonal contraceptives** and **hormonal IUCDs (LNG-IUS)**, which can suppress the hypothalamic-pituitary-ovarian axis. - **Copper IUCDs** (non-hormonal) act locally within the uterus and do NOT inhibit ovulation. - Women using copper IUCDs continue to ovulate normally. *Induce biochemical changes in the endometrium* - Copper IUCDs release copper ions, which create a **spermicidal inflammatory reaction** in the uterus and fallopian tubes. - This reaction causes biochemical and morphological changes in the endometrium, making it unsuitable for sperm survival and fertilization. - The inflammatory environment is hostile to both sperm and eggs. *Inhibit implantation of the fertilized egg* - This is a key mechanism of action for copper IUCDs. - The local uterine inflammatory changes and endometrial alterations prevent a fertilized egg from successfully implanting in the **uterine wall**. - This is one of the primary contraceptive mechanisms of copper-containing devices.
Question 692: Combined oral pills reduce the risk of?
- A. Breast cancer
- B. Ovarian cancer (Correct Answer)
- C. Cervical cancer
- D. Vaginal cancer
Explanation: ***Ovarian cancer*** - Combined oral contraceptive pills reduce the risk of **ovarian cancer** by suppressing ovulation and reducing exposure of ovarian cells to incessant hormonal stimulation. - The longer the duration of use, the greater the protective effect, which can persist for years after discontinuation. *Breast cancer* - Some studies suggest a **slight increase in breast cancer risk** with current or recent use of combined oral contraceptives, especially in women with a family history or other risk factors. - However, this increased risk typically **reverts to baseline 10 years after cessation** of use. *Cervical cancer* - Long-term use of combined oral contraceptives is associated with a **modestly increased risk of cervical cancer**, particularly in women who are also infected with **human papillomavirus (HPV)**. - This increased risk is thought to be due to chronic inflammation or hormonal effects on the cervix, but it is **HPV infection that drives cervical cancer pathogenesis**. *Vaginal cancer* - Vaginal cancer is a **rare malignancy**, and combined oral contraceptives have generally **not been shown to either increase or decrease its risk**. - **Diethylstilbestrol (DES) exposure in utero** is the primary risk factor for a specific type of vaginal cancer, **clear cell adenocarcinoma**.
Question 693: Best long-acting reversible contraception (LARC) that can be inserted immediately postpartum in a lactating mother is:
- A. Post Partum IUCD (Correct Answer)
- B. Depot provera
- C. Combined oral contraceptive pills (OCPs)
- D. Calendar method
Explanation: ***Post Partum IUCD*** - **Intrauterine contraceptive devices (IUCDs)** are highly effective long-acting reversible contraceptives (LARC) that can be inserted **immediately postpartum** (within 10 minutes of placental delivery) or within 48 hours of delivery. - They are **safe for breastfeeding mothers** as copper IUCDs are non-hormonal and levonorgestrel-releasing IUCDs (LNG-IUS) have only localized hormonal effects. - **WHO MEC Category 1** for breastfeeding women, with no interference with lactation or infant growth. - Provide immediate, long-term protection (3-10 years depending on type) with high continuation rates. *Depot provera* - **Depot medroxyprogesterone acetate (DMPA)** is a progestin-only injectable contraceptive that is also safe for breastfeeding mothers (WHO MEC Category 1 after 6 weeks postpartum). - However, it is **not a LARC method that can be inserted immediately postpartum** - it requires injection and has a 3-month duration requiring repeat visits. - While effective for lactating women, it cannot be given in the immediate postpartum period like IUCD insertion. *Combined oral contraceptive pills (OCPs)* - **Combined OCPs** contain estrogen, which can **reduce milk supply** and alter milk composition, especially in the early postpartum period. - **WHO MEC Category 3-4** for breastfeeding women (depending on timing postpartum), contraindicated in the first 6 weeks and generally avoided during lactation. - Not recommended as first-line contraception for lactating mothers. *Calendar method* - The **calendar method** is a natural family planning method that relies on tracking menstrual cycles to predict fertile windows. - It is **highly unreliable** in the postpartum period due to unpredictable ovulation and irregular cycles, especially during breastfeeding (lactational amenorrhea makes cycle tracking impossible). - Not an effective contraceptive method for postpartum women.
Question 694: What is the best index of contraceptive efficacy?
