Contraception and Family Planning — MCQs

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?

Q730

What is the dose of mifepristone in medical abortion?

Contraception and Family Planning Indian Medical PG Practice Questions and MCQs

Question 721: All of the following are postcoital contraception methods except?

A. IUD
B. Levonorgestrel
C. Mifepristone
D. Barrier methods (Correct Answer)

Explanation: ***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.

Question 722: Which of the following is not an absolute contraindication to the use of combined oral contraceptives?

A. Cerebral haemorrhage
B. Porphyria
C. Previous herpes genitalis (Correct Answer)
D. Trophoblastic disease with elevated hCG

Explanation: ***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.

Question 723: Which of the following is considered a temporary method of contraception?

A. Vasectomy
B. OCP (Correct Answer)
C. Tubectomy
D. Postpartum sterilisation

Explanation: ***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.

Question 724: IUCD lasting for 10 years is a:

A. CuT - 380A (Correct Answer)
B. Nova T
C. CuT - 220
D. Progestasert

Explanation: ***CuT - 380A*** - The **CuT-380A** is a copper-containing intrauterine device (IUD) specifically designed for a highly effective contraceptive duration of **10 years**. - Its mechanism involves the continuous release of copper ions, which create a hostile uterine environment for sperm and ova, preventing fertilization. *Progestase* - **Progestasert** (or Progestasert system) is a progesterone-releasing IUD that has a much **shorter duration of action**, typically around **1 year**. - Its contraceptive effect relies on the local release of progesterone, which thickens cervical mucus and thins the endometrial lining. *CuT - 220 (shorter duration)* - The **CuT-220** is an older generation copper IUD with a **shorter period of efficacy**, typically around **3 to 4 years**. - It contains a smaller surface area of copper compared to the CuT-380A, hence its shorter lifespan. *Nova T (shorter duration)* - **Nova T** is a copper IUD that is effective for a duration of **5 years**, making it a shorter-acting option compared to the CuT-380A. - While also copper-based, its design and total copper content allow for a more limited period of effectiveness.

Question 725: In which of the following conditions is IUCD contraindicated?

A. Anemia
B. Infection (Correct Answer)
C. None of the options
D. Hypertension

Explanation: ***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.

Question 726: All are long-acting reversible contraceptives except:

A. Implanon
B. IUCD
C. OCP (Correct Answer)
D. Jadelle

Explanation: ***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.

Question 727: The most common complication of intrauterine contraceptive devices is:

A. Bleeding (Correct Answer)
B. Ectopic pregnancy
C. Backache
D. Cervical stenosis

Explanation: ***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.

Question 728: Most preferable contraceptive method for a female suffering from rheumatic heart disease who has completed her family is:

A. Surgical sterilization (Tubal ligation) (Correct Answer)
B. Non-hormonal barrier methods
C. Long-term intrauterine device (IUCD)
D. Hormonal contraceptive implant

Explanation: ***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 729: 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?

A. Progesterone intrauterine device (IUD)
B. Depo-Provera (medroxyprogesterone acetate) shots every 3 months
C. Combination oral contraceptive pill with drospirenone and ethinyl estradiol (Correct Answer)
D. Tubal ligation (permanent sterilization)

Explanation: ***Combination oral contraceptive pill with drospirenone and ethinyl estradiol*** - This combination addresses **contraception**, **dysmenorrhea**, **heavy menstrual bleeding**, **premenstrual dysphoric disorder (PMDD)**, and **acne**. Drospirenone has anti-androgenic effects, improving acne and potentially reducing fluid retention. - The patient's symptoms of irregular mood and irritability before her period are consistent with **PMDD**, which is effectively treated by **combination oral contraceptives** (COCs). *Progesterone intrauterine device (IUD)* - While effective for **contraception** and reducing **heavy menstrual bleeding** and **dysmenorrhea**, it does not typically improve acne or PMDD symptoms. - It works primarily locally in the uterus and does not have the systemic anti-androgenic or mood-stabilizing effects of COCs. *Depo-Provera (medroxyprogesterone acetate) shots every 3 months* - This method is effective for contraception and can reduce menstrual bleeding and dysmenorrhea, but it is often associated with **weight gain**, which the patient wants to avoid. - It can also cause **worsening of mood symptoms** and **acne** in some individuals, conflicting with her specific concerns. *Tubal ligation (permanent sterilization)* - This method provides permanent **contraception** but does not address her heavy, painful periods, PMDD, or acne. - The patient only desires to avoid pregnancy for a few years, making a permanent method like tubal ligation inappropriate at this time.

Question 730: What is the dose of mifepristone in medical abortion?

A. 400 mg
B. 100 mg
C. 200 mg (Correct Answer)
D. 600 mg

Explanation: ***200 mg*** - The standard dose of **mifepristone** for **medical abortion** in various protocols, including those up to 10 weeks of gestation, is **200 mg orally**. - This dose effectively blocks **progesterone receptors**, leading to endometrial breakdown and sensitization of the uterus to prostaglandins. - **WHO-recommended dose** with optimal efficacy and safety profile. *400 mg* - **400 mg is not a standard or recommended dose** for medical abortion in any established protocol. - The evidence-based regimens use either **200 mg** (current standard) or 600 mg (older protocol), but not 400 mg. - No clinical advantage has been demonstrated for this intermediate dose. *100 mg* - A dose of **100 mg of mifepristone is considered suboptimal** and less effective for inducing medical abortion compared to the standard 200 mg dose. - It may not sufficiently block progesterone receptors, potentially leading to **incomplete abortion** or treatment failure. - Not recommended in any standard medical abortion protocol. *600 mg* - Although **600 mg was an older protocol** for medical abortion, it has largely been replaced by the **200 mg dose**. - Research has demonstrated that **200 mg is equally effective** while resulting in a better side effect profile and lower cost. - The dose reduction from 600 mg to 200 mg represents evidence-based protocol optimization.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free