Reproductive Health — MCQs
On this page
A 41-year-old woman attends for review 6 months after insertion of a levonorgestrel intrauterine system for contraception and heavy menstrual bleeding. She reports absent periods for the last 3 months and is very concerned about pregnancy. She has not experienced any other symptoms. A urine pregnancy test is negative. What is the most appropriate advice?
A 53-year-old woman presents with vasomotor symptoms 18 months after her last menstrual period. She has a history of oestrogen receptor-positive breast cancer treated with wide local excision and radiotherapy 3 years ago. She is currently taking tamoxifen. Her hot flushes are significantly affecting her quality of life. What is the most appropriate management?
A 37-year-old woman with known antiphospholipid syndrome presents requesting contraception. She had a provoked deep vein thrombosis 3 years ago following a long-haul flight and is currently on warfarin. She does not wish to become pregnant. Her blood pressure is 128/82 mmHg and BMI is 27 kg/m². Which contraceptive method is most appropriate?
A 57-year-old woman attends for review of her oestrogen-only HRT, which she has been taking for 7 years following total hysterectomy for cervical cancer at age 50. She remains asymptomatic and wishes to continue HRT. She has no other significant medical history, maintains a healthy weight, and does not smoke. Recent mammography was normal. In counselling her about continuing HRT, which of the following statements about breast cancer risk with oestrogen-only HRT is most accurate?
A 48-year-old woman with a history of uterine fibroids and adenomyosis presents with irregular heavy menstrual bleeding and symptoms of perimenopause. She has a levonorgestrel intrauterine system in situ that was inserted 4 years ago for menorrhagia management. She now requests HRT for vasomotor symptoms. Examination reveals a 14-week-size uterus. What is the most appropriate HRT regimen for this patient?
A 36-year-old woman presents requesting contraception. She has a history of stroke 3 years ago, which was attributed to a patent foramen ovale (PFO) that has since been surgically closed. She has made a full recovery with no residual neurological deficit and is not on any regular medications. She is a non-smoker with a BMI of 24 kg/m². Her blood pressure is 122/80 mmHg. According to UKMEC, what is the classification for combined hormonal contraception in this patient?
A 55-year-old woman has been taking continuous combined HRT for 5 years for menopausal symptoms. She now feels well and wishes to stop HRT. She asks about the best way to discontinue treatment. What is the most appropriate advice regarding stopping HRT?
A 29-year-old woman attends for emergency contraception. She had unprotected sexual intercourse 72 hours ago and also 5 days ago. She has a regular 28-day menstrual cycle and her last menstrual period started 12 days ago. She has a BMI of 29 kg/m² and takes no regular medications. What is the most appropriate emergency contraception for this patient?
A 43-year-old woman with body mass index of 44 kg/m² presents with symptoms of perimenopause including irregular periods, night sweats, and mood changes. She requests HRT for symptom management. She has no other significant medical history, does not smoke, and her blood pressure is 138/88 mmHg. What is the most appropriate HRT formulation for this patient?
According to current UK guidance, what is the Pearl Index (number of pregnancies per 100 woman-years of use) for the copper intrauterine device with typical use?
Reproductive Health UK Medical PG Practice Questions and MCQs
Question 51: A 41-year-old woman attends for review 6 months after insertion of a levonorgestrel intrauterine system for contraception and heavy menstrual bleeding. She reports absent periods for the last 3 months and is very concerned about pregnancy. She has not experienced any other symptoms. A urine pregnancy test is negative. What is the most appropriate advice?
