Contraception: postpartum combined pills: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

OBG · Contraception: postpartum combined pills

Sample item

A woman delivered 4 weeks ago and is exclusively breastfeeding. She asks to start the combined pill. What is the advice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Not advisable before 6 weeks, as oestrogen may reduce milk and she has an increased thrombotic risk; offer a progestin-only method

In the first 6 weeks after delivery, particularly in breastfeeding women, combined hormonal contraceptives are category 4 or 3 because of postpartum thrombotic risk and possible effects on lactation. Progestogen-only methods, LAM, copper or LNG IUCD and condoms are suitable. Combined methods may be reconsidered after 6 weeks, depending on risk factors.

Option by option

  • A. Not advisable before 6 weeks, as oestrogen may reduce milk and she has an increased thrombotic risk; offer a progestin-only method (correct)

    Correct. Oestrogen is avoided before 6 weeks postpartum in breastfeeding women.

  • B. Combined pill is the only method she can use

    Many other methods are suitable.

  • C. Start only after weaning

    Weaning is not required, only delay until after 6 weeks and with suitability.

  • D. Start immediately with no concerns

    Starting at once increases thrombotic risk and may impair lactation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Not advisable before 6 weeks, as oestrogen may reduce milk and she has an increased thrombotic risk; offer a progestin-only method. In the first 6 weeks after delivery, particularly in breastfeeding women, combined hormonal contraceptives are category 4 or 3 because of postpartum thrombotic risk and possible effects on lactation.

Why is "Combined pill is the only method she can use" not the answer?

Many other methods are suitable.

Why is "Start only after weaning" not the answer?

Weaning is not required, only delay until after 6 weeks and with suitability.

Why is "Start immediately with no concerns" not the answer?

Starting at once increases thrombotic risk and may impair lactation.

What concept does this question test?

It tests Contraception: postpartum combined pills in OBG. Progestogen-only methods, LAM, copper or LNG IUCD and condoms are suitable. Combined methods may be reconsidered after 6 weeks, depending on risk factors.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Contraception: postpartum combined pills?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.