Hormonal Contraceptives — 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?
Combined oral pills reduce the risk of?
Which of the following is not a long-acting reversible contraceptive method?
What is the most common gastrointestinal side effect of oral contraceptives?
Which of the following inhibit gonadotropin-releasing hormone pulse secretion?
The combined estrogen-progestin pill acts mainly by:
Which antitubercular drug reduces the efficacy of oral contraceptive pills (OCPs)?
A woman comes after 96 hours post coitus. Best contraceptive of choice is?
What is the management for women with polycystic ovary syndrome (PCOS) and hirsutism?
Which of the following is a selective progesterone receptor modulator?
Hormonal Contraceptives Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: 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 3: Which of the following is not a long-acting reversible contraceptive method?
- A. Combined oral contraceptives (Correct Answer)
- B. Implanon
- C. Copper T
- D. Depo-Provera injection
Explanation: ***Combined oral contraceptives*** - While effective, **combined oral contraceptives** require daily adherence and are not typically classified as long-acting due to their need for frequent, consistent administration. - Their mechanism involves **exogenous hormones** that suppress ovulation and thicken cervical mucus, but their contraceptive effect relies on continuous daily intake. *Implanon* - **Implanon** (etonogestrel implant) is a **subdermal contraceptive implant** that provides effective contraception for up to three years. - It works by slowly releasing progestin, making it a **long-acting reversible contraceptive (LARC)**. *Copper T* - The **Copper T intrauterine device (IUD)** is a non-hormonal LARC that can prevent pregnancy for **up to 10 years**. - It acts by creating an inflammatory reaction in the uterus that is toxic to sperm and eggs, preventing fertilization. *Depo-Provera injection* - The **Depo-Provera injection** (medroxyprogesterone acetate) is a progestin-only contraceptive given every **3 months**. - While it offers extended protection, it is **not universally classified as a LARC** by major guidelines (WHO, ACOG, CDC), which typically reserve this designation for IUDs and implants that do not require regular clinic visits.
Question 4: What is the most common gastrointestinal side effect of oral contraceptives?
- A. Decreased appetite
- B. Weight loss
- C. Nausea (Correct Answer)
- D. Constipation
Explanation: ***Nausea*** - **Nausea** is a very common gastrointestinal side effect of oral contraceptives, especially during the initial weeks of use, due to the **estrogen component**. - This side effect often **improves over time** as the body adjusts, or can be managed by taking the pill with food or at bedtime. *Weight loss* - Oral contraceptives are **not typically associated with weight loss**; in fact, some users may experience slight weight gain, although studies show no consistent significant effect. - Changes in weight are more often due to **fluid retention** rather than true fat loss. *Decreased appetite* - **Decreased appetite** is not a common side effect of oral contraceptives; rather, some individuals might experience an increased appetite due to hormonal fluctuations. - The hormonal effects on metabolism and appetite are **varied and not consistently demonstrated** to lead to decreased appetite. *Constipation* - **Constipation** is not a frequent gastrointestinal side effect of oral contraceptives; rather, some users may experience changes in bowel habits, but **diarrhea is more commonly reported** than constipation when GI issues occur. - Hormonal contraceptives primarily affect the gut through **estrogen and progestin**, leading to various effects, but constipation is not a predominant one.
Question 5: Which of the following inhibit gonadotropin-releasing hormone pulse secretion?
