Advantages and disadvantages of intrauterine devices (IUDs) MCQs With Answer

Introduction: Intrauterine devices (IUDs) are long-acting reversible contraceptives widely used in clinical practice. This introduction reviews advantages and disadvantages of intrauterine devices, including copper IUDs and levonorgestrel intrauterine systems (LNG-IUS). Key topics cover mechanisms of action, efficacy (failure rates <1%), duration of use, side effects such as heavy bleeding or amenorrhea, insertion and removal considerations, contraindications (e.g., active pelvic infection, copper-related disorders), complications like expulsion and uterine perforation, and counseling points for B.Pharm students. Understanding pharmacology, device types (Cu-IUD, LNG-IUS), and clinical implications enhances patient counselling and safe use. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which primary mechanism best describes how a copper IUD prevents pregnancy?

• Systemic ovulation suppression via hormonal feedback
• Copper-induced local inflammatory reaction toxic to sperm and ova
• Thickening of cervical mucus to block sperm entry
• Endometrial decidualization preventing implantation

Correct Answer: Copper-induced local inflammatory reaction toxic to sperm and ova

Q2. Which mechanism is most characteristic of levonorgestrel intrauterine systems (LNG-IUS)?

• Systemic estrogen replacement
• Local progestin effect causing endometrial atrophy and thickened cervical mucus
• Release of copper ions causing spermicidal action
• Mechanical barrier preventing sperm transport

Correct Answer: Local progestin effect causing endometrial atrophy and thickened cervical mucus

Q3. Which of the following is a major advantage of IUDs compared with short-acting methods?

• Higher daily adherence requirements
• Long-term reversible contraception with low maintenance
• Immediate immunity to STIs
• Guaranteed prevention of all ectopic pregnancies

Correct Answer: Long-term reversible contraception with low maintenance

Q4. Which is a common disadvantage specifically associated with copper IUDs?

• Decreased menstrual bleeding
• Increased menstrual bleeding and dysmenorrhea
• Significant systemic hormonal side effects
• High risk of breast tenderness

Correct Answer: Increased menstrual bleeding and dysmenorrhea

Q5. What is the approximate typical-use failure rate of modern IUDs?

• 10–15% per year
• 5–7% per year
• Less than 1% per year
• 20–25% per year

Correct Answer: Less than 1% per year

Q6. Which patient condition is a contraindication to copper IUD use?

• History of cesarean section
• Wilson’s disease or copper allergy
• Nulliparity in young women
• Controlled hypertension

Correct Answer: Wilson’s disease or copper allergy

Q7. Which of the following is a recognized benefit of LNG-IUS beyond contraception?

• Treatment of heavy menstrual bleeding (menorrhagia)
• Reliable prevention of urinary tract infections
• Permanent sterilization
• Prevention of osteoporosis

Correct Answer: Treatment of heavy menstrual bleeding (menorrhagia)

Q8. Which complication, though rare, is a serious risk during IUD insertion?

• Uterine perforation
• Systemic hormonal thrombosis
• Immediate pregnancy in all cases
• Chronic kidney disease

Correct Answer: Uterine perforation

Q9. Which factor increases the risk of IUD expulsion?

• Insertion >6 weeks postpartum
• Nulliparity only
• Heavy menses and younger age
• Using LNG-IUS rather than copper

Correct Answer: Heavy menses and younger age

Q10. How does LNG-IUS primarily reduce menstrual bleeding?

• Systemic suppression of ovarian estrogen production
• Local endometrial suppression and glandular atrophy
• Mechanical entrapment of blood in the uterine cavity
• Induction of hyperplasia to stabilize endometrium

Correct Answer: Local endometrial suppression and glandular atrophy

Q11. Which IUD is commonly known by the brand name ParaGard?

• Levonorgestrel IUS (Mirena)
• Copper T 380A
• Progesterone-only oral pill
• Combined hormonal ring

Correct Answer: Copper T 380A

Q12. For emergency contraception, which IUD is recommended when immediate long-term contraception is desired?

• Copper IUD inserted within 5 days after unprotected intercourse
• LNG-IUS inserted one month later
• Combined oral contraceptive emergency regimen only
• No IUD is effective as emergency contraception

Correct Answer: Copper IUD inserted within 5 days after unprotected intercourse

Q13. Which statement about IUD-related pelvic infection (PID) risk is correct?

• IUDs cause chronic PID in all users
• PID risk is highest in the first 20 days after insertion
• Infection risk is unrelated to STI exposure
• Once an IUD is in place, PID risk is permanently elevated

Correct Answer: PID risk is highest in the first 20 days after insertion

Q14. Which is a systemic effect typically associated with LNG-IUS?

• High plasma levonorgestrel levels causing acne in most users
• Minimal systemic hormonal effects due to local release
• Significant suppression of bone mineral density
• Systemic estrogenic side effects

Correct Answer: Minimal systemic hormonal effects due to local release

Q15. Which patient counseling point is essential before IUD insertion?

• No need to screen for STI history
• Inform about signs of infection, expulsion, and when to seek care
• Assure the IUD prevents all sexually transmitted infections
• Advise that fertility will be permanently lost

Correct Answer: Inform about signs of infection, expulsion, and when to seek care

Q16. Which IUD would be most appropriate for a woman seeking contraception plus treatment for heavy bleeding?

