NIA - 29 January 2023
Obstetrics & Gynaecology
Medium
Which of the following hormonal contraceptive cannot be used during lactation?
Appeared in: NIA - 29 January 2023
Explanation
- Combined oral contraceptive pills (COCPs) contain both estrogen and a progestin.
- The estrogen component in COCPs can suppress prolactin, the primary hormone responsible for milk production, leading to a decreased milk supply.
- Due to this effect, COCPs are generally contraindicated or not recommended for breastfeeding mothers, especially within the first 6 months postpartum.
Why Other Options Were Wrong
- Option A: Depot medroxyprogesterone acetate (DMPA) is a progestin-only injectable contraceptive. Progestin-only methods do not contain estrogen and are considered safe for use during lactation as they do not negatively affect milk supply.
- Option B: The LNG-IUS is a progestin-releasing intrauterine system. It acts locally within the uterus, and the systemic absorption of the hormone is very low. It is considered a safe and effective contraceptive method during lactation.
- Option D: The mini pill is a progestin-only pill (POP). Like other progestin-only methods, it does not contain estrogen and is a recommended oral contraceptive option for breastfeeding mothers.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Hormonal contraception during lactation as background academic context rather than a clinical decision trigger.
- Nurses play a crucial role in counseling postpartum mothers on family planning. It is essential to provide accurate information about which contraceptive methods are safe and will not interfere with breastfeeding.
- Incorrectly advising a breastfeeding mother to use a combined oral contraceptive could lead to diminished milk supply, potentially causing infant malnutrition and premature cessation of breastfeeding.
- What if? If a breastfeeding mother has a contraindication to progestin-only methods (a rare occurrence), the nurse should advise on non-hormonal methods like the copper IUD, barrier methods (condoms, diaphragm), or lactational amenorrhea method (LAM) if criteria are met, and refer her to a physician for further evaluation.
How to Approach the Question
- First, identify the core of the question: which contraceptive is UNSAFE during lactation.
- Recall or look up the hormonal composition of each option. The key distinction is 'combined' (estrogen + progestin) versus 'progestin-only'.
- Remember the physiological effect of estrogen on lactation: it suppresses prolactin and can reduce milk supply.
- Categorize the options: DMPA, LNG-IUS, and the Mini pill are all progestin-only methods.
- Identify the outlier: Combined oral contraceptive pills are the only option containing estrogen.
- Conclude that the estrogen-containing option is the one that cannot be used, or is not recommended, during lactation.
Concept Tested & Keywords
- Concept Tested: Hormonal contraception during lactation
- Stem keywords: hormonal contraceptive, lactation
- Lead-in keywords: cannot be used
- Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.
Question ID
QnRXTHjuM4JpAOsvoolpGu
Reference Book
E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart C (pp 404-604 of 604) p. 198-200
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 8410-8412
E6 Obstetrics Williams p. 76-90
Practise the full NIA - 29 January 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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