- A. Pearl index (Correct Answer)
- B. Quetelet index
- C. Broca index
- D. Chandelier's index
Explanation: ***Pearl index*** - The **Pearl Index** (also known as the Pearl Rate) is the most common measure of contraceptive efficacy, representing the number of unintended pregnancies per 100 woman-years of exposure. - It considers both the duration of use and the number of women-months a contraceptive method is used, providing a standardized way to compare different methods. *Chandelier's index* - **Chandelier's index** is not a recognized or standard measure for contraceptive efficacy in scientific literature or clinical practice. - This term does not correspond to any known medical or statistical index for evaluating contraceptive methods. *Quetlet index* - This is likely a misspelling or incorrect reference to the **Quetelet index**, which is another name for the **Body Mass Index (BMI)** used to assess body fat based on height and weight. - The **Quetelet index/BMI** has no relevance to measuring contraceptive efficacy. *Broca index* - The **Broca index** is a historical method for assessing ideal body weight based on height, often used in older anthropometric studies. - It is not used to measure contraceptive efficacy or any other aspect of reproductive health.
Question 695: What is the best contraceptive option for managing menorrhagia?
- A. Hormonal IUD (Correct Answer)
- B. Oral progestin
- C. Non-hormonal IUD
- D. Barrier contraceptives
Explanation: ***Hormonal IUD*** - The **levonorgestrel-releasing intrauterine device (LNG-IUD)** is highly effective for menorrhagia due to its localized release of progesterone, which thins the endometrial lining, significantly **reducing menstrual blood loss**. - It also provides highly effective, **long-acting contraception** while offering non-contraceptive benefits like menorrhagia management. *Non-hormonal IUD* - The **copper IUD** can actually **increase menstrual bleeding** and dysmenorrhea, which would worsen menorrhagia. - It works by inducing a local inflammatory reaction in the uterus to prevent fertilization and implantation, without hormonal effects on the endometrium. *Oral progestin* - While oral progestins can sometimes be used to manage menorrhagia, they are generally **less effective** than the hormonal IUD for long-term reduction in menstrual blood loss. - They require **daily adherence** and do not offer the same extended period of efficacy as the hormonal IUD. *Barrier contraceptives* - Barrier methods like **condoms or diaphragms** provide contraception by physically blocking sperm, but they have **no effect on menstrual bleeding** or menorrhagia. - They offer no therapeutic benefit for heavy menstrual bleeding and are solely contraceptive in function.
Question 696: Spermicidal jelly acts through what mechanism?
- A. Acrosomal enzyme activity
- B. Alteration of cervical mucus
- C. Lysis of sperm cell membrane (Correct Answer)
- D. Inhibition of glucose uptake by sperm
Explanation: ***Lysis of sperm cell membrane*** - Spermicidal jelly typically contains a chemical agent, most commonly **nonoxynol-9**, which acts as a **surfactant**. - This surfactant mechanism disrupts the **lipid bilayer of the sperm cell membrane**, leading to its rupture and cell death. *Acrosomal enzyme activity* - Spermicides do not primarily work by affecting **acrosomal enzymes**, which are crucial for fertilization by breaking down the egg's outer layers. - While sperm death would prevent acrosomal reaction, it's not the direct mechanism of action of spermicides. *Alteration of cervical mucus* - While some contraceptive methods, such as **progestin-only pills**, alter cervical mucus to impede sperm passage, this is not the primary mechanism of action for **spermicidal jelly**. - Spermicides aim to directly kill sperm rather than solely hindering their movement through the cervix. *Inhibition of glucose uptake by sperm* - Spermicides do not primarily function by inhibiting the **metabolic processes** of sperm, such as glucose uptake. - Their main action is a direct cytotoxic effect on the **sperm cell structure**.
Question 697: Following vasectomy, what is the recommended approach for contraceptive management?
- A. Sterility is achieved immediately
- B. Onset of sterility is predictable
- C. Semen has to be analyzed till 2 consecutive sperm counts are zero (Correct Answer)
- D. No need to use additional contraception after 1 month
Explanation: ***Semen has to be analyzed till 2 consecutive sperm counts are zero*** - Following a vasectomy, **sperm** can remain in the **distal ejaculatory ducts** for some time. - **Semen analysis** is crucial to confirm sterility, typically requiring two consecutive **azoospermic** (no sperm) samples. - This usually takes **15-20 ejaculations** or **8-12 weeks** to achieve. *Sterility is achieved immediately* - This is incorrect as remaining **sperm** in the **vas deferens** can still be ejaculated, preventing immediate sterility. - Therefore, **additional contraception** is needed until **azoospermia** is confirmed. *Onset of sterility is predictable* - The onset of sterility is **not entirely predictable** and depends on the clearance of residual sperm, which varies among individuals. - The only reliable way to confirm sterility is through **semen analysis**. *No need to use additional contraception after 1 month* - This is an **unsafe practice** as one month may not be sufficient for all residual sperm to be cleared. - **Confirmation of azoospermia** via semen analysis is the only reliable indicator for discontinuing other contraceptive methods.