- A. Remove the device immediately and perform ultrasound scan to exclude pregnancy
- B. Arrange urgent blood test for serum beta-hCG
- C. Reassure that amenorrhoea is a common and expected effect of the levonorgestrel IUS (Correct Answer)
- D. Arrange pelvic ultrasound to check device position
- E. Advise additional barrier contraception for the next 3 months
Explanation: ***Reassure that amenorrhoea is a common and expected effect of the levonorgestrel IUS*** - **Amenorrhoea** is a common side effect of the **levonorgestrel intrauterine system (LNG-IUS)**, occurring in approximately 20% of users as the local progestogen suppresses and thins the **endometrium**. - Given the **negative pregnancy test** and lack of other symptoms, no further investigation is needed as the device is highly effective with a failure rate of <0.2%.*Remove the device immediately and perform ultrasound scan to exclude pregnancy* - **Device removal** is unnecessary and contraindicated here, as it would leave the patient without contraception and lose the therapeutic benefit for her **heavy menstrual bleeding**. - A **urine pregnancy test** is highly sensitive 3 months after missed periods, making a routine ultrasound to exclude pregnancy redundant.*Arrange urgent blood test for serum beta-hCG* - There is no clinical indication for an **urgent serum beta-hCG** when a urine pregnancy test is negative and the patient is asymptomatic. - This intervention would cause unnecessary anxiety and utilize healthcare resources for an expected side effect of the **progestogen**.*Arrange pelvic ultrasound to check device position* - An **ultrasound** for position check is only indicated if the **threads are not visible**, there is persistent pain, or abnormal bleeding patterns occur. - **Amenorrhoea** is a hormonal effect on the uterine lining and does not suggest that the device has displaced or failed.*Advise additional barrier contraception for the next 3 months* - The **LNG-IUS** is one of the most effective forms of contraception, and its efficacy is not compromised by the development of **amenorrhoea**. - Additional **barrier methods** are not required if the device was inserted correctly and there are no signs of expulsion or failure.
Question 52: A 53-year-old woman presents with vasomotor symptoms 18 months after her last menstrual period. She has a history of oestrogen receptor-positive breast cancer treated with wide local excision and radiotherapy 3 years ago. She is currently taking tamoxifen. Her hot flushes are significantly affecting her quality of life. What is the most appropriate management?
- A. Transdermal oestrogen-only HRT
- B. Continuous combined HRT
- C. Venlafaxine 75 mg daily (Correct Answer)
- D. Black cohosh herbal supplement
- E. Tibolone 2.5 mg daily
Explanation: ***Venlafaxine 75 mg daily***- **Venlafaxine**, an SNRI, is a recommended non-hormonal treatment for **vasomotor symptoms** in breast cancer survivors as it effectively reduces hot flushes.- It is preferred over certain SSRIs (like paroxetine) because it does not significantly interfere with the metabolism of **tamoxifen** via the CYP2D6 pathway, thus preserving its efficacy.*Transdermal oestrogen-only HRT*- **Systemic Hormone Replacement Therapy (HRT)** is strictly contraindicated in patients with a history of **oestrogen receptor-positive breast cancer** due to the risk of recurrence.- Additionally, **oestrogen-only therapy** would be inappropriate as this patient has an intact uterus (implied), which would require progesterone to prevent endometrial hyperplasia.*Continuous combined HRT*- **Combined HRT** increases the risk of **breast cancer recurrence** and is therefore contraindicated in patients with a history of oestrogen receptor-positive breast cancer, regardless of symptom severity.- Clinical guidelines strongly recommend focusing on **non-hormonal alternatives** for managing vasomotor symptoms in these high-risk patients.*Black cohosh herbal supplement*- **Black cohosh** lacks robust clinical evidence for efficacy and its safety profile regarding **oestrogen-sensitive tissues** in breast cancer survivors is not well-established.- Patients are generally advised against herbal remedies because they are not regulated with the same rigor as pharmaceuticals and may interact with **tamoxifen**.*Tibolone 2.5 mg daily*- **Tibolone** is a synthetic compound with oestrogenic, progestogenic, and androgenic activity that is contraindicated in breast cancer survivors.- Studies, such as the **LIBERATE trial**, have shown that tibolone significantly increases the risk of **breast cancer recurrence**.
Question 53: A 37-year-old woman with known antiphospholipid syndrome presents requesting contraception. She had a provoked deep vein thrombosis 3 years ago following a long-haul flight and is currently on warfarin. She does not wish to become pregnant. Her blood pressure is 128/82 mmHg and BMI is 27 kg/m². Which contraceptive method is most appropriate?
