MCQs on Contraception

Written by Dr. Priya Menon (MBBS, FRANZCOG) – Obstetrician and Gynaecologist

Question 1

Emily, a 19-year-old university student, presents to the GP clinic seeking contraceptive advice. She recently became sexually active with her partner and wants a method that is highly effective, safe, and requires minimal daily attention. She is healthy, has no significant past medical history, does not smoke, and is not on any medications. Emily expresses concern about maintaining privacy regarding her contraception choice and prefers a method that is discreet and long-lasting. She also mentions a busy schedule and worries she may forget to take something regularly.

Which of the following is the most appropriate contraceptive method to recommend?

A) Combined oral contraceptive pill
B) Contraceptive vaginal ring
C) Copper intrauterine device (IUD)
D) Etonogestrel subdermal implant
E) Male condoms

Correct Answer: D) Etonogestrel subdermal implant

The etonogestrel subdermal implant (Implanon NXT) is a long-acting reversible contraceptive (LARC) that provides effective contraception for up to 3 years. It contains a progestogen hormone and is inserted under the skin of the upper arm. Its typical-use failure rate is less than 1%, making it one of the most effective reversible methods available.

This option is particularly suited for Emily because:

It is low maintenance, requiring no daily or weekly action once inserted.
It is private, as it is not visible and cannot be felt unless specifically palpated.
It has minimal systemic side effects and is safe for non-smoking women under 35.
It is fully reversible, with rapid return of fertility upon removal.

Option A (COCP) requires daily compliance, which may not be suitable given Emily’s busy lifestyle and concern about forgetting.
Option B (vaginal ring) is effective but still requires monthly maintenance and may be noticed during intercourse.
Option C (copper IUD) is a good LARC option but can increase menstrual bleeding and cramping, which some young women find unacceptable.
Option E (condoms) provide STI protection but are less effective than LARCs for pregnancy prevention and are not suitable as a sole method for someone wanting maximum contraceptive efficacy.

Given Emily’s preferences for effectiveness, low maintenance, and privacy, the etonogestrel implant is the most appropriate recommendation.

Question 2

Sarah, a 24-year-old woman, presents to a GP clinic seeking emergency contraception. She had unprotected sexual intercourse approximately 72 hours ago. Her last menstrual period was 10 days ago, and her cycles are regular, occurring every 28 days. She is not currently using any form of contraception and is not on any medications. She is otherwise healthy and has no known allergies.

Which of the following is the most appropriate emergency contraceptive method to offer Sarah?

A) Levonorgestrel emergency contraceptive pill
B) Ulipristal acetate emergency contraceptive pill
C) Copper intrauterine device (IUD)
D) Mifepristone
E) Combined oral contraceptive pill (Yuzpe method)

Correct Answer: B) Ulipristal acetate emergency contraceptive pill

Ulipristal acetate (EllaOne) is the most effective oral emergency contraceptive pill and can be used up to 120 hours (5 days) after unprotected intercourse. It works primarily by delaying ovulation, even if the luteinizing hormone surge has begun. It is particularly recommended between 72–120 hours, where levonorgestrel becomes less effective.

Key points:

Ulipristal is available over the counter in Australia.
It has a higher efficacy compared to levonorgestrel, especially when taken in the later window (beyond 72 hours).
Women should be advised to avoid starting or restarting hormonal contraception for 5 days after taking ulipristal, as it can reduce its effectiveness.

Option A (Levonorgestrel) is appropriate within 72 hours, but Sarah is at the 72-hour threshold, and efficacy diminishes after that point.
Option C (Copper IUD) is the most effective emergency contraception overall and can be used up to 5 days post-intercourse, but requires insertion by a trained provider, and Sarah may not prefer this invasive option or may not have access within the time window.
Option D (Mifepristone) is used for medical termination of pregnancy, not emergency contraception.
Option E (Yuzpe method) is outdated and has a higher rate of side effects and lower efficacy compared to current options.

Therefore, ulipristal acetate is the best choice for Sarah, given the timing and her preference for a non-invasive method.

Question 3

James and Emily, a couple in their early 30s, present to their GP to discuss long-term contraception. They have completed their family and do not wish to have more children. Emily has experienced side effects with hormonal contraception in the past and prefers to avoid any further hormonal methods. James is open to taking responsibility for contraception. They are seeking advice on a reliable, permanent option with minimal long-term health impact.

Which of the following is the most appropriate contraceptive recommendation for this couple?

A) Insertion of a copper intrauterine device (IUD)
B) Female sterilisation via laparoscopic tubal ligation
C) Male sterilisation via vasectomy
D) Use of barrier methods such as condoms
E) Levonorgestrel-releasing intrauterine system (LNG-IUS)

Correct Answer: C) Male sterilisation via vasectomy

Vasectomy is the most appropriate recommendation in this scenario. It is a highly effective, permanent method of contraception suitable for couples who have completed their family. Vasectomy is less invasive, safer, and more cost-effective compared to female sterilisation. It is performed under local anaesthesia, has a short recovery time, and has a lower complication rate than tubal ligation.

Since Emily prefers to avoid hormonal contraception and has had adverse experiences with it, options like the LNG-IUS are not suitable. Although copper IUDs are hormone-free and effective, they are not considered permanent and carry a risk of heavier menstrual bleeding.

Option A (copper IUD) is a long-acting reversible contraceptive, not permanent.
Option B (female sterilisation) is more invasive than male sterilisation and has higher surgical risks.
Option D (condoms) are not suitable as a long-term or permanent solution due to higher typical-use failure rates.
Option E (LNG-IUS) is hormonal and contradicts Emily’s preference.

Given that James is willing to take responsibility and they both want a permanent method, vasectomy is the most suitable recommendation.

Previous Next

14. Gynecology Module

14.1 Abnormal Uterine Bleeding

14.2 Amenorrhea

14.3 Subfertility

14.4 Contraception

14.5 Menopause

14.6 Gynecological Oncology

14.7 Other Gynecological Disorders

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