Question 698: What is the hormonal contraceptive of choice in a lactating woman?
- A. Combined oral contraceptive
- B. Progestin-only pill (Correct Answer)
- C. Centchroman
- D. Multiphasic oral contraceptive
Explanation: ***Progestin-only pill*** - The **progestin-only pill** is generally considered the hormonal contraceptive of choice for lactating women because it does not negatively impact **milk supply** or the **growth of the infant**. - Progestin-only methods have minimal to no effect on the **quality or quantity of breast milk**. *Combined oral contraceptive* - **Combined oral contraceptives (COCs)** contain both estrogen and progestin, and the **estrogen component** can **reduce milk supply**. - Due to the potential for impacting lactation, COCs are generally **not recommended** for use in the early postpartum period while a woman is breastfeeding exclusively. *Centchroman (non-hormonal option)* - **Centchroman** is a non-hormonal contraceptive that functions as a **selective estrogen receptor modulator (SERM)**. While it is an oral contraceptive, it is not a hormonal choice in the same category as progestin-only or combined pills and is less commonly used as a first-line option specifically for lactating women over progestin-only methods. - While it may not affect lactation, it is **not the 'hormonal contraceptive of choice'** among the given options, and its efficacy and availability may vary. *Multiphasic oral contraceptive* - **Multiphasic oral contraceptives** are a type of combined oral contraceptive, meaning they contain both **estrogen and progestin**, with varying doses throughout the cycle. - Similar to other combined hormonal contraceptives, the **estrogen content** can **suppress milk production**, making it an unsuitable choice for lactating women.
Question 699: Which of the following is not typically used as an emergency contraceptive?
- A. Combined oral pills
- B. Levonorgestrel
- C. Estrogen (Correct Answer)
- D. Ulipristal acetate
Explanation: ***Estrogen*** - High-dose estrogen alone is **not typically used for emergency contraception** due to a high incidence of adverse effects (severe nausea and vomiting) and significantly lower effectiveness compared to progestin-only or selective progesterone receptor modulator methods. - The **Yuzpe method** (an older emergency contraceptive regimen) used **combined** oral contraceptives containing both estrogen and progestin, but estrogen alone has no role in modern emergency contraception. *Combined oral pills* - Certain combined oral contraceptive pills (containing both estrogen and progestin) can be used as **emergency contraception in specific dosages**, known as the **Yuzpe method**. - This method involves taking two doses of combined pills within 72 hours of unprotected intercourse, but it has largely been superseded by more effective and better-tolerated options. *Ulipristal acetate* - **Ulipristal acetate is a selective progesterone receptor modulator (SPRM)** that is highly effective as an emergency contraceptive. - It can be taken up to **120 hours (5 days)** after unprotected intercourse and is **more effective than levonorgestrel**, especially between 72-120 hours. - It works primarily by **delaying or inhibiting ovulation**. *Levonorgestrel* - **Levonorgestrel is the most widely used progestin-only emergency contraceptive pill**, typically taken as a single 1.5 mg dose or two 0.75 mg doses. - It is most effective when taken within **72 hours** of unprotected intercourse. - It primarily works by **delaying or inhibiting ovulation** and preventing fertilization.
Question 700: Which of the following tubal sterilization procedures is considered the least effective?
- A. Laparoscopic Yoon's ring method
- B. Hysteroscopic occlusion (Correct Answer)
- C. Pomeroy's method
- D. Vaginal fimbriectomy
Explanation: ***Hysteroscopic occlusion*** - This method, using devices like the **Essure system** (discontinued in 2018), historically had higher reported failure rates and has been associated with more complications compared to surgical ligation methods. - Its effectiveness relies on adequate fibrosis around the device to block the fallopian tubes, which can take several months, and requires a **confirmation hysterosalpingogram (HSG)**. - Failure rates reported at **0.9-1.6%**, making it the least effective among standard tubal sterilization methods. *Laparoscopic Yoon's ring method* - Involves applying a **silastic band (Falope Ring or Yoon's Ring)** to a loop of the fallopian tube, causing necrosis and effective occlusion. - It is a highly effective method with a low failure rate of approximately **0.5%** when performed correctly. *Pomeroy's method* - Involves ligating and excising a section of the fallopian tube, widely recognized as one of the **most effective** and commonly performed tubal ligation techniques. - Its high success rate (failure rate **0.4%**) is due to the complete transection of the tube, creating a physical barrier to sperm and egg meeting. *Vaginal fimbriectomy* - This procedure involves the removal of the **fimbrial portion of the fallopian tube** via a vaginal approach, making it an effective sterilization method. - While effective, it is less commonly performed than laparoscopic methods and offers similar efficacy to other surgical ligation techniques.
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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