- A. Combined oral contraceptive pill
- B. Progestogen-only pill
- C. Etonogestrel implant
- D. Copper intrauterine device (Correct Answer)
- E. Combined transdermal patch
Explanation: ***Copper intrauterine device*** - The **copper IUD** is a non-hormonal method that does not increase the risk of **venous thromboembolism (VTE)**, making it a **UKMEC 1** (no restriction) choice for patients with **antiphospholipid syndrome** and previous VTE. - It provides highly effective long-acting reversible contraception while avoiding the metabolic and pro-thrombotic effects associated with estrogen-containing methods. *Combined oral contraceptive pill* - Ethinylestradiol increases the synthesis of **clotting factors**, significantly raising the risk of recurrent **thrombosis** in patients with a history of VTE or thrombophilia. - In patients with **antiphospholipid syndrome**, it is classified as **UKMEC 4** (unacceptable health risk) and is strictly contraindicated. *Progestogen-only pill* - While progestogen-only methods are generally considered **UKMEC 2** (advantages outweigh risks) for patients with a history of VTE, they are less effective than long-acting methods. - It does not carry the same high risk as combined pills, but the **copper IUD** remains the superior non-hormonal choice for minimizing all thrombotic risks. *Etonogestrel implant* - The **implant** is a highly effective long-acting progestogen-only method, but it is typically categorized as **UKMEC 2** in the context of known thrombogenic mutations. - Unlike the **copper IUD**, it is hormonal and may not be the first choice if a completely **hormone-free** alternative is available for a patient with a high thrombotic profile. *Combined transdermal patch* - Similar to the combined pill, the **patch** delivers **estrogen** and carries a significantly increased risk of **thromboembolic events**. - It is classified as **UKMEC 4** for this patient due to the synergistic risk of **antiphospholipid antibodies** and hormonal estrogen exposure.
Question 54: A 57-year-old woman attends for review of her oestrogen-only HRT, which she has been taking for 7 years following total hysterectomy for cervical cancer at age 50. She remains asymptomatic and wishes to continue HRT. She has no other significant medical history, maintains a healthy weight, and does not smoke. Recent mammography was normal. In counselling her about continuing HRT, which of the following statements about breast cancer risk with oestrogen-only HRT is most accurate?
- A. Oestrogen-only HRT carries the same breast cancer risk as combined HRT
- B. Oestrogen-only HRT is associated with reduced breast cancer risk compared to no HRT use
- C. Oestrogen-only HRT carries lower breast cancer risk than combined HRT, with little or no increased risk for at least 7 years of use (Correct Answer)
- D. All forms of HRT double the risk of breast cancer within 5 years
- E. Breast cancer risk with oestrogen-only HRT is highest in the first 2 years of use
Explanation: ***Oestrogen-only HRT carries lower breast cancer risk than combined HRT, with little or no increased risk for at least 7 years of use***- Extensive evidence from the **WHI** and **Million Women Study** indicates that the addition of **progestogen** is the primary driver of increased breast cancer risk, making oestrogen-only therapy significantly safer.- For women who have had a **hysterectomy**, oestrogen-only HRT is associated with **little or no change** in breast cancer risk for approximately the first 7 to 10 years of treatment.*Oestrogen-only HRT carries the same breast cancer risk as combined HRT*- **Combined HRT** (oestrogen and progestogen) carries a consistently higher and more immediate risk of breast cancer compared to oestrogen-only regimens.- **Progestogens** are known to increase the proliferation of mammary epithelial cells more than oestrogen alone.*Oestrogen-only HRT is associated with reduced breast cancer risk compared to no HRT use*- While some subgroups in the **WHI trial** showed a potential decrease in risk, most clinical guidelines state there is **no significant reduction** compared to the general population.- It is more medically accurate to counsel patients that the risk remains **neutral** or only minimally elevated, rather than protective.*All forms of HRT double the risk of breast cancer within 5 years*- The absolute risk of HRT is low; for example, **combined HRT** adds only about 4 to 8 extra cases per 1000 women over 5 years of use, which is far from **doubling** the baseline risk.- The risk profile varies significantly between **oestrogen-only** and **combined** preparations, making a blanket statement about all HRT incorrect.*Breast cancer risk with oestrogen-only HRT is highest in the first 2 years of use*- Breast cancer risk associated with HRT is **duration-dependent**, meaning the risk typically increases with the **cumulative years** of exposure rather than being highest at the start.- Early use (less than 5 years) of oestrogen-only HRT shows **minimal impact** on breast cancer statistics.
Question 55: A 48-year-old woman with a history of uterine fibroids and adenomyosis presents with irregular heavy menstrual bleeding and symptoms of perimenopause. She has a levonorgestrel intrauterine system in situ that was inserted 4 years ago for menorrhagia management. She now requests HRT for vasomotor symptoms. Examination reveals a 14-week-size uterus. What is the most appropriate HRT regimen for this patient?