- A. Prolactin (Correct Answer)
- B. Oxytocin
- C. Thyroxine
- D. Insulin
Explanation: ***Prolactin*** - Elevated levels of **prolactin** inhibit the pulsatile secretion of **gonadotropin-releasing hormone (GnRH)** from the hypothalamus. - This inhibition leads to decreased production of **luteinizing hormone (LH)** and **follicle-stimulating hormone (FSH)** from the pituitary, ultimately affecting gonadal function. *Thyroxine* - **Thyroxine** (thyroid hormone) primarily regulates metabolism and growth, and while it interacts with the reproductive axis, its direct effect is not typically the **inhibition of GnRH pulse secretion**. - Extreme thyroid dysfunction can indirectly impact reproductive hormones, but it's not the primary mechanism of GnRH inhibition. *Oxytocin* - **Oxytocin** is largely involved in **uterine contractions** during labor and **milk ejection** during lactation, and has roles in social bonding. - It does not directly inhibit the pulsatile release of **GnRH**. *Insulin* - **Insulin** is a key hormone in **glucose metabolism** and energy regulation. - While insulin resistance and hyperinsulinemia can affect reproductive function (e.g., in polycystic ovary syndrome, PCOS), it does not **directly inhibit GnRH pulse secretion**.
Question 6: The combined estrogen-progestin pill acts mainly by:
- A. Suppression of FSH and LH release (Correct Answer)
- B. Enhancing uterine contraction to dislodge the fertilized ovum
- C. Making the endometrium less suitable for implantation
- D. Thickening of cervical mucus to prevent sperm penetration
Explanation: ***Suppression of FSH and LH release*** - The **estrogen** and **progestin** components of combined oral contraceptives exert a negative feedback on the **hypothalamus** and **pituitary gland**. - This leads to the suppression of **follicle-stimulating hormone (FSH)** and **luteinizing hormone (LH)**, which prevents **ovarian follicle development** and **ovulation**. *Making the endometrium less suitable for implantation* - While combined oral contraceptives do make the **endometrium** less receptive, this is a **secondary mechanism** and not the primary way they prevent pregnancy. - The endometrial changes primarily serve as a **backup plan** if ovulation accidentally occurs. *Enhancing uterine contraction to dislodge the fertilized ovum* - Combined oral contraceptives do **not enhance uterine contractions** to dislodge a fertilized ovum. - This mechanism is generally associated with methods like certain **emergency contraceptives** or early abortion methods. *Thickening of cervical mucus to prevent sperm penetration* - This is a significant effect of the **progestin component**, but it is also a **secondary mechanism** of action for combined pills. - While crucial for contraception, the **primary mechanism** remains the inhibition of ovulation.
Question 7: Which antitubercular drug reduces the efficacy of oral contraceptive pills (OCPs)?
- A. Rifampicin (Correct Answer)
- B. Isoniazid
- C. Ethambutol
- D. Pyrazinamide
- E. Streptomycin
Explanation: ***Rifampicin*** - **Rifampicin** is a potent inducer of **cytochrome P450 enzymes**, particularly CYP3A4, which metabolize oral contraceptive pills (OCPs). - This increased metabolism leads to lower systemic levels of contraceptive hormones, reducing their efficacy and increasing the risk of **unintended pregnancy**. - Women on Rifampicin should use **additional barrier contraception** or alternative contraceptive methods. *Isoniazid* - **Isoniazid** is primarily metabolized by N-acetyltransferase and cytochrome P450, but it is not a significant enzyme inducer. - It does not typically interfere with the effectiveness of **oral contraceptive pills**. *Ethambutol* - **Ethambutol** is eliminated largely unchanged via renal excretion and is not a significant inducer or inhibitor of cytochrome P450 enzymes. - It does not interact with **oral contraceptive pills**. *Pyrazinamide* - **Pyrazinamide** is metabolized by the liver, but it does not significantly induce or inhibit the cytochrome P450 system involved in OCP metabolism. - It is not known to reduce the effectiveness of **oral contraceptive pills**. *Streptomycin* - **Streptomycin** is an aminoglycoside antibiotic that is not metabolized by the liver and does not affect cytochrome P450 enzymes. - It has no interaction with **oral contraceptive pills**.
Question 8: A woman comes after 96 hours post coitus. Best contraceptive of choice is?
