Contraception: breakthrough bleeding with COC: 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.

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OBG · Contraception: breakthrough bleeding with COC

Sample item

A woman in her second month of a low-dose combined pill has light spotting in the middle of the pack but no missed pills, drug interaction or other symptoms. What is the advice?

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

The answer and the reasoning

A. Reassure that breakthrough bleeding is common in the first 3 months and usually settles

Breakthrough bleeding is the commonest side effect of combined pills and is more frequent with low-dose preparations in the first 3 months, usually settling with continued use. Persistent bleeding after 3 months, or any alarm features, needs further evaluation for infection, pregnancy, cervical pathology and compliance. Missed pills and smoking increase the likelihood.

Option by option

  • A. Reassure that breakthrough bleeding is common in the first 3 months and usually settles (correct)

    Correct. Reassurance is appropriate in the first 3 months.

  • B. Stop the pill immediately

    Stopping the pill removes protection and is not necessary.

  • C. Perform an urgent hysteroscopy

    Investigations are for persistent or unusual bleeding.

  • D. Insert an IUCD

    An IUCD is not needed.

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.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Reassure that breakthrough bleeding is common in the first 3 months and usually settles. Breakthrough bleeding is the commonest side effect of combined pills and is more frequent with low-dose preparations in the first 3 months, usually settling with continued use.

Why is "Stop the pill immediately" not the answer?

Stopping the pill removes protection and is not necessary.

Why is "Perform an urgent hysteroscopy" not the answer?

Investigations are for persistent or unusual bleeding.

Why is "Insert an IUCD" not the answer?

An IUCD is not needed.

What concept does this question test?

It tests Contraception: breakthrough bleeding with COC in OBG. Persistent bleeding after 3 months, or any alarm features, needs further evaluation for infection, pregnancy, cervical pathology and compliance. Missed pills and smoking increase the likelihood.

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: breakthrough bleeding with COC?

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.