- A. Remove the LNG-IUS and start continuous combined oral HRT
- B. Add transdermal oestrogen only, utilising the LNG-IUS for endometrial protection (Correct Answer)
- C. Start sequential combined HRT without removing the LNG-IUS
- D. Start tibolone and remove the LNG-IUS
- E. Oestrogen therapy is contraindicated due to her fibroids
Explanation: ***Add transdermal oestrogen only, utilising the LNG-IUS for endometrial protection***- The **LNG-IUS (Mirena)** is licensed for 5 years as the **progestogenic component** of Hormone Replacement Therapy (HRT), providing excellent **endometrial protection** while managing the patient's existing menorrhagia.- **Transdermal oestrogen** is the preferred route as it bypasses first-pass metabolism and carries a lower risk of **venous thromboembolism** compared to oral preparations, especially in patients with bulky fibroids.*Remove the LNG-IUS and start continuous combined oral HRT*- Removing the device is unnecessary and subjects the patient to the discomfort of **reinsertion** when she already has an effective system for **menorrhagia** and contraception.- **Continuous combined oral HRT** may result in inferior bleeding control compared to the **LNG-IUS** in a patient with significant **adenomyosis** and uterine fibroids.*Start sequential combined HRT without removing the LNG-IUS*- **Sequential combined HRT** includes a progestogen phase which is redundant because the **LNG-IUS** already achieves continuous **local endometrial suppression**.- Adding extra systemic progestogen increases the risk of **progestogenic side effects** (mood swings, bloating) without providing additional clinical benefit.*Start tibolone and remove the LNG-IUS*- **Tibolone** is a synthetic compound with oestrogenic, progestogenic, and androgenic properties, but it would require removing the **LNG-IUS**, which is currently managing her **heavy menstrual bleeding**.- Without the local delivery of levonorgestrel, the patient's **adenomyosis** and **uterine fibroids** are likely to cause a recurrence of severe menorrhagia.*Oestrogen therapy is contraindicated due to her fibroids*- **Uterine fibroids** are not a contraindication to HRT, although **oestrogen** can occasionally cause them to increase in size; the benefits for **vasomotor symptoms** typically outweigh this risk.- Clinical management involves **monitoring fibroid size** via examination or ultrasound rather than withholding effective symptom relief for perimenopause.
Question 56: A 36-year-old woman presents requesting contraception. She has a history of stroke 3 years ago, which was attributed to a patent foramen ovale (PFO) that has since been surgically closed. She has made a full recovery with no residual neurological deficit and is not on any regular medications. She is a non-smoker with a BMI of 24 kg/m². Her blood pressure is 122/80 mmHg. According to UKMEC, what is the classification for combined hormonal contraception in this patient?
- A. UKMEC 1 - no restriction on use
- B. UKMEC 2 - advantages generally outweigh risks
- C. UKMEC 3 - risks generally outweigh advantages (Correct Answer)
- D. UKMEC 4 - unacceptable health risk
- E. UKMEC classification depends on whether she had ischaemic or haemorrhagic stroke
Explanation: ***UKMEC 3 - risks generally outweigh advantages*** - A **history of stroke** (ischaemic or haemorrhagic), even with full recovery and PFO closure, typically classifies combined hormonal contraception (CHC) as **UKMEC 3** for patients without current active symptoms or additional major unmanaged risk factors. - **Combined hormonal contraception (CHC)** increases the risk of **venous thromboembolism (VTE)** and **arterial thrombotic events**; a previous cerebrovascular incident indicates a predisposition, making the risks generally outweigh the benefits. *UKMEC 1 - no restriction on use* - This category is reserved for patients with **no medical contraindications** that increase the risk of CHC use, such as healthy non-smokers with no vascular history. - A **prior stroke**, regardless of recovery or cause, represents a significant medical history that precludes a UKMEC 1 classification for CHC. *UKMEC 2 - advantages generally outweigh risks* - While the patient is otherwise healthy (non-smoker, normal BMI, controlled BP) and has recovered, a **history of stroke** is a too serious a risk factor for a UKMEC 2 rating with **estrogen-containing** contraception. - UKMEC 2 usually applies to conditions where minor risks are outweighed by advantages, but a **cerebrovascular event** is a major vascular risk. *UKMEC 4 - unacceptable health risk* - **UKMEC 4** is typically assigned to patients with **current** cerebrovascular disease, active symptoms, or very recent stroke events (e.g., within the last 6 months). - Since the stroke occurred 3 years ago and she has made a **full recovery** with no residual neurological deficit and PFO closure, the risk is significant but not considered an
Question 57: A 55-year-old woman has been taking continuous combined HRT for 5 years for menopausal symptoms. She now feels well and wishes to stop HRT. She asks about the best way to discontinue treatment. What is the most appropriate advice regarding stopping HRT?