- A. Progesterone only pills
- B. OCP
- C. IUCD (Correct Answer)
- D. Mifepristone
Explanation: ***IUCD*** - An **intrauterine contraceptive device (IUCD)** can be inserted up to **5 days (120 hours)** after unprotected intercourse or within 5 days of the earliest estimated ovulation. - It is the **most effective form of emergency contraception**, offering approximately **99% efficacy**. - Provides **immediate ongoing contraception** after insertion, making it the optimal choice at 96 hours post-coitus. *Progesterone only pills* - **Progesterone-only emergency contraceptive pills** (e.g., levonorgestrel) are most effective when taken within **72 hours (3 days)** of unprotected intercourse. - At **96 hours**, their efficacy is **significantly reduced**, making them suboptimal compared to IUCD. *OCP* - **Combined oral contraceptive pills (OCPs)** used for emergency contraception (Yuzpe method) are less effective and have more side effects than other emergency contraceptive methods. - Their effectiveness also significantly declines after **72 hours** post-coitus. *Mifepristone* - **Mifepristone** is an **anti-progestin** that can be used for emergency contraception within **120 hours (5 days)** of unprotected intercourse. - While effective within this timeframe at **96 hours**, the **IUCD remains superior** due to its higher efficacy (>99% vs ~98%) and provision of ongoing contraception.
Question 9: What is the management for women with polycystic ovary syndrome (PCOS) and hirsutism?
- A. Ethinyl estradiol + Cyproterone Acetate (Correct Answer)
- B. Ethinyl estradiol
- C. Levonorgestrel
- D. Ethinyl estradiol + Levonorgestrel
Explanation: ***Ethinyl estradiol + Cyproterone Acetate*** - This combination is effective for managing **hirsutism** in PCOS because ethinyl estradiol suppresses **gonadotropins** and ovarian androgen production, while **cyproterone acetate** is a potent **anti-androgen** that blocks androgen effects at the receptor level. - The anti-androgenic properties of cyproterone acetate directly address the excess androgen activity responsible for hirsutism. *Ethinyl estradiol* - While ethinyl estradiol (an estrogen) can suppress **gonadotropins** and thus reduce ovarian androgen production, it alone is not primarily effective in directly addressing and reversing existing hirsutism. - It would not sufficiently counteract the effects of high androgens on hair follicles without an additional anti-androgen. *Levonorgestrel* - Levonorgestrel is a **progestin** with **androgenic properties**, particularly at higher doses. - This would potentially worsen hirsutism rather than improve it, as it contributes to androgenic effects. *Ethinyl estradiol + Levonorgestrel* - This combination is a common component of oral contraceptive pills, but **levonorgestrel** has some **androgenic activity**, which means it could worsen or fail to improve hirsutism. - While ethinyl estradiol lowers androgens, the mild androgenic effect of levonorgestrel might counteract the desired anti-androgenic effect needed to treat hirsutism effectively.
Question 10: Which of the following is a selective progesterone receptor modulator?
- A. Onapristone
- B. Ulipristal (Correct Answer)
- C. Nomegestrol
- D. Toremifene
Explanation: ***Ulipristal*** - **Ulipristal acetate** is a **selective progesterone receptor modulator (SPRM)** that acts as a progesterone receptor agonist/antagonist. - It is primarily used for **emergency contraception** and for the pre-operative treatment of **uterine fibroids**. *Onapristone* - **Onapristone** is an **antiprogestin** and a **progesterone receptor antagonist**, not a selective modulator. - It has been primarily investigated for its potential role in **breast cancer** treatment but is not approved for general clinical use. *Nomegestrol* - **Nomegestrol** is a **synthetic progestin** used in hormonal contraception. - It functions as a **progesterone receptor agonist** and does not exhibit selective modulation properties. *Toremifene* - **Toremifene** is a **selective estrogen receptor modulator (SERM)**, not a progesterone receptor modulator. - It is used in the treatment of **estrogen receptor-positive metastatic breast cancer** in postmenopausal women.
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