• Copper T 380A
• Combined oral contraceptive pill
• Levonorgestrel intrauterine system (LNG-IUS)
• Condoms only

Correct Answer: Levonorgestrel intrauterine system (LNG-IUS)

Q17. Which is a recognized disadvantage of LNG-IUS in the initial months after insertion?

• Immediate permanent amenorrhea in all users
• Irregular spotting and unpredictable bleeding
• Severe systemic estrogen excess
• Guaranteed infertility for 2 years

Correct Answer: Irregular spotting and unpredictable bleeding

Q18. Which laboratory or clinical condition is a contraindication for LNG-IUS?

• Current pregnancy and untreated pelvic infection
• Well-controlled hypothyroidism
• Desire for future fertility within 1 month
• Previous uncomplicated vaginal delivery

Correct Answer: Current pregnancy and untreated pelvic infection

Q19. Regarding fertility after IUD removal, which statement is accurate?

• Fertility remains impaired for several years after removal
• Fertility typically returns quickly after IUD removal
• Pregnancy is impossible after removal of LNG-IUS
• Removal always requires surgical intervention under general anesthesia

Correct Answer: Fertility typically returns quickly after IUD removal

Q20. What is a pharmacological reason copper IUDs are effective without hormones?

• Copper provides systemic contraceptive hormone levels
• Copper ions create a spermicidal environment in the uterus
• Copper physically blocks the cervical os
• Copper stimulates ovulation inhibition centrally

Correct Answer: Copper ions create a spermicidal environment in the uterus

Q21. Which of the following is TRUE about IUD use in breastfeeding women?

• LNG-IUS is contraindicated during breastfeeding
• Copper IUD can generally be used and LNG-IUS is acceptable after immediate postpartum period per guidelines
• IUDs cause failure of lactation in all cases
• IUDs must be avoided for at least 2 years postpartum

Correct Answer: Copper IUD can generally be used and LNG-IUS is acceptable after immediate postpartum period per guidelines

Q22. Which effect is relatively more associated with copper IUDs than with LNG-IUS?

• Reduction in menstrual blood loss
• Increased menstrual bleeding and cramping
• Endometrial thinning
• Therapeutic effect on menorrhagia

Correct Answer: Increased menstrual bleeding and cramping

Q23. What is the recommended action if an IUD string is not palpable and pregnancy is suspected?

• Assume device is fine and start oral contraceptives
• Perform pregnancy test and pelvic ultrasound to locate device
• Immediately insert a second IUD without evaluation
• Wait six months and reassess

Correct Answer: Perform pregnancy test and pelvic ultrasound to locate device

Q24. Which is a pharmacoeconomic advantage of IUDs?

• High ongoing medication costs making them unaffordable
• Cost-effectiveness due to long duration and low failure rates
• Require daily pharmacy visits increasing costs
• Not covered by health systems due to short-term use

Correct Answer: Cost-effectiveness due to long duration and low failure rates

Q25. Which adverse outcome is more commonly associated with pregnancy while using an IUD?

• Increased likelihood of normal intrauterine pregnancy without complications
• Higher relative risk of ectopic pregnancy among pregnancies that occur
• Guaranteed miscarriage in all cases
• No risk of infection

Correct Answer: Higher relative risk of ectopic pregnancy among pregnancies that occur

Q26. Which feature differentiates hormonal IUS (LNG-IUS) from copper IUD in systemic hormone exposure?

• LNG-IUS provides high systemic estrogen levels
• LNG-IUS releases low-dose progestin locally with minimal systemic exposure
• Copper IUD delivers systemic levonorgestrel
• Both devices deliver identical systemic hormone levels

Correct Answer: LNG-IUS releases low-dose progestin locally with minimal systemic exposure

Q27. When counseling adolescents about IUDs, which statement is correct?

• IUDs are unsuitable for nulliparous adolescents
• IUDs can be a safe, effective option for adolescents with appropriate counseling
• IUD insertion is always contraindicated under age 21
• IUDs invariably cause infertility in adolescents

Correct Answer: IUDs can be a safe, effective option for adolescents with appropriate counseling

Q28. Which monitoring or follow-up is typically advised after IUD insertion?

• No follow-up is ever needed
• Check strings at 4–6 weeks and seek care if pain, fever, or abnormal bleeding occur
• Hospitalization for one week post-insertion
• Repeat insertion every month

Correct Answer: Check strings at 4–6 weeks and seek care if pain, fever, or abnormal bleeding occur

Q29. Which statement about drug interactions with LNG-IUS is most accurate?

• CYP inducers significantly reduce the local efficacy of LNG-IUS in the uterus
• Systemic drug interactions are minimal due to low systemic levonorgestrel levels
• Antibiotics always render LNG-IUS ineffective
• All enzyme-inducing drugs completely negate IUD function

Correct Answer: Systemic drug interactions are minimal due to low systemic levonorgestrel levels

Q30. Which is an appropriate reason to remove an IUD promptly?

• New desire for long-term contraception continuation
• Confirmed intrauterine pregnancy or severe pelvic infection
• Mild spotting in the first week after insertion
• Routine change of IUD color

Correct Answer: Confirmed intrauterine pregnancy or severe pelvic infection

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com