- A. Gradually taper the dose over 6-12 months before stopping completely
- B. Stop abruptly and monitor symptoms (Correct Answer)
- C. Continue HRT indefinitely as stopping will cause severe symptoms
- D. Switch to oestrogen-only HRT first, then gradually stop
- E. Reduce to alternate day dosing for 3 months before stopping
Explanation: ***Stop abruptly and monitor symptoms*** - Guidelines from bodies like **NICE** and the **British Menopause Society** state that **Hormone Replacement Therapy (HRT)** can be stopped abruptly without clinical harm. - There is no evidence that **tapering** reduces the long-term recurrence of menopausal symptoms compared to **immediate cessation**. *Gradually taper the dose over 6-12 months before stopping completely* - While some women prefer this for personal comfort, it is not medically superior and may **prolong exposure** to HRT risks unnecessarily. - Clinical evidence does not demonstrate that a prolonged **weaning process** prevents the eventual return of symptoms. *Continue HRT indefinitely as stopping will cause severe symptoms* - Indefinite use is generally avoided due to the increased risk of **breast cancer** and **venous thromboembolism (VTE)** with long-term therapy. - The decision to continue should be based on an **individualized balance** of benefits and risks rather than the assumption that symptoms will always be severe. *Switch to oestrogen-only HRT first, then gradually stop* - Switching to **estrogen-only** therapy is contraindicated in women with an **intact uterus** due to the risk of **endometrial hyperplasia**. - There is no clinical rationale for changing the **hormonal formulation** as a step toward discontinuation. *Reduce to alternate day dosing for 3 months before stopping* - **Alternate day dosing** is not a recommended evidence-based strategy and can lead to **hormonal fluctuations**. - Similar to other tapering methods, it does not offer a clear advantage over **abrupt cessation** in preventing symptom recurrence.
Question 58: A 29-year-old woman attends for emergency contraception. She had unprotected sexual intercourse 72 hours ago and also 5 days ago. She has a regular 28-day menstrual cycle and her last menstrual period started 12 days ago. She has a BMI of 29 kg/m² and takes no regular medications. What is the most appropriate emergency contraception for this patient?
- A. Levonorgestrel 1.5 mg single dose
- B. Ulipristal acetate 30 mg single dose
- C. Copper intrauterine device (Correct Answer)
- D. Levonorgestrel 3 mg as a double dose due to her BMI
- E. Emergency contraception is not required as she is not in her fertile window
Explanation: ***Copper intrauterine device*** - The **copper IUD** is the most effective form of emergency contraception (>99% efficacy) and can be inserted up to **5 days (120 hours)** after the earliest episode of unprotected intercourse, or up to 5 days after the **earliest calculated ovulation**. - Given the patient had unprotected sex 5 days ago and is on day 12 of her cycle (around ovulation), the **copper IUD** is the most appropriate and effective choice for preventing pregnancy from both incidents. *Levonorgestrel 1.5 mg single dose* - This hormonal method is primarily effective when taken within **72 hours** (3 days) of unprotected intercourse; thus, it would not cover the incident 5 days ago. - Its efficacy can be reduced in women with a **BMI of 29 kg/m²**, making it a less reliable option compared to the IUD. *Ulipristal acetate 30 mg single dose* - While effective up to **120 hours** (5 days) post-intercourse, making it potentially suitable for both incidents, it is still less effective than the **copper IUD**. - Its efficacy may also be reduced in women with a **BMI >30 kg/m²**, although the evidence for BMI 29 kg/m² is less clear, the IUD remains superior. *Levonorgestrel 3 mg as a double dose due to her BMI* - Even a double dose of **levonorgestrel** does not extend its therapeutic window beyond 72 hours for maximal efficacy, and therefore would not effectively cover the intercourse that occurred 5 days ago. - Although a higher dose might mitigate some concerns regarding efficacy in women with **higher BMI**, the **copper IUD** remains the gold standard for its superior efficacy and longer time window. *Emergency contraception is not required as she is not in her fertile window* - The patient's last menstrual period started 12 days ago, placing her on day 12 of a 28-day cycle, which is well within her **fertile window** (ovulation typically occurs around day 14). - **Sperm can survive in the female reproductive tract for up to 5 days**, meaning both instances of unprotected intercourse carry a significant risk of pregnancy.
