Contraception: progestogen-only bleeding: 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: progestogen-only bleeding

Sample item

A woman with a contraceptive implant has been troubled by irregular light bleeding for 3 months. Pregnancy is excluded and there are no contraindications to oestrogen. What is a reasonable treatment?

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

The answer and the reasoning

D. A short course of a combined pill or an NSAID, with counselling

Irregular bleeding is the commonest reason for discontinuing progestin-only methods. After excluding pregnancy, infection and other pathology, counselling and short-term treatment with NSAIDs, tranexamic acid or a combined pill for a few cycles can reduce bleeding. Removal is offered if the woman is dissatisfied.

Option by option

  • A. Immediate implant removal in all cases

    Removal is an option but not the only or first step.

  • B. Hysterectomy

    Surgery is not warranted.

  • C. Tranexamic acid for 1 year

    Long-term tranexamic acid for a year is not standard.

  • D. A short course of a combined pill or an NSAID, with counselling (correct)

    Correct. Counselling with a short medical course is the usual approach.

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 D, A short course of a combined pill or an NSAID, with counselling. Irregular bleeding is the commonest reason for discontinuing progestin-only methods.

Why is "Immediate implant removal in all cases" not the answer?

Removal is an option but not the only or first step.

Why is "Hysterectomy" not the answer?

Surgery is not warranted.

Why is "Tranexamic acid for 1 year" not the answer?

Long-term tranexamic acid for a year is not standard.

What concept does this question test?

It tests Contraception: progestogen-only bleeding in OBG. After excluding pregnancy, infection and other pathology, counselling and short-term treatment with NSAIDs, tranexamic acid or a combined pill for a few cycles can reduce bleeding. Removal is offered if the woman is dissatisfied.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: progestogen-only bleeding?

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.