Question 59: A 43-year-old woman with body mass index of 44 kg/m² presents with symptoms of perimenopause including irregular periods, night sweats, and mood changes. She requests HRT for symptom management. She has no other significant medical history, does not smoke, and her blood pressure is 138/88 mmHg. What is the most appropriate HRT formulation for this patient?
- A. Oral combined HRT (oestrogen and progestogen)
- B. Transdermal oestrogen patch with oral micronised progesterone (Correct Answer)
- C. Oestrogen-only HRT as obesity provides endogenous progestogen
- D. Tibolone
- E. HRT is contraindicated due to her BMI being over 40 kg/m²
Explanation: ***Transdermal oestrogen patch with oral micronised progesterone*** - **Transdermal oestrogen** is the preferred delivery method for women with a **BMI >30 kg/m²** because it bypasses **first-pass hepatic metabolism** and does not increase the risk of **venous thromboembolism (VTE)**. - This patient has an intact uterus (as evidenced by irregular periods), so she requires a **progestogen** for **endometrial protection**; **micronised progesterone** is considered a "body-identical" option with an excellent safety profile. *Oral combined HRT (oestrogen and progestogen)* - **Oral oestrogen** significantly increases the risk of **VTE** and **stroke**, which is particularly dangerous in patients with **obesity** (BMI 44 kg/m²). - Transdermal routes are safer for metabolic health and managing blood pressure in high-BMI individuals. *Oestrogen-only HRT as obesity provides endogenous progestogen* - **Oestrogen-only HRT** is never appropriate for women with an **intact uterus** because it leads to **unopposed oestrogen** and a high risk of **endometrial hyperplasia** and **cancer**. - While adipose tissue produces endogenous oestrogen (oestrone), it does not provide **progestogen**, making exogenous progestogen essential. *Tibolone* - **Tibolone** is a synthetic steroid that carries a higher risk of **stroke** in older women and would not be the first-choice safe delivery method in a woman with a **high BMI**. - It is generally recommended for **postmenopausal** women (12 months amenorrhea) rather than those in the **perimenopausal** phase with irregular cycles. *HRT is contraindicated due to her BMI being over 40 kg/m²* - **Obesity** is not an absolute contraindication to HRT, though it is a factor that dictates the **route of administration**. - Managing perimenopausal symptoms can improve quality of life and potentially help with lifestyle modifications in women with high BMIs.
Question 60: According to current UK guidance, what is the Pearl Index (number of pregnancies per 100 woman-years of use) for the copper intrauterine device with typical use?
- A. Less than 1 (Correct Answer)
- B. 2-3
- C. 6-8
- D. 9-12
- E. 15-20
Explanation: ***Less than 1*** - The **copper intrauterine device (Cu-IUD)** is classified as a **Long-Acting Reversible Contraceptive (LARC)**, known for its high efficacy. - According to **UK guidance (e.g., FSRH)**, its **Pearl Index** for **typical use** is consistently **less than 1**, reflecting its excellent effectiveness and minimal user dependence. *2-3* - A Pearl Index of 2-3 indicates a higher failure rate than what is observed with the **Cu-IUD**, which is among the most effective contraceptive methods available. - This range is not consistent with the documented efficacy of **intrauterine contraception** but might reflect some other contraceptive methods or perfect use rates of less effective ones. *6-8* - A Pearl Index of 6-8 signifies a considerably lower efficacy, typically associated with **user-dependent methods** that have a greater potential for human error. - Examples include the **progestogen-only pill (POP)** or **male condoms** when considering typical use failure rates. *9-12* - This range represents a moderate to high failure rate, often seen with methods like the **combined oral contraceptive pill (COCP)** or the **diaphragm** under typical use conditions. - The **Cu-IUD** significantly outperforms these methods due to its mechanism and non-reliance on daily user adherence. *15-20* - A Pearl Index of 15-20 suggests a very high failure rate, characteristic of **less effective contraceptive methods** or those with significant user dependency and improper use. - This range is much higher than any accepted efficacy for modern, reliable contraceptive methods like the **Cu-IUD**.
Practice by Chapter
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free